Control approach for high sensitivity cardiopulmonary exercise testing during stimulated cycle ergometry in spinal cord injured subjects

A Distributed Automatic Control Framework for Simultaneous Control of Torque and Cadence in Functional Electrical Stimulation Cycling

One of the major challenges facing functional electrical stimulation (FES) cycling is the design of an automatic control system that addresses the problem of disturbance with unknown bound and time-varying behavior of the muscular system. The previous methods for FES-cycling are based on the system modeling and require pre-adjustment of the control parameters which are based on the model parameters. These will degrade the FES-cycling performance and limit the clinical application of the methods. In this paper, a distributed cooperative control framework, which is based on an adaptive higher-order sliding mode (AHOSM) controller, is proposed for simultaneous control of torque and cadence in FES-cycling. The proposed control system is free-model which does not require any pre-adjustment of the control parameters and does not need the boundary of the disturbance to be known. Another major issue in FES-cycling is the stimulation pattern. In the paper, an automatic pattern generator is proposed which is capable of providing not only the regions of the crank angle in which each muscle group should be stimulated but also a specific gain for each muscle group. The results of the simulation studies and experiments on three spinal cord injuries showed that the proposed control strategy significantly increases the efficiency and tracking accuracy of motor-assisted FES-cycling in paraplegic patients and decreases the power consumption compared to HOSM controller with the fixed stimulation pattern. Reducing power consumption can slow down muscle fatigue and consequently increase cycling endurance. The average of cadence and torque tracking errors over three subjects using the proposed method are 5.77± 0.5% and 5.23± 0.8%, respectively.

Fully automatic control of paraplegic FES pedaling using higher-order sliding mode and fuzzy logic control

In this paper, a fully automatic robust control strategy is proposed for control of paraplegic pedaling using functional electrical stimulation (FES). The method is based on higher-order sliding mode (HOSM) control and fuzzy logic control. In FES, the strength of muscle contraction can be altered either by varying the pulse width (PW) or by the pulse amplitude (PA) of the stimulation signal. The proposed control strategy regulates simultaneously both PA and PW (i.e., PA/PW modulation). A HOSM controller is designed for regulating the PW and a fuzzy logic controller for the PA. The proposed control scheme is free-model and does not require any offline training phase and subject-specific information. Simulation studies on a virtual patient and experiments on three paraplegic subjects demonstrate good tracking performance and robustness of the proposed control strategy against muscle fatigue and external disturbances during FES-induced pedaling. The results of simulation studies show that the power and cadence tracking errors are 5.4% and 4.8%, respectively. The experimental results indicate that the proposed controller can improve pedaling system efficacy and increase the endurance of FES pedaling. The average of power tracking error over three paraplegic subjects is 7.4±1.4% using PA/PW modulation, while the tracking error is 10.2±1.2% when PW modulation is used. The subjects could pedal for 15 min with about 4.1% power loss at the end of experiment using proposed control strategy, while the power loss is 14.3% using PW modulation. The controller could adjust the stimulation intensity to compensate the muscle fatigue during long period of FES pedaling.

Higher-order sliding mode control of leg power in paraplegic FES-cycling

In this paper, we propose a robust control methodology based on high order sliding mode (HOSM) for control of the leg power in FES-Cycling. A major obstacle to the development of control systems for functional electrical stimulation (FES) has been the highly non-linear, time-varying properties of neuromusculoskeletal systems. A useful and powerful control scheme to deal with the uncertainties, nonlinearities, and bounded external disturbances is the sliding mode control (SMC). The main drawback of the classical sliding mode is mostly related to the so-called chattering which is dangerous for FES applications. To avoid chattering, HOSM approaches were proposed. Keeping the main advantages of the original approach, at the same time they totally remove the chattering effect and provide for even higher accuracy in realization. The results of simulation studies and experiments on two paraplegic subjects show the superior performance of the leg power control during different conditions of operation using HOSM control scheme.

High-volume FES-cycling partially reverses bone loss in people with chronic spinal cord injury

Spinal cord injury (SCI) leads to severe bone loss in the paralysed limbs and to a resulting increased fracture risk thereof. Since long bone fractures can lead to comorbidities and a reduction in quality of life, it is important to improve bone strength in people with chronic SCI. In this prospective longitudinal cohort study, we investigated whether functional electrical stimulation (FES) induced high-volume cycle training can partially reverse the loss of bone substance in the legs after chronic complete SCI. Eleven participants with motor-sensory complete SCI (mean age 41.9+/-7.5 years; 11.0+/-7.1 years post injury) were recruited. After an initial phase of 14+/-7 weeks of FES muscle conditioning, participants performed on average 3.7+/-0.6 FES-cycling sessions per week, of 58+/-5 min each, over 12 months at each individual's highest power output. Bone and muscle parameters were investigated in the legs by means of peripheral quantitative computed tomography before the muscle conditioning (t1), and after six (t2) and 12 months (t3) of high-volume FES-cycle training. After 12 months of FES-cycling, trabecular and total bone mineral density (BMD) as well as total cross-sectional area in the distal femoral epiphysis increased significantly by 14.4+/-21.1%, 7.0+/-10.8% and 1.2+/-1.5%, respectively. Bone parameters in the femoral shaft showed small but significant decreases, with a reduction of 0.4+/-0.4% in cortical BMD, 1.8+/-3.0% in bone mineral content, and 1.5+/-2.1% in cortical thickness. These decreases mainly occurred between t1 and t2. No significant changes were found in any of the measured bone parameters in the tibia. Muscle CSA at the thigh increased significantly by 35.5+/-18.3%, while fat CSA at the shank decreased by 16.7+/-12.3%. Our results indicate that high-volume FES-cycle training leads to site-specific skeletal changes in the paralysed limbs, with an increase in bone parameters at the actively loaded distal femur but not the passively loaded tibia. Thus, we conclude that high-volume FES-induced cycle training has clinical relevance as it can partially reverse bone loss and thus may reduce fracture risk at this fracture prone site.