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Gil-Castillo J, Herrera-Valenzuela D, Torricelli D, Gil-Agudo Á, Opisso E, Vidal J, Font-Llagunes JM, Del-Ama AJ, Moreno JC. A new modular neuroprosthesis suitable for hybrid FES-robot applications and tailored assistance. J Neuroeng Rehabil 2024; 21:153. [PMID: 39232831 PMCID: PMC11373245 DOI: 10.1186/s12984-024-01450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/30/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND To overcome the application limitations of functional electrical stimulation (FES), such as fatigue or nonlinear muscle response, the combination of neuroprosthetic systems with robotic devices has been evaluated, resulting in hybrid systems that have promising potential. However, current technology shows a lack of flexibility to adapt to the needs of any application, context or individual. The main objective of this study is the development of a new modular neuroprosthetic system suitable for hybrid FES-robot applications to meet these needs. METHODS In this study, we conducted an analysis of the requirements for developing hybrid FES-robot systems and reviewed existing literature on similar systems. Building upon these insights, we developed a novel modular neuroprosthetic system tailored for hybrid applications. The system was specifically adapted for gait assistance, and a technological personalization process based on clinical criteria was devised. This process was used to generate different system configurations adjusted to four individuals with spinal cord injury or stroke. The effect of each system configuration on gait kinematic metrics was analyzed by using repeated measures ANOVA or Friedman's test. RESULTS A modular NP system has been developed that is distinguished by its flexibility, scalability and personalization capabilities. With excellent connection characteristics, it can be effectively integrated with robotic devices. Its 3D design facilitates fitting both as a stand-alone system and in combination with other robotic devices. In addition, it meets rigorous requirements for safe use by incorporating appropriate safety protocols, and features appropriate battery autonomy, weight and dimensions. Different technological configurations adapted to the needs of each patient were obtained, which demonstrated an impact on the kinematic gait pattern comparable to that of other devices reported in the literature. CONCLUSIONS The system met the identified technical requirements, showcasing advancements compared to systems reported in the literature. In addition, it demonstrated its versatility and capacity to be combined with robotic devices forming hybrids, adapting well to the gait application. Moreover, the personalization procedure proved to be useful in obtaining various system configurations tailored to the diverse needs of individuals.
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Affiliation(s)
- Javier Gil-Castillo
- BioRobotics Group, Center for Automation and Robotics, CSIC, Madrid, Spain
- ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, España
| | - Diana Herrera-Valenzuela
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Diego Torricelli
- BioRobotics Group, Center for Automation and Robotics, CSIC, Madrid, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
- Unit of Neurorehabilitation, Biomechanics and Sensorimotor Function (HNP-SESCAM), Associated Unit of R&D&I to the CSIC, Madrid, Spain
| | - Eloy Opisso
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, 08916, Spain
| | - Joan Vidal
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, 08916, Spain
| | - Josep M Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, Barcelona, 08028, Spain
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, Esplugues de Llobregat, 08950, Spain
| | - Antonio J Del-Ama
- Bioengineering Systems and Technologies Research Group, Department of Applied Mathematics, Materials Science and Engineering and Electronic Technology, Rey Juan Carlos University, C/ Tulipan S/N, Móstoles, 28933, Spain
| | - Juan C Moreno
- BioRobotics Group, Center for Automation and Robotics, CSIC, Madrid, Spain.
- ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, España.
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Garnier B, Marquez-Chin M, DiNunzio S, Iwasa SN, Saadatnia Z, Naguib HE, Popovic MR. A novel functional electrical stimulation sleeve based on textile-embedded dry electrodes. Biomed Eng Online 2024; 23:51. [PMID: 38835079 DOI: 10.1186/s12938-024-01246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Functional electrical stimulation (FES) is a rehabilitation technique that enables functional improvements in patients with motor control impairments. This study presents an original design and prototyping method for a smart sleeve for FES applications. The article explains how to integrate a carbon-based dry electrode into a textile structure and ensure an electrical connection between the electrodes and the stimulator for effective delivery of the FES. It also describes the materials and the step-by-step manufacturing processes. RESULTS The carbon-based dry electrode is integrated into the textile substrate by a thermal compression molding process on an embroidered conductive matrix. This matrix is composed of textile silver-plated conductive yarns and is linked to the stimulator. Besides ensuring the electrical connection, the matrix improves the fixation between the textile substrate and the electrode. The stimulation intensity, the perceived comfort and the muscle torque generated by the smart FES sleeve were compared to hydrogel electrodes. The results show a better average comfort and a higher average stimulation intensity with the smart FES sleeve, while there were no significant differences for the muscle torque generated. CONCLUSIONS The integration of the proposed dry electrodes into a textile is a viable solution. The wearable FES system does not negatively impact the electrodes' performance, and tends to improve it. Additionally, the proposed prototyping method is applicable to an entire garment in order to target all muscles. Moreover, the process is feasible for industrial production and commercialization since all materials and processes used are already available on the market.
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Affiliation(s)
- Baptiste Garnier
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Melissa Marquez-Chin
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Stephanie DiNunzio
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Stephanie N Iwasa
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Zia Saadatnia
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Mechanical and Manufacturing Engineering, Ontario Tech University, Oshawa, Canada
| | - Hani E Naguib
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Canada
- Department of Mechanical and Manufacturing Engineering, Ontario Tech University, Oshawa, Canada
| | - Milos R Popovic
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
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Barelli RG, Avelino VF, Castro MCF. STIMGRASP: A Home-Based Functional Electrical Stimulator for Grasp Restoration in Daily Activities. SENSORS (BASEL, SWITZERLAND) 2022; 23:10. [PMID: 36616607 PMCID: PMC9824213 DOI: 10.3390/s23010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/22/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Thousands of people currently suffer from motor limitations caused by SCI and strokes, which impose personal and social challenges. These individuals may have a satisfactory recovery by applying functional electrical stimulation that enables the artificial restoration of grasping after a muscular conditioning period. This paper presents the STIMGRASP, a home-based functional electrical stimulator to be used as an assistive technology for users with tetraplegia or hemiplegia. The STIMGRASP is a microcontrolled stimulator with eight multiplexed and independent symmetric biphasic constant current output channels with USB and Bluetooth communication. The system generates pulses with frequency, width, and maximum amplitude set at 20 Hz, 300 µs/phase, and 40 mA (load of 1 kΩ), respectively. It is powered by a rechargeable lithium-ion battery of 3100 mAh, allowing more than 10 h of continuous use. The development of this system focused on portability, usability, and wearability, resulting in portable hardware with user-friendly mobile app control and an orthosis with electrodes, allowing the user to carry out muscle activation sequences for four grasp modes to use for achieving daily activities.
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Popović‐Maneski L, Mateo S. MotiMove: Multi‐purpose transcutaneous functional electrical stimulator. Artif Organs 2022. [DOI: 10.1111/aor.14379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Sébastien Mateo
- Trajectoires Team, Lyon Neuroscience Research Center, CNRS UMR5292, INSERM U1028 Université Lyon 1, Université de Lyon Lyon France
- Plate‐forme Mouvement et Handicap Hospices Civils de Lyon, Hôpital Henry Gabrielle Lyon France
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5
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Garcia-Garcia MG, Jovanovic LI, Popovic MR. Comparing preference related to comfort in torque-matched muscle contractions between two different types of functional electrical stimulation pulses in able-bodied participants. J Spinal Cord Med 2021; 44:S215-S224. [PMID: 34779723 PMCID: PMC8604463 DOI: 10.1080/10790268.2021.1970882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
CONTEXT/OBJECTIVE Functional electrical stimulation (FES) is commonly used in rehabilitation to generate electrically-induced muscle contractions. FES has been shown to assist in the recovery of voluntary motor functions after stroke or spinal cord injury. However, discomfort associated with FES can motivate patients to withdraw their participation from FES therapy despite its benefits. To address this issue, a functional electrical stimulator, called MyndMove™ (MyndTec Inc., Canada), has been developed to generate more comfortable contractions than conventional stimulators. DESIGN Cross-sectional, interventional, with two treatment arms. SETTING A laboratory within a rehabilitation center. PARTICIPANTS Twelve able-bodied participants. INTERVENTION FES delivered with two different stimulators, MyndMove™ and Compex Motion (Compex, Switzerland), during muscle contractions of high, moderate and low stimulation intensity. OUTCOME MEASURES Comfort-related preference to a given stimulator and the discomfort score rated through a Numeric Rating Scale (NRS-101) for both stimulators. RESULTS Participants perceived a reduction in discomfort during high-intensity stimulation generated using MyndMove™. In addition, MyndMove™ stimulations were preferred in 60% of all contractions. The reduction in discomfort associated with MyndMove™ might be due the fact that MyndMove™ delivers less charge to generate contractions of equivalent intensity, compared to Compex Motion. CONCLUSION Reducing discomfort during FES may help in generating stronger and more clinically useful contractions, increasing accessibility of FES therapy to include individuals with low tolerance to FES.
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Affiliation(s)
- Martha G. Garcia-Garcia
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada,CRANIA, University Health Network & University of Toronto, Toronto, Canada,Correspondence to: Martha G. Garcia-Garcia, Lyndhurst Centre, Toronto Rehabilitation Institute, 520 Sutherland Drive, Room B1, Toronto, OntarioM4G 3V9, Canada. ;
| | - Lazar I. Jovanovic
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada,CRANIA, University Health Network & University of Toronto, Toronto, Canada
| | - Milos R. Popovic
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada,CRANIA, University Health Network & University of Toronto, Toronto, Canada
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Martins Â, Gouveia D, Cardoso A, Gamboa Ó, Millis D, Ferreira A. Nervous system modulation through electrical stimulation in companion animals. Acta Vet Scand 2021; 63:22. [PMID: 34053462 PMCID: PMC8167506 DOI: 10.1186/s13028-021-00585-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
Domestic animals with severe spontaneous spinal cord injury (SCI), including dogs and cats that are deep pain perception negative (DPP-), can benefit from specific evaluations involving neurorehabilitation integrative protocols. In human medicine, patients without deep pain sensation, classified as grade A on the American Spinal Injury Association (ASIA) impairment scale, can recover after multidisciplinary approaches that include rehabilitation modalities, such as functional electrical stimulation (FES), transcutaneous electrical spinal cord stimulation (TESCS) and transcranial direct current stimulation (TDCS). This review intends to explore the history, biophysics, neurophysiology, neuroanatomy and the parameters of FES, TESCS, and TDCS, as safe and noninvasive rehabilitation modalities applied in the veterinary field. Additional studies need to be conducted in clinical settings to successfully implement these guidelines in dogs and cats.
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Jovanovic LI, Popovic MR, Marquez-Chin C. KITE-BCI: A brain-computer interface system for functional electrical stimulation therapy. J Spinal Cord Med 2021; 44:S203-S214. [PMID: 34779740 PMCID: PMC8648007 DOI: 10.1080/10790268.2021.1970895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT/OBJECTIVE Integrating brain-computer interface (BCI) technology with functional electrical stimulation therapy (FEST) is an emerging strategy for upper limb motor rehabilitation after spinal cord injury (SCI). Despite promising results, the combined use of these technologies (BCI-FEST) in clinical practice is minimal. To address this issue, we developed KITE-BCI, a BCI system specifically designed for clinical application and integration with dynamic FEST. In this paper, we report its technical features and performance. In addition, we discuss the differences in distributions of the BCI- and therapist-triggered stimulation latencies. DESIGN Two single-arm 40-session interventional studies to test the feasibility of BCI-controlled FEST for upper limb motor rehabilitation in individuals with cervical SCI. SETTING Rehabilitation programs within the University and Lyndhurst Centres of the Toronto Rehabilitation Institute - University Health Network, Toronto, Canada. PARTICIPANTS Five individuals with sub-acute (< 6 months post-injury) SCI at the C4-C5 level, AIS B-D, and three individuals with chronic (> 24 months post-injury) SCI at C4 level, AIS B-C. OUTCOME MEASURES We measured BCI setup duration, and to characterize the performance of KITE-BCI, we recorded BCI sensitivity, defined as the percentage of successful BCI activations out of the total number of cued movements. RESULTS The overall BCI sensitivities were 74.46% and 79.08% for the sub-acute and chronic groups, respectively. The average KITE-BCI setup duration across the two studies was 11 min and 13 s. CONCLUSION KITE-BCI demonstrates a clinically viable single-channel BCI system for integration with FEST resulting in a versatile technology-enhanced upper limb motor rehabilitation strategy after SCI.
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Affiliation(s)
- Lazar I. Jovanovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- CRANIA, University Health Network, Toronto, Ontario, Canada
| | - Milos R. Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- CRANIA, University Health Network, Toronto, Ontario, Canada
| | - Cesar Marquez-Chin
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- CRANIA, University Health Network, Toronto, Ontario, Canada
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Franz KS, Patel K, Kilkenny DM. A biomedical Engineering Laboratory module for exploring involuntary muscle reflexes using Electromyography. J Biol Eng 2020; 14:26. [PMID: 33292462 PMCID: PMC7650172 DOI: 10.1186/s13036-020-00248-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Undergraduate biomedical engineering (BME) students interested in pursuing a career in research and development of medical or physiological monitoring devices require a strong foundation in biosignal analysis as well as physiological theory. Applied learning approaches are reported to be effective for reinforcing physiological coursework; therefore, we propose a new laboratory protocol for BME undergraduate physiology courses that integrates both neural engineering and physiological concepts to explore involuntary skeletal muscle reflexes. The protocol consists of two sections: the first focuses on recruiting soleus motor units through transcutaneous electrical nerve stimulation (TENS), while the second focuses on exploring the natural stretch reflex with and without the Jendrassik maneuver. In this case study, third-year biomedical engineering students collected electromyographic (EMG) activity of skeletal muscle contractions in response to peripheral nerve stimulation using a BioRadio Wireless Physiology Monitor system and analyzed the corresponding signal parameters (latency and amplitude) using the MATLAB platform. Results/protocol validation Electrical tibial nerve stimulation successfully recruited M-waves in all 8 student participants and F-waves in three student participants. The students used this data to learn about orthodromic and antidromic motor fiber activation as well as estimate the neural response latency and amplitude. With the stretch reflex, students were able to collect distinct signals corresponding to the tendon strike and motor response. From this, they were able to estimate the sensorimotor conduction velocity. Additionally, a significant increase in the stretch reflex EMG amplitude response was observed when using the Jendrassik maneuver during the knee-jerk response. A student exit survey on the laboratory experience reported that the class found the module engaging and helpful for reinforcing physiological course concepts. Conclusion This newly developed protocol not only allows BME students to explore physiological responses using natural and electrically-induced involuntary reflexes, but demonstrates that budget-friendly commercially available devices are capable of eliciting and measuring involuntary reflexes in an engaging manner. Despite some limitations caused by the equipment and students’ lack of signal processing experience, this new laboratory protocol provides a robust framework for integrating engineering and physiology in an applied approach for BME students to learn about involuntary reflexes, neurophysiology, and neural engineering. Supplementary Information The online version contains supplementary material available at 10.1186/s13036-020-00248-z.
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Affiliation(s)
- Karly S Franz
- Institute of Biomedical Engineering, University of Toronto, 164 College St Room 407, Toronto, ON, M5S 3G9, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation, 150 Kilgour Rd, East York, ON, M4G 1R8, Canada
| | - Kramay Patel
- Institute of Biomedical Engineering, University of Toronto, 164 College St Room 407, Toronto, ON, M5S 3G9, Canada.,Krembil Research Institute, 60 Leonard Avenue, Toronto, ON, M5T 0S8, Canada.,Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Dawn M Kilkenny
- Institute of Biomedical Engineering, University of Toronto, 164 College St Room 407, Toronto, ON, M5S 3G9, Canada. .,Institute for Studies in Transdisciplinary Engineering Education & Practice, University of Toronto, 35 St. George Street, Toronto, ON, M5S 1A4, Canada.
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Electric Field Application In Vivo Regulates Neural Precursor Cell Behavior in the Adult Mammalian Forebrain. eNeuro 2020; 7:ENEURO.0273-20.2020. [PMID: 32719101 PMCID: PMC7452733 DOI: 10.1523/eneuro.0273-20.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 01/02/2023] Open
Abstract
Deep brain stimulation (DBS), which uses electrical stimulation, is a well-established neurosurgical technique used to treat neurologic disorders. Despite its broad therapeutic use, the effects of electrical stimulation on brain cells is not fully understood. Here, we examine the effects of electrical stimulation on neural stem and progenitor cells (collectively neural precursor cells; NPCs) from the subventricular zone in the adult forebrain of C57BL/6J mice. Previous work has demonstrated that adult-derived NPCs are electro sensitive and undergo rapid and directed migration in response to application of clinically relevant electric fields (EFs). We examine NPC proliferation kinetics and their differentiation profile following EF application using in vitro and in vivo assays. In vitro direct current electrical stimulation of 250 mV/mm is sufficient to elicit a 2-fold increase in the neural stem cell pool and increases neurogenesis and oligogenesis. In vivo, asymmetric biphasic electrical stimulation similarly increases the size of the NPC pool and alters neurogenesis. These findings provide insight into the effects of electrical stimulation on NPCs and suggest its potential use as a regenerative approach to neural repair.
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Marquez-Chin C, Popovic MR. Functional electrical stimulation therapy for restoration of motor function after spinal cord injury and stroke: a review. Biomed Eng Online 2020; 19:34. [PMID: 32448143 PMCID: PMC7245767 DOI: 10.1186/s12938-020-00773-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/25/2020] [Indexed: 11/10/2022] Open
Abstract
Functional electrical stimulation is a technique to produce functional movements after paralysis. Electrical discharges are applied to a person's muscles making them contract in a sequence that allows performing tasks such as grasping a key, holding a toothbrush, standing, and walking. The technology was developed in the sixties, during which initial clinical use started, emphasizing its potential as an assistive device. Since then, functional electrical stimulation has evolved into an important therapeutic intervention that clinicians can use to help individuals who have had a stroke or a spinal cord injury regain their ability to stand, walk, reach, and grasp. With an expected growth in the aging population, it is likely that this technology will undergo important changes to increase its efficacy as well as its widespread adoption. We present here a series of functional electrical stimulation systems to illustrate the fundamentals of the technology and its applications. Most of the concepts continue to be in use today by modern day devices. A brief description of the potential future of the technology is presented, including its integration with brain-computer interfaces and wearable (garment) technology.
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Affiliation(s)
- Cesar Marquez-Chin
- Kite Research Institute, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
- Center for Advancing Neurotechnological Innovation to Application, CRANIA, University Health Network, Toronto, ON, Canada.
| | - Milos R Popovic
- Kite Research Institute, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application, CRANIA, University Health Network, Toronto, ON, Canada
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11
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Gil-Castillo J, Alnajjar F, Koutsou A, Torricelli D, Moreno JC. Advances in neuroprosthetic management of foot drop: a review. J Neuroeng Rehabil 2020; 17:46. [PMID: 32213196 PMCID: PMC7093967 DOI: 10.1186/s12984-020-00668-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
This paper reviews the technological advances and clinical results obtained in the neuroprosthetic management of foot drop. Functional electrical stimulation has been widely applied owing to its corrective abilities in patients suffering from a stroke, multiple sclerosis, or spinal cord injury among other pathologies. This review aims at identifying the progress made in this area over the last two decades, addressing two main questions: What is the status of neuroprosthetic technology in terms of architecture, sensorization, and control algorithms?. What is the current evidence on its functional and clinical efficacy? The results reveal the importance of systems capable of self-adjustment and the need for closed-loop control systems to adequately modulate assistance in individual conditions. Other advanced strategies, such as combining variable and constant frequency pulses, could also play an important role in reducing fatigue and obtaining better therapeutic results. The field not only would benefit from a deeper understanding of the kinematic, kinetic and neuromuscular implications and effects of more promising assistance strategies, but also there is a clear lack of long-term clinical studies addressing the therapeutic potential of these systems. This review paper provides an overview of current system design and control architectures choices with regard to their clinical effectiveness. Shortcomings and recommendations for future directions are identified.
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Affiliation(s)
- Javier Gil-Castillo
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Fady Alnajjar
- College of Information Technology (CIT), The United Arab Emirates University, P.O. Box 15551, Al Ain, UAE.
| | - Aikaterini Koutsou
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002, Madrid, Spain
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12
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Cerone GL, Vieira TMM, Botter A, Gazzoni M. Design of a Wireless, Modular and Programmable Neuromuscular Electrical Stimulator . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2019:3815-3818. [PMID: 31946705 DOI: 10.1109/embc.2019.8856848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The use of electrical stimulation to elicit single twitches and tetanic contractions of skeletal muscles has increased markedly in the last years, with applications ranging from basic physiology to clinical settings. Addressing all possible needs required by different applications with an electrical stimulator is challenging as it requires the device to be highly flexible in terms of stimulation configurations (number of channels and electrode location), and possibility to control the stimulation patterns (timing and stimulation profiles). This paper describes a new wireless, modular, and programmable electrical stimulator integrating the possibility to acquire and use biomechanical signals to trigger the stimulation output. A closed-loop FES Cycling setup has been presented to show a possible application of the system.
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13
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Cuesta-Gómez A, Carratalá-Tejada M, Molina-Rueda F, Miangolarra-Page JC. Functional electrical stimulation improves reaching movement in the shoulder and elbow muscles of stroke patients: A three-dimensional motion analysis. Restor Neurol Neurosci 2019; 37:231-238. [PMID: 31177249 DOI: 10.3233/rnn-180884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recovery of motor function following stroke is essential to restore adequate functionality. The use of functional electrical stimulation (FES) technology as a neuroprosthesis to enhance the motor function of the UL, and thus facilitate the performance of ADL, could lead to a stroke patient's greater activity and participation in daily life. OBJECTIVE The aim of the present study was to establish whether the application of FES in patients who have suffered a stroke with UL motor impairment is able to modify and facilitate their reaching patterns, measured by a three-dimensional motion capture system. METHODS 20 patients with chronic stroke participated in this study. For muscle stimulation, the electrical stimulator Compex® was used. Motion analysis was performed using the VICON Motion System®. Joint movements of the thorax, shoulder and elbow were analyzed in the sagittal plane, during the reaching movement under two different conditions of stimulation: FES condition and placebo condition. RESULTS Differences between FES condition and placebo condition were observed. In the FES condition it was recorded: an increased shoulder flexion and elbow extension in the reaching movement. CONCLUSIONS Functional electrical stimulation improved reaching movement in stroke patients with upper limb impairment.
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Affiliation(s)
- Alicia Cuesta-Gómez
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | - María Carratalá-Tejada
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | - Francisco Molina-Rueda
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | - Juan Carlos Miangolarra-Page
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain.,Chair of Rehabilitation and Physical Medicine, Fuenlabrada University Hospital, Madrid, Spain
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Likitlersuang J, Koh R, Gong X, Jovanovic L, Bolivar-Tellería I, Myers M, Zariffa J, Márquez-Chin C. EEG-Controlled Functional Electrical Stimulation Therapy With Automated Grasp Selection: A Proof-of-Concept Study. Top Spinal Cord Inj Rehabil 2018; 24:265-274. [PMID: 29997429 DOI: 10.1310/sci2403-265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Functional electrical stimulation therapy (FEST) is a promising intervention for the restoration of upper extremity function after cervical spinal cord injury (SCI). Objectives: This study describes and evaluates a novel FEST system designed to incorporate voluntary movement attempts and massed practice of functional grasp through the use of brain-computer interface (BCI) and computer vision (CV) modules. Methods: An EEG-based BCI relying on a single electrode was used to detect movement initiation attempts. A CV system identified the target object and selected the appropriate grasp type. The required grasp type and trigger command were sent to an FES stimulator, which produced one of four multichannel muscle stimulation patterns (precision, lateral, palmar, or lumbrical grasp). The system was evaluated with five neurologically intact participants and one participant with complete cervical SCI. Results: An integrated BCI-CV-FES system was demonstrated. The overall classification accuracy of the CV module was 90.8%, when selecting out of a set of eight objects. The average latency for the BCI module to trigger the movement across all participants was 5.9 ± 1.5 seconds. For the participant with SCI alone, the CV accuracy was 87.5% and the BCI latency was 5.3 ± 9.4 seconds. Conclusion: BCI and CV methods can be integrated into an FEST system without the need for costly resources or lengthy setup times. The result is a clinically relevant system designed to promote voluntary movement attempts and more repetitions of varied functional grasps during FEST.
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Affiliation(s)
- Jirapat Likitlersuang
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Ryan Koh
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Xinyi Gong
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Division of Engineering Science, University of Toronto, Toronto, Canada
| | - Lazar Jovanovic
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Isabel Bolivar-Tellería
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Matthew Myers
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - José Zariffa
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - César Márquez-Chin
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
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15
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Garzon LC, Switzer L, Musselman KE, Fehlings D. The use of functional electrical stimulation to improve upper limb function in children with hemiplegic cerebral palsy: A feasibility study. J Rehabil Assist Technol Eng 2018; 5:2055668318768402. [PMID: 31191936 PMCID: PMC6453088 DOI: 10.1177/2055668318768402] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/28/2018] [Indexed: 11/17/2022] Open
Abstract
Background Grasping and manipulating objects are common problems for children with
hemiplegic cerebral palsy. Multichannel-functional electrical stimulation
may help facilitate upper limb movements and improve function. Objective To evaluate the feasibility of multichannel-functional electrical stimulation
to improve grasp and upper limb function in children with hemiplegic
cerebral palsy to inform the development of a clinical trial. Methods A prospective pre-/post-test/follow-up (six months) design with three
children, aged 6–13 years, was used. Multichannel-functional electrical
stimulation (mFES) was applied to the hemiplegic upper limb for up to 48
sessions over 16 weeks. Feasibility indicators included recruitment of
participants and adherence rates, safety, and discomfort/pain. Effectiveness
was assessed using the grasp domain of the Quality of Upper Extremity Skills
Test, and other secondary clinical outcome measures with “success” criteria
set a priori. Results Participant recruitment target was not met but adherence was high, and
multichannel-functional electrical stimulation was found to be safe and
comfortable. Of the three participants, two improved in grasp at post-test,
whereas one child’s ability deteriorated. Only one child met success
criteria on most outcomes at post-test. Conclusions Feasibility indicators met success criteria, except for participant
recruitment. Treatment effectiveness was mixed. A future case comparison
investigation with a larger but more selected sample is suggested.
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Affiliation(s)
- Luisa C Garzon
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,2Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, East York, Canada
| | - Lauren Switzer
- 2Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, East York, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute-University Health Network, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Darcy Fehlings
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,2Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, East York, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
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16
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Marquez-Chin C, Atwell K, Popovic MR. Prediction of specific hand movements using electroencephalographic signals. J Spinal Cord Med 2017; 40:696-705. [PMID: 28880131 PMCID: PMC5778933 DOI: 10.1080/10790268.2017.1369215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To identify specific hand movements from electroencephalographic activity. DESIGN Proof of concept study. SETTING Rehabilitation hospital in Toronto, Canada. PARTICIPANTS Fifteen healthy individuals with no neurological conditions. INTERVENTION Each individual performed six different hand movements, including four grasps commonly targeted during rehabilitation. All of them used their dominant hand and four of them repeated the experiment with their non-dominant hand. EEG was acquired from 8 different locations (C1, C2, C3, C4, CZ, F3, F4 and Fz). Time-frequency distributions (spectrogram) of the pre-movement EEG activity for each electrode were generated and each of the time-resolved spectral components (1 Hz to 50 Hz) was correlated with a hyperbolic tangent function to detect power decreases. The spectral components and time ranges with the largest correlation values were identified using a threshold. The resulting features were then used to implement a distance-based classifier. OUTCOME MEASURES Accuracy of classification. RESULTS A minimum of three different dominant hand movements were classified correctly with average accuracies between 65-75% across all 15 participants. Average accuracies between 67-85% for the same three movements were achieved across four of the 15 participants who were tested with their non-dominant hand. CONCLUSION The results suggest that it may be possible to predict specific hand movements from a small number of electroencephalographic electrodes. Further studies including members of the spinal cord injury community are necessary to verify the suitability of the proposed process.
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Affiliation(s)
- Cesar Marquez-Chin
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada,Therapeutic Applications of Complex Systems Laboratory, University Centre, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada,Correspondence to: Cesar Marquez-Chin, Therapeutic Applications of Complex Systems Laboratory, University Centre, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue #12-104, Toronto, ON, M5G 2A2, Canada. Phone: (416) 597-3422 Ext.7899.
| | - Kathryn Atwell
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada,Therapeutic Applications of Complex Systems Laboratory, University Centre, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Milos R Popovic
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada,Therapeutic Applications of Complex Systems Laboratory, University Centre, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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17
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Casco S, Fuster I, Galeano R, Moreno JC, Pons JL, Brunetti F. Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation. IEEE Int Conf Rehabil Robot 2017; 2017:1660-1665. [PMID: 28814058 DOI: 10.1109/icorr.2017.8009486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hybrid rehabilitation robotics combine neuro-prosthetic devices (close-loop functional electrical stimulation systems) and traditional robotic structures and actuators to explore better therapies and promote a more efficient motor function recovery or compensation. Although hybrid robotics and ankle neuroprostheses (NPs) have been widely developed over the last years, there are just few studies on the use of NPs to electrically control both ankle flexion and extension to promote ankle recovery and improved gait patterns in paretic limbs. The aim of this work is to develop an ankle NP specifically designed to work in the field of hybrid robotics. This article presents early steps towards this goal and makes a brief review about motor NPs and Functional Electrical Stimulation (FES) principles and most common devices used to aid the ankle functioning during the gait cycle. It also shows a current sources analysis done in this framework, in order to choose the best one for this intended application.
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18
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Cuesta-Gómez A, Molina-Rueda F, Carratala-Tejada M, Imatz-Ojanguren E, Torricelli D, Miangolarra-Page JC. The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study. Front Neurol 2017; 8:186. [PMID: 28539911 PMCID: PMC5423909 DOI: 10.3389/fneur.2017.00186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints and greater displacements of the trunk, compared to healthy subjects. The importance of an appropriate and specific contraction of the interscapular and upper limb (UL) muscles is crucial to achieving proper reaching movements. Functional electrical stimulation (FES) is used to activate the paretic muscles using short-duration electrical pulses. Objective To evaluate whether the application of FES in the UL and interscapular muscles of stroke patients with motor impairments of the UL modifies patients’ reaching patterns, measured using instrumental movement analysis systems. Design A cross-sectional study was carried out. Setting The VICON Motion System® was used to conduct motion analysis. Participants Twenty-one patients with chronic stroke. Intervention The Compex® electric stimulator was used to provide muscle stimulation during two conditions: a placebo condition and a FES condition. Main outcome measures We analyzed the joint kinematics (trunk, shoulder, and elbow) from the starting position until the affected hand reached the glass. Results Participants receiving FES carried out the movement with less trunk flexion, while shoulder flexion elbow extension was increased, compared to placebo conditions. Conclusion The application of FES to the UL and interscapular muscles of stroke patients with motor impairment of the UL has improved reaching movements.
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Affiliation(s)
- Alicia Cuesta-Gómez
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | - Francisco Molina-Rueda
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | - Maria Carratala-Tejada
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
| | | | | | - Juan Carlos Miangolarra-Page
- Motion Analysis, Ergonomics, Biomechanics and Motor Control Laboratory (LAMBECOM), Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain.,Chair of Rehabilitation and Physical Medicine, Fuenlabrada University Hospital, Madrid, Spain
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Marquez-Chin C, Bagher S, Zivanovic V, Popovic MR. Functional electrical stimulation therapy for severe hemiplegia: Randomized control trial revisited. The Canadian Journal of Occupational Therapy 2017; 84:87-97. [DOI: 10.1177/0008417416668370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Stroke is the leading cause of long-term disability. Stroke survivors seldom improve their upper-limb function when their deficit is severe, despite recently developed therapies. Purpose. This study aims to assess the efficacy of functional electrical stimulation therapy in improving voluntary reaching and grasping after severe hemiplegia. Method. A post hoc analysis of a previously completed randomized control trial ( clinicaltrials.gov , No. NCT00221078) was carried out involving 21 participants with severe upper-limb hemiplegia (i.e., Fugl-Meyer Assessment–Upper Extremity [FMA-UE] ≤ 15) resulting from stroke. Findings. Functional Independence Measure Self-Care subscores increased 22.8 (±6.7) points in the intervention group and 9 (±6.5) in the control group, following 40 hr of equal-intensity therapy. FMA-UE score changes were 27.2 (±13.5) and 5.3 (±11.0) for the intervention and control groups, respectively. Implications. The results may represent the largest upper-limb function improvements in any stroke population to date, especially in those with severe upper-limb deficit.
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EEG-Triggered Functional Electrical Stimulation Therapy for Restoring Upper Limb Function in Chronic Stroke with Severe Hemiplegia. Case Rep Neurol Med 2016; 2016:9146213. [PMID: 27882256 PMCID: PMC5110888 DOI: 10.1155/2016/9146213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/27/2016] [Accepted: 10/04/2016] [Indexed: 11/18/2022] Open
Abstract
We report the therapeutic effects of integrating brain-computer interfacing technology and functional electrical stimulation therapy to restore upper limb reaching movements in a 64-year-old man with severe left hemiplegia following a hemorrhagic stroke he sustained six years prior to this study. He completed 40 90-minute sessions of functional electrical stimulation therapy using a custom-made neuroprosthesis that facilitated 5 different reaching movements. During each session, the participant attempted to reach with his paralyzed arm repeatedly. Stimulation for each of the movement phases (e.g., extending and retrieving the arm) was triggered when the power in the 18 Hz–28 Hz range (beta frequency range) of the participant's EEG activity, recorded with a single electrode, decreased below a predefined threshold. The function of the participant's arm showed a clinically significant improvement in the Fugl-Meyer Assessment Upper Extremity (FMA-UE) subscore (6 points) as well as moderate improvement in Functional Independence Measure Self-Care subscore (7 points). The changes in arm's function suggest that the combination of BCI technology and functional electrical stimulation therapy may restore voluntary motor function in individuals with chronic hemiplegia which results in severe upper limb deficit (FMA-UE ≤ 15), a population that does not benefit from current best-practice rehabilitation interventions.
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21
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Marquez-Chin C, Marquis A, Popovic MR. BCI-Triggered Functional Electrical Stimulation Therapy for Upper Limb. Eur J Transl Myol 2016; 26:6222. [PMID: 27990247 PMCID: PMC5128980 DOI: 10.4081/ejtm.2016.6222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present here the integration of brain-computer interfacing (BCI) technology with functional electrical stimulation therapy to restore voluntary function. The system was tested with a single man with chronic (6 years) severe left hemiplegia resulting from a stroke. The BCI, implemented as a simple "brain-switch" activated by power decreases in the 18 Hz - 28 Hz frequency range of the participant's electroencephalograpic signals, triggered a neuroprosthesis designed to facilitate forward reaching, reaching to the mouth, and lateral reaching movements. After 40 90-minute sessions in which the participant attempted the reaching tasks repeatedly, with the movements assisted by the BCI-triggered neuroprosthesis, the participant's arm function showed a clinically significant six point increase in the Fugl-Meyer Asessment Upper Extermity Sub-Score. These initial results suggest that the combined use of BCI and functional electrical stimulation therapy may restore voluntary reaching function in individuals with chronic severe hemiplegia for whom the rehabilitation alternatives are very limited.
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Affiliation(s)
- Cesar Marquez-Chin
- Toronto Rehabilitation Institute - University Health Network , Toronto, Canada
| | - Aaron Marquis
- Toronto Rehabilitation Institute - University Health Network , Toronto, Canada
| | - Milos R Popovic
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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22
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Popovic MR, Zivanovic V, Valiante TA. Restoration of Upper Limb Function in an Individual with Cervical Spondylotic Myelopathy using Functional Electrical Stimulation Therapy: A Case Study. Front Neurol 2016; 7:81. [PMID: 27375547 PMCID: PMC4901066 DOI: 10.3389/fneur.2016.00081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/05/2016] [Indexed: 11/13/2022] Open
Abstract
Non-traumatic spinal cord pathology is responsible for 25–52% of all spinal cord lesions. Studies have revealed that spinal stenosis accounts for 16–21% of spinal cord injury (SCI) admissions. Impaired grips as well as slow unskilled hand and finger movements are the most common complaints in patients with spinal cord disorders, such as myelopathy secondary to cervical spondylosis. In the past, our team carried out couple of successful clinical trials, including two randomized control trials, showing that functional electrical stimulation therapy (FEST) can restore voluntary reaching and/or grasping function, in people with stroke and traumatic SCI. Motivated by this success, we decided to examine changes in the upper limb function following FEST in a patient who suffered loss of hand function due to myelopathy secondary to cervical spondylosis. The participant was a 61-year-old male who had C3–C7 posterior laminectomy and instrumented fusion for cervical myelopathy. The participant presented with progressive right hand weakness that resulted in his inability to voluntarily open and close the hand and to manipulate objects unilaterally with his right hand. The participant was enrolled in the study ~22 months following initial surgical intervention. Participant was assessed using Toronto Rehabilitation Institute’s Hand Function Test (TRI-HFT), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Spinal Cord Independence Measure (SCIM). The pre–post differences in scores on all measures clearly demonstrated improvement in voluntary hand function following 15 1-h FEST sessions. The changes observed were meaningful and have resulted in substantial improvement in performance of activities of daily living. These results provide preliminary evidence that FEST has a potential to improve upper limb function in patients with non-traumatic SCI, such as myelopathy secondary to cervical spondylosis.
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Affiliation(s)
- Milos R Popovic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Vera Zivanovic
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto, ON , Canada
| | - Taufik A Valiante
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Krembil Research Institute - University Health Network, Toronto, ON, Canada
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23
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Sweeney D, Quinlan LR, OLaighin G. Smartphone app design for the wireless control of a neuromuscular electrical stimulator device with integrated randomization allocation process for RCT applications. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:4574-7. [PMID: 26737312 DOI: 10.1109/embc.2015.7319412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The use of NMES has evolved over the last five decades. Technological advancements have transformed these once complex systems into user-friendly devices with enhanced control functions, leading to new applications of NMES being investigated. The use of Randomized Control Trial (RCT) methodology in evaluating the effectiveness of new and existing applications of NMES is a demanding process adding time and cost to a translation into clinical practice. Poor quality trials may result in poor evidence of NMES effectiveness. In this paper some of the key challenges encountered in NMES clinical trials are identified with the aim of purposing a solution to address these challenges through the adoption of Smartphone technology. The design and evaluation of a smartphone application to provide automatic blind randomization control and facilitating the wireless temporal control of a portable Bluetooth enabled NMES is presented.
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24
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Nagai MK, Marquez-Chin C, Popovic MR. Why Is Functional Electrical Stimulation Therapy Capable of Restoring Motor Function Following Severe Injury to the Central Nervous System? Transl Neurosci 2016. [DOI: 10.1007/978-1-4899-7654-3_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Milosevic M, Masani K, Wu N, McConville KMV, Popovic MR. Trunk muscle co-activation using functional electrical stimulation modifies center of pressure fluctuations during quiet sitting by increasing trunk stiffness. J Neuroeng Rehabil 2015; 12:99. [PMID: 26555128 PMCID: PMC4641430 DOI: 10.1186/s12984-015-0091-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the impact of functional electrical stimulation (FES) induced co-activation of trunk muscles during quiet sitting. We hypothesized that FES applied to the trunk muscles will increase trunk stiffness. The objectives of this study were to: 1) compare the center of pressure (COP) fluctuations during unsupported and FES-assisted quiet sitting - an experimental study and; 2) investigate how FES influences sitting balance - an analytical (simulation) study. METHODS The experimental study involved 15 able-bodied individuals who were seated on an instrumented chair. During the experiment, COP of the body projected on the seating surface was calculated to compare sitting stability of participants during unsupported and FES-assisted quiet sitting. The analytical (simulation) study examined dynamics of quiet sitting using an inverted pendulum model, representing the body, and a proportional-derivative (PD) controller, representing the central nervous system control. This model was used to analyze the relationship between increased trunk stiffness and COP fluctuations. RESULTS In the experimental study, the COP fluctuations showed that: i) the mean velocity, mean frequency and the power frequency were higher during FES-assisted sitting; ii) the frequency dispersion for anterior-posterior fluctuations was smaller during FES-assisted sitting; and iii) the mean distance, range and centroidal frequency did not change during FES-assisted sitting. The analytical (simulation) study showed that increased mechanical stiffness of the trunk had the same effect on COP fluctuations as the FES. CONCLUSIONS The results of this study suggest that FES applied to the key trunk muscles increases the speed of the COP fluctuations by increasing the trunk stiffness during quiet sitting.
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Affiliation(s)
- Matija Milosevic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada. .,Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada.
| | - Kei Masani
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada. .,Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada.
| | - Noel Wu
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada. .,Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada.
| | - Kristiina M V McConville
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada. .,Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada. .,Department of Electrical and Computer Engineering, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
| | - Milos R Popovic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada. .,Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada.
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27
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Dimbwadyo-Terrer I, Trincado-Alonso F, de Los Reyes-Guzmán A, Aznar MA, Alcubilla C, Pérez-Nombela S, Del Ama-Espinosa A, Polonio-López B, Gil-Agudo Á. Upper limb rehabilitation after spinal cord injury: a treatment based on a data glove and an immersive virtual reality environment. Disabil Rehabil Assist Technol 2015; 11:462-7. [PMID: 26181226 DOI: 10.3109/17483107.2015.1027293] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Purpose state: The aim of this preliminary study was to test a data glove, CyberTouch™, combined with a virtual reality (VR) environment, for using in therapeutic training of reaching movements after spinal cord injury (SCI). METHOD Nine patients with thoracic SCI were selected to perform a pilot study by comparing two treatments: patients in the intervention group (IG) conducted a VR training based on the use of a data glove, CyberTouch™ for 2 weeks, while patients in the control group (CG) only underwent the traditional rehabilitation. Furthermore, two functional parameters were implemented in order to assess patient's performance of the sessions: normalized trajectory lengths and repeatability. RESULTS Although no statistical significance was found, the data glove group seemed to obtain clinical changes in the muscle balance (MB) and functional parameters, and in the dexterity, coordination and fine grip tests. Moreover, every patient showed variations in at least one of the functional parameters, either along Y-axis trajectory or Z-axis trajectory. CONCLUSIONS This study might be a step forward for the investigation of new uses of motion capture systems in neurorehabilitation, making it possible to train activities of daily living (ADLs) in motivational environments while measuring objectively the patient's functional evolution. Implications for Rehabilitation Key findings: A motion capture application based on a data glove is presented, for being used as a virtual reality tool for rehabilitation. This application has provided objective data about patient's functional performance. What the study has added: (1) This study allows to open new areas of research based on the use of different motion capture systems as rehabilitation tools, making it possible to train Activities of Daily Living in motivational environments. (2) Furthermore, this study could be a contribution for the development of clinical protocols to identify which types of patients will benefit most from the VR treatments, which interfaces are more suitable to be used in neurorehabilitation, and what types of virtual exercises will work best.
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Affiliation(s)
- Iris Dimbwadyo-Terrer
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
| | - Fernando Trincado-Alonso
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
| | - Ana de Los Reyes-Guzmán
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
| | | | | | - Soraya Pérez-Nombela
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
| | - Antonio Del Ama-Espinosa
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
| | - Begoña Polonio-López
- c Nursing, Physiotherapy and Occupational Therapy Department, University of Castilla la Mancha , Talavera de la Reina , Spain
| | - Ángel Gil-Agudo
- a Biomechanics and Technical Aids Department, National Hospital for Spinal Cord Injury , Toledo , Spain
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Thompson DM, Koppes AN, Hardy JG, Schmidt CE. Electrical stimuli in the central nervous system microenvironment. Annu Rev Biomed Eng 2015; 16:397-430. [PMID: 25014787 DOI: 10.1146/annurev-bioeng-121813-120655] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electrical stimulation to manipulate the central nervous system (CNS) has been applied as early as the 1750s to produce visual sensations of light. Deep brain stimulation (DBS), cochlear implants, visual prosthetics, and functional electrical stimulation (FES) are being applied in the clinic to treat a wide array of neurological diseases, disorders, and injuries. This review describes the history of electrical stimulation of the CNS microenvironment; recent advances in electrical stimulation of the CNS, including DBS to treat essential tremor, Parkinson's disease, and depression; FES for the treatment of spinal cord injuries; and alternative electrical devices to restore vision and hearing via neuroprosthetics (retinal and cochlear implants). It also discusses the role of electrical cues during development and following injury and, importantly, manipulation of these endogenous cues to support regeneration of neural tissue.
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Affiliation(s)
- Deanna M Thompson
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York 12180;
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Kapadia NM, Bagher S, Popovic MR. Influence of different rehabilitation therapy models on patient outcomes: hand function therapy in individuals with incomplete SCI. J Spinal Cord Med 2014; 37:734-43. [PMID: 24968955 PMCID: PMC4231961 DOI: 10.1179/2045772314y.0000000203] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES The primary objective was to compare the benefits of single (COT1) versus double (COT2) dose of conventional occupational therapy (COT) in improving voluntary hand function in individuals with incomplete, sub-acute C3-C7 spinal cord injury (SCI). The secondary objective was to compare these two interventions versus functional electrical stimulation therapy plus COT (FES + COT). DESIGN Retrospective analysis. Setting Inpatient spinal cord rehabilitation center, Toronto. PARTICIPANTS Individuals with traumatic incomplete sub-acute SCI. INTERVENTIONS Data from Phases I and II (ClinicalTrials.gov ID NCT00221117) randomized control trials were pooled together for the purpose of this study. Participants in the COT1 group received 45 hours of therapy, the COT2 group received 80 hours of therapy, and the FES + COT group received 40 hours of COT therapy +40 hours of FES therapy. OUTCOME MEASURES We analyzed the functional independence measure (FIM) and the spinal cord independence measure (SCIM) self-care sub-scores. Results The mean change scores on the FIM self-care sub-score for the COT1, COT2, and FES + COT groups were 12.8, 10, and 20.1 points, respectively. Similarly, the mean change scores on the SCIM self-care sub-score for the COT1, COT2, and FES + COT groups were, 2.6, 3.16, and 10.2 points, respectively. CONCLUSION Increased rehabilitation intensity alone may not always be beneficial. The type of intervention plays a significant role in determining functional changes. In this instance, receiving one (COT1) or two (COT2) doses of COT resulted in similar outcomes, however, FES + COT therapy yielded much better outcomes compared to COT1 and COT2 interventions.
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Affiliation(s)
- Naaz M. Kapadia
- Correspondence to: Naaz M. Kapadia, Spinal Cord Injury Research Program, Toronto Rehabilitation Institute, University Hospital Network, 520 Sutherland Drive, Toronto, Canada ON M4G 3V9.
| | - Shaghayegh Bagher
- Toronto Rehabilitation Institute, University Hospital Network, Toronto, Canada
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Kapadia N, Masani K, Catharine Craven B, Giangregorio LM, Hitzig SL, Richards K, Popovic MR. A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on walking competency. J Spinal Cord Med 2014; 37:511-24. [PMID: 25229735 PMCID: PMC4166186 DOI: 10.1179/2045772314y.0000000263] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Multi-channel surface functional electrical stimulation (FES) for walking has been used to improve voluntary walking and balance in individuals with spinal cord injury (SCI). OBJECTIVE To investigate short- and long-term benefits of 16 weeks of thrice-weekly FES-assisted walking program, while ambulating on a body weight support treadmill and harness system, versus a non-FES exercise program, on improvements in gait and balance in individuals with chronic incomplete traumatic SCI, in a randomized controlled trial design. METHODS Individuals with traumatic and chronic (≥18 months) motor incomplete SCI (level C2 to T12, American Spinal Cord Injury Association Impairment Scale C or D) were recruited from an outpatient SCI rehabilitation hospital, and randomized to FES-assisted walking therapy (intervention group) or aerobic and resistance training program (control group). Outcomes were assessed at baseline, and after 4, 6, and 12 months. Gait, balance, spasticity, and functional measures were collected. RESULTS Spinal cord independence measure (SCIM) mobility sub-score improved over time in the intervention group compared with the control group (baseline/12 months: 17.27/21.33 vs. 19.09/17.36, respectively). On all other outcome measures the intervention and control groups had similar improvements. Irrespective of group allocation walking speed, endurance, and balance during ambulation all improved upon completion of therapy, and majority of participants retained these gains at long-term follow-ups. CONCLUSIONS Task-oriented training improves walking ability in individuals with incomplete SCI, even in the chronic stage. Further randomized controlled trials, involving a large number of participants are needed, to verify if FES-assisted treadmill training is superior to aerobic and strength training.
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Affiliation(s)
- Naaz Kapadia
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Canada
| | | | | | | | - Sander L. Hitzig
- Faculty of Medicine, Institute for Life Course and Aging, University of Toronto, Canada
| | - Kieva Richards
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Canada
| | - Milos R. Popovic
- Correspondence to: Milos R. Popovic, Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute at the University Health Network, 520 Sutherland Drive, room 206H, Toronto, Ontario M4G 3V9, Canada. , http://www.toronto-fes.ca
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McGie SC, Zariffa J, Popovic MR, Nagai MK. Short-term neuroplastic effects of brain-controlled and muscle-controlled electrical stimulation. Neuromodulation 2014; 18:233-40; discussion 240. [PMID: 24802088 DOI: 10.1111/ner.12185] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/15/2013] [Accepted: 03/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Functional electrical stimulation (FES) has been shown to facilitate the recovery of grasping function in individuals with incomplete spinal cord injury. Neurophysiological theory suggests that this benefit may be further enhanced by a more consistent pairing of the voluntary commands sent from the user's brain down their spinal cord with the electrical stimuli applied to the user's periphery. The objective of the study was to compare brain-machine interfaces (BMIs)-controlled and electromyogram (EMG)-controlled FES therapy to three more well-researched therapies, namely, push button-controlled FES therapy, voluntary grasping (VOL), and BMI-guided voluntary grasping. MATERIALS AND METHODS Ten able-bodied participants underwent one hour of each of five grasping training modalities, including BMI-controlled FES (BMI-FES), EMG-controlled FES (EMG-FES), conventional push button-controlled FES, VOL, and BMI-guided voluntary grasping. Assessments, including motor-evoked potential, grip force, and maximum voluntary contraction, were conducted immediately before and after each training period. RESULTS Motor-evoked potential-based outcome measures were more upregulated following BMI-FES and especially EMG-FES than they were following VOL or FES. No significant changes were found in the more functional outcome measures. CONCLUSIONS These results provide preliminary evidence suggesting the potential of BMI-FES and EMG-FES to induce greater neuroplastic changes than conventional therapies, although the precise mechanism behind these changes remains speculative. Further investigation will be required to elucidate the underlying mechanisms and to conclusively determine whether these effects can translate into better long-term functional outcomes and quality of life for individuals with spinal cord injury.
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Affiliation(s)
- Steven C McGie
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Kapadia NM, Nagai MK, Zivanovic V, Bernstein J, Woodhouse J, Rumney P, Popovic MR. Functional electrical stimulation therapy for recovery of reaching and grasping in severe chronic pediatric stroke patients. J Child Neurol 2014; 29:493-9. [PMID: 23584687 DOI: 10.1177/0883073813484088] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stroke affects 2.7 children per 100,000 annually, leaving many of them with lifelong residual impairments despite intensive rehabilitation. In the present study the authors evaluated the effectiveness of 48 hours of transcutaneous functional electrical stimulation therapy for retraining voluntary reaching and grasping in 4 severe chronic pediatric stroke participants. Participants were assessed using the Rehabilitation Engineering Laboratory Hand Function Test, Quality of Upper Extremity Skills Test, Pediatric Evaluation of Disability Inventory, and Assisting Hand Assessment. All participants improved on all measures. The average change scores on selected Rehabilitation Engineering Laboratory Hand Function Test components were 14.5 for object manipulation (P = .042), 0.78 Nm for instrumented cylinder (P = .068), and 14 for wooden blocks (P = .068) and on the grasp component of Quality of Upper Extremity Skills Test was 25.93 (P = .068). These results provide preliminary evidence that functional electrical stimulation therapy has the potential to improve upper limb function in severe chronic pediatric stroke patients.
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Affiliation(s)
- Naaz M Kapadia
- 1Toronto Rehabilitation Institute, University Hospital Network, Toronto, Canada
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Rupp R, Kreilinger A, Rohm M, Kaiser V, Müller-Putz GR. Development of a non-invasive, multifunctional grasp neuroprosthesis and its evaluation in an individual with a high spinal cord injury. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:1835-8. [PMID: 23366269 DOI: 10.1109/embc.2012.6346308] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the last decade the improvement of a missing hand function by application of neuroprostheses in particular the implantable Freehand system has been successfully shown in high spinal cord injured individuals. The clinically proven advantages of the Freehand system is its ease of use, the reproducible generation of two distinct functional grasp patterns and an analog control scheme based on movements of the contralateral shoulder. However, after the Freehand system is not commercially available for more than ten years, alternative grasp neuroprosthesis with a comparable functionality are still missing. Therefore, the aim of this study was to develop a non-invasive neuroprosthesis and to show that a degree of functional restoration can be provided to end users comparable to implanted devices. By introduction of an easy to handle forearm electrode sleeve the reproducible generation of two grasp patterns has been achieved. Generated grasp forces of the palmar grasp are in the range of the implanted system. Though pinch force of the lateral grasp is significantly lower, it can effectively used by a tetraplegic subject to perform functional tasks. The non-invasive grasp neuroprosthesis developed in this work may serve as an easy to apply and inexpensive way to restore a missing hand and finger function at any time after spinal cord injury.
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Affiliation(s)
- Rüdiger Rupp
- Spinal Cord Injury center, Heidelberg university hospital, 69118 Heidelberg, Germany.
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van Hedel HJA, Wirz M, Dietz V. Standardized assessment of walking capacity after spinal cord injury: the European network approach. Neurol Res 2013; 30:61-73. [PMID: 17767814 DOI: 10.1179/016164107x230775] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES After a spinal cord injury (SCI), walking function is an important outcome measure for rehabilitation and new treatment interventions. The current status of four walking capacity tests that are applied to SCI subjects is presented: the revised walking index for spinal cord injury (WISCI II), the 6 minute walk test (6MinWT), 10 meter walk test (10MWT) and the timed up and go (TUG) test. Then, we investigated which categories of the WISCI II apply to SCI subjects who participated in the European Multicenter Study of Human Spinal Cord Injury (EM-SCI), and the relationship between the 10MWT and the TUG. METHODS In the EM-SCI, the walking tests were applied 2 weeks and 1, 3, 6 and 12 months after SCI. We identified the WISCI II categories that applied to the EM-SCI subjects at each time point and quantified the relationship between the 10MWT and the TUG using Spearman's correlation coefficients (rho) and linear regression. RESULTS Five WISCI II categories applied to 71% of the EM-SCI subjects with walking ability, while 11 items applied to 11% of the subjects. The 10MWT correlated excellently with the TUG at each time point (rho>0.80). However, this relationship changed over time. One year after SCI, the time needed to accomplish the TUG was 1.25 times greater than the 10MWT time. DISCUSSION Some categories of the WISCI II appear to be redundant, while some discriminate to an insufficient degree. In addition, there appear to be ceiling effects, which limit its usefulness. The relationship between the 10MWT and TUG is high, but changes over time. We suggest that, at present, the 10MWT appears to be the best tool to assess walking capacity in SCI subjects. Additional valuable information is provided by assessing the needs for walking aids or personal assistance. To ensure comparability of study results, proposals for standardized instructions are presented.
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Affiliation(s)
- H J A van Hedel
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.
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Modulation of spinal neuronal excitability by spinal direct currents and locomotion after spinal cord injury. Clin Neurophysiol 2013; 124:1187-95. [DOI: 10.1016/j.clinph.2012.11.021] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 10/29/2012] [Accepted: 11/05/2012] [Indexed: 12/18/2022]
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Interfaces with the peripheral nerve for the control of neuroprostheses. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 109:63-83. [PMID: 24093606 DOI: 10.1016/b978-0-12-420045-6.00002-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Nervous system injuries lead to loss of control of sensory, motor, and autonomic functions of the affected areas of the body. Provided the high amount of people worldwide suffering from these injuries and the impact on their everyday life, numerous and different neuroprostheses and hybrid bionic systems have been developed to restore or partially mimic the lost functions. A key point for usable neuroprostheses is the electrode that interfaces the nervous system and translates not only motor orders into electrical outputs that activate the prosthesis but is also able to transform sensory information detected by the machine into signals that are transmitted to the central nervous system. Nerve electrodes have been classified with regard to their invasiveness in extraneural, intraneural, and regenerative. The more invasive is the implant the more selectivity of interfacing can be reached. However, boosting invasiveness and selectivity may also heighten nerve damage. This chapter provides a general overview of nerve electrodes as well as the state-of-the-art of their biomedical applications in neuroprosthetic systems.
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Kapadia N, Zivanovic V, Popovic MR. Restoring voluntary grasping function in individuals with incomplete chronic spinal cord injury: pilot study. Top Spinal Cord Inj Rehabil 2013; 19:279-87. [PMID: 24244093 PMCID: PMC3816722 DOI: 10.1310/sci1904-279] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Functional electrical stimulation (FES) therapy has been shown to be one of the most promising approaches for improving voluntary grasping function in individuals with subacute cervical spinal cord injury (SCI). OBJECTIVE To determine the effectiveness of FES therapy, as compared to conventional occupational therapy (COT), in improving voluntary hand function in individuals with chronic (≥24 months post injury), incomplete (American Spinal Injury Association Impairment Scale [AIS] B-D), C4 to C7 SCI. METHODS Eight participants were randomized to the intervention group (FES therapy; n = 5) or the control group (COT; n = 3). Both groups received 39 hours of therapy over 13 to 16 weeks. The primary outcome measure was the Toronto Rehabilitation Institute-Hand Function Test (TRI-HFT), and the secondary outcome measures were Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Functional Independence Measure (FIM) self-care subscore, and Spinal Cord Independence Measure (SCIM) self-care subscore. Outcome assessments were performed at baseline, after 39 sessions of therapy, and at 6 months following the baseline assessment. RESULTS After 39 sessions of therapy, the intervention group improved by 5.8 points on the TRI-HFT's Object Manipulation Task, whereas the control group changed by only 1.17 points. Similarly, after 39 sessions of therapy, the intervention group improved by 4.6 points on the FIM self-care subscore, whereas the control group did not change at all. CONCLUSION The results of the pilot data justify a clinical trial to compare FES therapy and COT alone to improve voluntary hand function in individuals with chronic incomplete tetraplegia.
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Affiliation(s)
- Naaz Kapadia
- Spinal Cord Injury Research Program, Toronto Rehabilitation Institute, University Health Network , Toronto, Ontario , Canada
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Oess NP, Wanek J, Curt A. Design and evaluation of a low-cost instrumented glove for hand function assessment. J Neuroeng Rehabil 2012; 9:2. [PMID: 22248160 PMCID: PMC3305482 DOI: 10.1186/1743-0003-9-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 01/17/2012] [Indexed: 11/17/2022] Open
Abstract
Background The evaluation of hand function impairment following a neurological disorder (stroke and cervical spinal cord injury) requires sensitive, reliable and clinically meaningful assessment tools. Clinical performance measures of hand function mainly focus on the accomplishment of activities of daily living (ADL), typically rather complex tasks assessed by a gross ordinal rating; while the motor performance (i.e. kinematics) is less detailed. The goal of this study was to develop a low-cost instrumented glove to capture details in grasping, feasible for the assessment of hand function in clinical practice and rehabilitation settings. Methods Different sensor types were tested for output signal stability over time by measuring the signal drift of their step responses. A system that converted sensor output voltages into angles based on pre-measured curves was implemented. Furthermore, the voltage supply of each sensor signal conditioning circuit was increased to enhance the sensor resolution. The repeatability of finger bending trajectories, recorded during the performance of three ADL-based tasks, was established using the intraclass correlation coefficient (ICC). Moreover, the accuracy of the glove was evaluated by determining the agreement between angles measured with the embedded sensors and angles measured by traditional goniometry. In addition, the feasibility of the glove was tested in four patients with a pathological hand function caused by a cervical spinal cord injury (cSCI). Results A sensor type that displayed a stable output signal over time was identified, and a high sensor resolution of 0.5° was obtained. The evaluation of the glove's reliability yielded high ICC values (0.84 to 0.92) with an accuracy error of about ± 5°. Feasibility testing revealed that the glove was sensitive to distinguish different levels of hand function impairment in cSCI patients. Conclusions The device satisfied the desired system requirements in terms of low cost, stable sensor signal over time, full finger-flexion range of motion tracking and capability to monitor all three joints of one finger. The developed rapid calibration system for easy use (high feasibility) and excellent psychometric properties (i.e. reliability and validity) qualify the device for the assessment of hand function in clinical practice and rehabilitation settings.
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Affiliation(s)
- Ninja P Oess
- SCI Research Center, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
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Abstract
Background. Alterations in the function of spinal neuronal circuits underlying locomotion after a spinal cord injury (SCI) are associated with changes in the behavior of spinal reflexes (SRs) in both rats and humans. In healthy subjects, the SR consists of a dominant early reflex component, whereas in chronic, severely affected SCI subjects, a later component dominates. Objective. The aim of this study was to investigate the relationship between SR behavior and walking ability in para-/tetraplegic subjects. Method. The SR was evoked by nonnoxious tibial nerve stimulation. Walking ability was assessed by functional tests and questionnaires. Results. There was a correlation between walking ability and SR behavior in chronic SCI: Severely affected SCI subjects unable to walk showed dominant late SR components, whereas in ambulatory SCI subjects an early SR component dominated. A functional training with an improvement of locomotor ability was accompanied by both a shift from a dominant to a smaller late and the appearance of an early SR component. Conclusions. Our findings indicate that SR can serve as a marker for the locomotor ability of SCI subjects. Neuronal plasticity exploited by a functional training is reflected in both an improvement of locomotor ability and a change in balance of SR components toward the early SR component.
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Affiliation(s)
- Michèle Hubli
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Volker Dietz
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marc Bolliger
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Sensory-Motor Systems Laboratory, ETH Zurich, Zurich, Switzerland
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Krenn M, Haller M, Bijak M, Unger E, Hofer C, Kern H, Mayr W. Safe neuromuscular electrical stimulator designed for the elderly. Artif Organs 2011; 35:253-6. [PMID: 21401669 DOI: 10.1111/j.1525-1594.2011.01217.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A stimulator for neuromuscular electrical stimulation (NMES) was designed, especially suiting the requirements of elderly people with reduced cognitive abilities and diminished fine motor skills. The aging of skeletal muscle is characterized by a progressive decline in muscle mass, force, and condition. Muscle training with NMES reduces the degradation process. The discussed system is intended for evoked muscle training of the anterior and posterior thigh. The core of the stimulator is based on a microcontroller with two modular output stages. The system has two charge-balanced biphasic voltage-controlled stimulation channels. Additionally, the evoked myoelectric signal (M-wave) and the myokinematic signal (surface acceleration) are measured. A central controller unit allows using the stimulator as a stand-alone device. To set up the training sequences and to evaluate the compliance data, a personal computer is connected to the stimulator via a universal serial bus. To help elderly people handle the stimulator by themselves, the user interface is kept very simple. For safety reasons, the electrode impedance is monitored during stimulation. A comprehensive compliance management with included measurements of muscle activity and stimulation intensity enables a scientific use of the stimulator in clinical trials.
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Affiliation(s)
- Matthias Krenn
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna Ludwig, Austria.
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Kapadia N, Popovic M. Functional Electrical Stimulation Therapy for Grasping in Spinal Cord Injury: An Overview. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1701-70] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Popovic MR, Kapadia N, Zivanovic V, Furlan JC, Craven BC, McGillivray C. Functional electrical stimulation therapy of voluntary grasping versus only conventional rehabilitation for patients with subacute incomplete tetraplegia: a randomized clinical trial. Neurorehabil Neural Repair 2011; 25:433-42. [PMID: 21304020 DOI: 10.1177/1545968310392924] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Functional electrical stimulation therapy (FET) has a potential to improve voluntary grasping among individuals with tetraplegia secondary to traumatic spinal cord injury (SCI). OBJECTIVE This single-site, randomized controlled trial examined the efficacy of 40 hours of FET with conventional occupational therapy (COT) compared with COT alone to improve grasping. METHODS Twenty-four subjects with subacute traumatic incomplete SCI (C4-C7, AIS B-D) consented to participate in 40 hours of therapy over 8 weeks, beyond the conventional rehabilitation program. Subjects were randomized to receive FET + COT (n = 9) or COT (n = 12). The key outcomes were changes in Functional Independence Measure (FIM) self-care subscores, Spinal Cord Independence Measure (SCIM) self-care subscores, and Toronto Rehabilitation Institute Hand Function Test (TRI-HFT) performed at baseline and follow-up. RESULTS At the end of the treatments, the change in mean FIM self-care subscore for the FET + COT group was 20.1 versus 10 (P = .015) for the COT group. Subjects randomized to FET + COT also had greater improvements in the SCIM and TRI-HFT. No longer term follow-up was feasible. CONCLUSION FET significantly reduced disability and improved voluntary grasping beyond the effects of considerable conventional upper extremity therapy in individuals with tetraplegia.
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Video game-based neuromuscular electrical stimulation system for calf muscle training: a case study. Med Eng Phys 2010; 33:249-55. [PMID: 21036093 DOI: 10.1016/j.medengphy.2010.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 10/07/2010] [Accepted: 10/10/2010] [Indexed: 11/21/2022]
Abstract
A video game-based training system was designed to integrate neuromuscular electrical stimulation (NMES) and visual feedback as a means to improve strength and endurance of the lower leg muscles, and to increase the range of motion (ROM) of the ankle joints. The system allowed the participants to perform isotonic concentric and isometric contractions in both the plantarflexors and dorsiflexors using NMES. In the proposed system, the contractions were performed against exterior resistance, and the angle of the ankle joints was used as the control input to the video game. To test the practicality of the proposed system, an individual with chronic complete spinal cord injury (SCI) participated in the study. The system provided a progressive overload for the trained muscles, which is a prerequisite for successful muscle training. The participant indicated that he enjoyed the video game-based training and that he would like to continue the treatment. The results show that the training resulted in a significant improvement of the strength and endurance of the paralyzed lower leg muscles, and in an increased ROM of the ankle joints. Video game-based training programs might be effective in motivating participants to train more frequently and adhere to otherwise tedious training protocols. It is expected that such training will not only improve the properties of their muscles but also decrease the severity and frequency of secondary complications that result from SCI.
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Funktionelle Elektrostimulation. NeuroRehabilitation 2010. [DOI: 10.1007/978-3-642-12915-5_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Márquez-Chin C, Popovic MR, Cameron T, Lozano AM, Chen R. Control of a neuroprosthesis for grasping using off-line classification of electrocorticographic signals: case study. Spinal Cord 2009; 47:802-8. [PMID: 19381156 DOI: 10.1038/sc.2009.41] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Proof of concept study to control a neuroprosthesis for grasping using identification of arm movements from ECoG signals. OBJECTIVE To test the feasibility of using electrocorticographic (ECoG) signals as a control method for a neuroprosthesis for grasping. SETTING Acute care hospital, Toronto Western Hospital and spinal cord injury (SCI) rehabilitation centre, Toronto Rehabilitation Institute, Lyndhurst Centre. Both hospitals are located in Toronto, Canada. METHODS Two subjects participated in this study. The first subject had subdural electrodes implanted on the motor cortex for the treatment of essential tremor (ET). ECoG signals were recorded while the subject performed specific arm movements. The second subject had a complete SCI at C6 level (ASIA B score) and was fitted with a neuroprosthesis, capable of identifying arm movements from ECoG signals off-line, for grasping. To operate the neuroprosthesis, subject 2 issued a command that would trigger the release of a randomly selected ECoG signal recorded from subject 1, associated with a particular arm movement. The neuroprosthesis identified which arm movement was performed at the time of recording and used that information to trigger the stimulation sequence. A correct ECoG classification resulted in the neuroprosthesis producing the correct hand function (that is grasp and release). RESULTS The neuroprosthesis classified ECoG signals correctly delivering the correct stimulation strategy with 94.5% accuracy. CONCLUSIONS The feasibility of using ECoG signals as a control strategy for a neuroprosthesis for grasping was shown.
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Affiliation(s)
- C Márquez-Chin
- Rehabilitation Engineering Laboratory, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada M4G 3V9
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Mangold S, Schuster C, Keller T, Zimmermann-Schlatter A, Ettlin T. Motor training of upper extremity with functional electrical stimulation in early stroke rehabilitation. Neurorehabil Neural Repair 2009; 23:184-90. [PMID: 19189940 DOI: 10.1177/1545968308324548] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Functional electrical stimulation (FES) allows active exercises in stroke patients with upper extremity paralysis. OBJECTIVE To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and/or hand paralysis. METHODS For this pilot study, 23 acute and subacute stroke patients were randomly assigned to the intervention (n = 12) and control group (n = 11). Distributed over 4 weeks, FES training replaced 12 conventional training sessions in the intervention group. An Extended Barthel Index (EBI) subscore assessed the performance of activities of daily living (ADL). The Chedoke McMaster Stroke Assessment (CMSA) measured hand and arm function and shoulder pain. The Modified Ashworth Scale (MAS) assessed resistance to passive movement. Unblinded assessments were performed prior to and following the end of the training period. RESULTS The EBI subscore and CMSA arm score improved significantly in both groups. The CMSA hand function improved significantly in the FES group. Resistance to passive movement of finger and wrist flexors increased significantly in the FES group. Shoulder pain did not change significantly. None of the outcome measures, however, demonstrated significant gain differences between the groups. CONCLUSIONS We did not find clear evidence for superiority or inferiority of FES. Our findings, and those of similar trials, suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences.
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Affiliation(s)
- Sabine Mangold
- Balgrist University Hospital, Spinal Cord Center, Zurich, Switzerland.
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Corrêa JB, Borges HC, Lucareli PRG, Liebano RE. Estimulação elétrica funcional na subluxação crônica do ombro após acidente vascular encefálico: relato de casos. FISIOTERAPIA E PESQUISA 2009. [DOI: 10.1590/s1809-29502009000100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A subluxação do ombro é comum em indivíduos que sofreram acidente vascular encefálico (AVE), podendo gerar dor, lesões do plexo braquial, capsulite adesiva e lesões nos músculos da bainha rotatória, implicando atraso da reabilitação e interferência na qualidade de vida. O objetivo deste estudo foi verificar os efeitos da estimulação elétrica funcional (EEF) na subluxação crônica do ombro em pacientes hemiplégicos que sofreram AVE. Foram avaliados três pacientes tendo tido AVE há mais de um ano com subluxação do ombro confirmada por exame de raios X. Foram analisados, antes e após o tratamento, o grau de subluxação e amplitude de movimento (ADM) do ombro, função sensório-motora pela escala de Fugl-Meyer e dor em repouso e à movimentação passiva por meio de escala visual analógica. Todos os pacientes foram submetidos a tratamento com fisioterapia convencional e EEF no membro hemiplégico por dez sessões. A análise dos resultados mostrou melhora em relação às medidas iniciais da ADM, da avaliação sensório-motora, dor e subluxação do ombro após o uso da EEF. Concluiu-se que a EEF, asociada à fisioterapia convencional, mostrou-se eficaz em produzir diminuição da subluxação, aumento da função do membro superior e agir no alívio da dor em pacientes com subluxação do ombro pós-AVE.
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Vogelstein RJ, Tenore F, Guevremont L, Etienne-Cummings R, Mushahwar VK. A silicon central pattern generator controls locomotion in vivo. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2008; 2:212-222. [PMID: 23852970 DOI: 10.1109/tbcas.2008.2001867] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present a neuromorphic silicon chip that emulates the activity of the biological spinal central pattern generator (CPG) and creates locomotor patterns to support walking. The chip implements ten integrate-and-fire silicon neurons and 190 programmable digital-to-analog converters that act as synapses. This architecture allows for each neuron to make synaptic connections to any of the other neurons as well as to any of eight external input signals and one tonic bias input. The chip's functionality is confirmed by a series of experiments in which it controls the motor output of a paralyzed animal in real-time and enables it to walk along a three-meter platform. The walking is controlled under closed-loop conditions with the aide of sensory feedback that is recorded from the animal's legs and fed into the silicon CPG. Although we and others have previously described biomimetic silicon locomotor control systems for robots, this is the first demonstration of a neuromorphic device that can replace some functions of the central nervous system in vivo.
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49
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Tortolero X, Masani K, Maluly C, Popovic MR. Body Movement Induced by Electrical Stimulation of Toe Muscles During Standing. Artif Organs 2007. [DOI: 10.1111/j.1525-1594.2007.00451.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Siekierka EM, Eng K, Bassetti C, Blickenstorfer A, Cameirao MS, Dietz V, Duff A, Erol F, Ettlin T, Hermann DM, Keller T, Keisker B, Kesselring J, Kleiser R, Kollias S, Kool JP, Kurre A, Mangold S, Nef T, Pyk P, Riener R, Schuster C, Tosi F, Verschure PFMJ, Zimmerli L. New Technologies and Concepts for Rehabilitation in the Acute Phase of Stroke: A Collaborative Matrix. NEURODEGENER DIS 2007; 4:57-69. [PMID: 17429220 DOI: 10.1159/000100360] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The process of developing a successful stroke rehabilitation methodology requires four key components: a good understanding of the pathophysiological mechanisms underlying this brain disease, clear neuroscientific hypotheses to guide therapy, adequate clinical assessments of its efficacy on multiple timescales, and a systematic approach to the application of modern technologies to assist in the everyday work of therapists. Achieving this goal requires collaboration between neuroscientists, technologists and clinicians to develop well-founded systems and clinical protocols that are able to provide quantitatively validated improvements in patient rehabilitation outcomes. In this article we present three new applications of complementary technologies developed in an interdisciplinary matrix for acute-phase upper limb stroke rehabilitation - functional electrical stimulation, arm robot-assisted therapy and virtual reality-based cognitive therapy. We also outline the neuroscientific basis of our approach, present our detailed clinical assessment protocol and provide preliminary results from patient testing of each of the three systems showing their viability for patient use.
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Affiliation(s)
- E M Siekierka
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
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