Development of an upper extremity FES system for individuals with C4 tetraplegia

Earable Ω (OMEGA): A Novel Clenching Interface Using Ear Canal Sensing for Human Metacarpophalangeal Joint Control by Functional Electrical Stimulation

(1) Background: A mouth-free interface is required for functional electrical stimulation (FES) in people with spinal cord injuries. We developed a novel system for clenching the human metacarpophalangeal (MP) joint using an earphone-type ear canal movement sensor. Experiments to control joint angle and joint stiffness were performed using the developed system. (2) Methods: The proposed FES used an equilibrium point control signal and stiffness control signal: electrical agonist-antagonist ratio and electrical agonist-antagonist sum. An angle sensor was used to acquire the joint angle, and system identification was utilized to measure joint stiffness using the external force of a robot arm. Each experiment included six and five subjects, respectively. (3) Results: While the joint angle could be controlled well by clenching with some hysteresis and delay in three subjects, it could not be controlled relatively well after hyperextension in the other subjects, which revealed a calibration problem and a change in the characteristics of the human MP joint caused by hyperextension. The joint stiffness increased with the clenching amplitude in five subjects. In addition, the results indicated that viscosity can be controlled. (4) Conclusions: The developed system can control joint angle and stiffness. In future research, we will develop a method to show that this system can control the equilibrium point and stiffness simultaneously.

Towards the clinical translation of optogenetic skeletal muscle stimulation

Paralysis is a frequent phenomenon in many diseases, and to date, only functional electrical stimulation (FES) mediated via the innervating nerve can be employed to restore skeletal muscle function in patients. Despite recent progress, FES has several technical limitations and significant side effects. Optogenetic stimulation has been proposed as an alternative, as it may circumvent some of the disadvantages of FES enabling cell type–specific, spatially and temporally precise stimulation of cells expressing light-gated ion channels, commonly Channelrhodopsin2. Two distinct approaches for the restoration of skeletal muscle function with optogenetics have been demonstrated: indirect optogenetic stimulation through the innervating nerve similar to FES and direct optogenetic stimulation of the skeletal muscle. Although both approaches show great promise, both have their limitations and there are several general hurdles that need to be overcome for their translation into clinics. These include successful gene transfer, sustained optogenetic protein expression, and the creation of optically active implantable devices. Herein, a comprehensive summary of the underlying mechanisms of electrical and optogenetic approaches is provided. With this knowledge in mind, we substantiate a detailed discussion of the advantages and limitations of each method. Furthermore, the obstacles in the way of clinical translation of optogenetic stimulation are discussed, and suggestions on how they could be overcome are provided. Finally, four specific examples of pathologies demanding novel therapeutic measures are discussed with a focus on the likelihood of direct versus indirect optogenetic stimulation.

Case study: Head orientation and neck electromyography for cursor control in persons with high cervical tetraplegia

We evaluated the ability of an individual with a high cervical spinal cord injury (SCI) to control a cursor on a computer screen using two different user interfaces: (1) head movements measured via a head-mounted orientation sensor and (2) electromyography (EMG) signals from four head and neck muscles acquired using a 4-channel implanted upper-limb neuroprosthesis that had been deployed in an earlier study. The subject moved the cursor to a set of targets on the screen in a two-dimensional, center-out, target-acquisition task, and his performance was evaluated with a variety of performance measures to assess both position and velocity control accuracy. The subject's performance with both command sources was also compared with the performance of a group of nondisabled subjects. Head orientation provided more accurate performance but was less responsive than EMG. Both command sources showed some directionally dependent performance, with movement to diagonally located targets being performed by a series of sequential motions rather than via straight paths. Overall, the SCI subject's performance with each command source was similar to that reported for a nondisabled population using the same interfaces and performing the same task.

Effects and effectiveness of dynamic arm supports: a technical review

Numerous dynamic arm supports have been developed in recent decades to increase independence in the performance of activities of daily living. Much effort and money have been spent on their development and prescription, yet insight into their effects and effectiveness is lacking. This article is a systematic review of evaluations of dynamic arm supports. The 8 technical evaluations, 12 usability evaluations, and 27 outcome studies together make 47 evaluations. Technical evaluations were often used as input for new developments and directed at balancing quality, forces and torques, and range of motion of prototypes. Usability studies were mostly single-measure designs that had varying results as to whether devices were usable for potential users. An increased ability to perform activities of daily living and user satisfaction were reported in outcome studies. However, the use of dynamic arm supports in the home situation was reported to be low. Gaining insight into why devices are not used when their developers believe them to be effective seems crucial for every new dynamic arm support developed. The methodological quality of the outcome studies was often low, so it is important that this is improved in the future.

Feedback control of arm movements using Neuro-Muscular Electrical Stimulation (NMES) combined with a lockable, passive exoskeleton for gravity compensation

Within the European project MUNDUS, an assistive framework was developed for the support of arm and hand functions during daily life activities in severely impaired people. This contribution aims at designing a feedback control system for Neuro-Muscular Electrical Stimulation (NMES) to enable reaching functions in people with no residual voluntary control of the arm and shoulder due to high level spinal cord injury. NMES is applied to the deltoids and the biceps muscles and integrated with a three degrees of freedom (DoFs) passive exoskeleton, which partially compensates gravitational forces and allows to lock each DOF. The user is able to choose the target hand position and to trigger actions using an eyetracker system. The target position is selected by using the eyetracker and determined by a marker-based tracking system using Microsoft Kinect. A central controller, i.e., a finite state machine, issues a sequence of basic movement commands to the real-time arm controller. The NMES control algorithm sequentially controls each joint angle while locking the other DoFs. Daily activities, such as drinking, brushing hair, pushing an alarm button, etc., can be supported by the system. The robust and easily tunable control approach was evaluated with five healthy subjects during a drinking task. Subjects were asked to remain passive and to allow NMES to induce the movements. In all of them, the controller was able to perform the task, and a mean hand positioning error of less than five centimeters was achieved. The average total time duration for moving the hand from a rest position to a drinking cup, for moving the cup to the mouth and back, and for finally returning the arm to the rest position was 71 s.

An overview and categorization of dynamic arm supports for people with decreased arm function

BACKGROUND

Assistive devices that augment arm function were already introduced during the polio era. Devices are still being developed, but a review has not been performed thus far.

OBJECTIVE

To create an overview and categorize assistive devices facilitating arm function in activities of daily living for people with decreased arm function.

STUDY DESIGN

Literature review.

METHODS

A systematic review in three scientific literature databases. Conference proceedings, assistive technology databases, and references were searched and experts consulted. This resulted in a database of dynamic arm supports. Product information was added, and the devices were categorized.

RESULTS

A total of 104 dynamic arm supports were found. These could be categorized as nonactuated devices (N = 39), passively actuated devices (N = 24), actively actuated devices (N = 34), or devices using the functional electrical stimulation principle (N = 7). Functionality analysis resulted in second-level categorization: tremor suppression, facilitation of anti-gravity movement, and assistance of specific joint motion.

CONCLUSION

All devices could be ordered in a categorization of low complexity. Many have been developed; most have disappeared and have been succeeded by similar devices. Limitations of the devices found mainly concern interfacing and the range of motion facilitated. Future devices could make use of whatever residual strength is available in the users' arm for control.

CLINICAL RELEVANCE

The provided overview of devices in this article and the classification developed is relevant for practitioners seeking assistive solutions for their clients as it makes the range of developed solutions both accessible and comprehensible.

Equilibrium-point control of human elbow-joint movement under isometric environment by using multichannel functional electrical stimulation

Functional electrical stimulation (FES) is considered an effective technique for aiding quadriplegic persons. However, the human musculoskeletal system has highly non-linearity and redundancy. It is thus difficult to stably and accurately control limbs using FES. In this paper, we propose a simple FES method that is consistent with the motion-control mechanism observed in humans. We focus on joint motion by a pair of agonist-antagonist muscles of the musculoskeletal system, and define the "electrical agonist-antagonist muscle ratio (EAA ratio)" and "electrical agonist-antagonist muscle activity (EAA activity)" in light of the agonist-antagonist muscle ratio and agonist-antagonist muscle activity, respectively, to extract the equilibrium point and joint stiffness from electromyography (EMG) signals. These notions, the agonist-antagonist muscle ratio and agonist-antagonist muscle activity, are based on the hypothesis that the equilibrium point and stiffness of the agonist-antagonist motion system are controlled by the central nervous system. We derived the transfer function between the input EAA ratio and force output of the end-point. We performed some experiments in an isometric environment using six subjects. This transfer-function model is expressed as a cascade-coupled dead time element and a second-order system. High-speed, high-precision, smooth control of the hand force were achieved through the agonist-antagonist muscle stimulation pattern determined by this transfer function model.

Implanted neuroprosthesis for restoring arm and hand function in people with high level tetraplegia

OBJECTIVE

To develop and apply an implanted neuroprosthesis to restore arm and hand function to individuals with high level tetraplegia.

DESIGN

Case study.

SETTING

Clinical research laboratory.

PARTICIPANTS

Individuals with spinal cord injuries (N=2) at or above the C4 motor level.

INTERVENTIONS

The individuals were each implanted with 2 stimulators (24 stimulation channels and 4 myoelectric recording channels total). Stimulating electrodes were placed in the shoulder and arm, being, to our knowledge, the first long-term application of spiral nerve cuff electrodes to activate a human limb. Myoelectric recording electrodes were placed in the head and neck areas.

MAIN OUTCOME MEASURES

Successful installation and operation of the neuroprosthesis and electrode performance, range of motion, grasp strength, joint moments, and performance in activities of daily living.

RESULTS

The neuroprosthesis system was successfully implanted in both individuals. Spiral nerve cuff electrodes were placed around upper extremity nerves and activated the intended muscles. In both individuals, the neuroprosthesis has functioned properly for at least 2.5 years postimplant. Hand, wrist, forearm, elbow, and shoulder movements were achieved. A mobile arm support was needed to support the mass of the arm during functional activities. One individual was able to perform several activities of daily living with some limitations as a result of spasticity. The second individual was able to partially complete 2 activities of daily living.

CONCLUSIONS

Functional electrical stimulation is a feasible intervention for restoring arm and hand functions to individuals with high tetraplegia. Forces and movements were generated at the hand, wrist, elbow, and shoulder that allowed the performance of activities of daily living, with some limitations requiring the use of a mobile arm support to assist the stimulated shoulder forces.

Real-time fusion of gaze and EMG for a reaching neuroprosthesis

For rehabilitative devices to restore functional movement to paralyzed individuals, user intent must be determined from signals that remain under voluntary control. Tracking eye movements is a natural way to learn about an intended reach target and, when combined with just a small set of electromyograms (EMGs) in a probabilistic mixture model, can reliably generate accurate trajectories even when the target information is uncertain. To experimentally assess the effectiveness of our algorithm in closed-loop control, we developed a robotic system to simulate a reaching neuroprosthetic. Incorporating target information by tracking subjects' gaze greatly improved performance when the set of EMGs was most limited. In addition we found that online performance was better than predicted by the offline accuracy of the training data. By enhancing the trajectory model with target information the decoder relied less on neural control signals, reducing the burden on the user.

Real-time evaluation of a noninvasive neuroprosthetic interface for control of reach

Injuries of the cervical spinal cord can interrupt the neural pathways controlling the muscles of the arm, resulting in complete or partial paralysis. For individuals unable to reach due to high-level injuries, neuroprostheses can restore some of the lost function. Natural, multidimensional control of neuroprosthetic devices for reaching remains a challenge. Electromyograms (EMGs) from muscles that remain under voluntary control can be used to communicate intended reach trajectories, but when the number of available muscles is limited control can be difficult and unintuitive. We combined shoulder EMGs with target estimates obtained from gaze. Natural gaze data were integrated with EMG during closed-loop robotic control of the arm, using a probabilistic mixture model. We tested the approach with two different sets of EMGs, as might be available to subjects with C4- and C5-level spinal cord injuries. Incorporating gaze greatly improved control of reaching, particularly when there were few EMG signals. We found that subjects naturally adapted their eye-movement precision as we varied the set of available EMGs, attaining accurate performance in both tested conditions. The system performs a near-optimal combination of both physiological signals, making control more intuitive and allowing a natural trajectory that reduces the burden on the user.

Brain-Computer Interface-FES Integration: Towards a Hands-free Neuroprosthesis Command System

This paper presents a critical review of brain-computer interfaces (BCIs) and their potential for neuroprosthetic applications. Summaries are provided for the command interface requirements of hand grasp, multijoint, and lower extremity neuroprostheses, and the characteristics of various BCIs are discussed in relation to these requirements. The review highlights the current limitations of BCIs and areas of research that need to be addressed to enhance BCI-FES integration.

Decoding with limited neural data: a mixture of time-warped trajectory models for directional reaches

Neuroprosthetic devices promise to allow paralyzed patients to perform the necessary functions of everyday life. However, to allow patients to use such tools it is necessary to decode their intent from neural signals such as electromyograms (EMGs). Because these signals are noisy, state of the art decoders integrate information over time. One systematic way of doing this is by taking into account the natural evolution of the state of the body--by using a so-called trajectory model. Here we use two insights about movements to enhance our trajectory model: (1) at any given time, there is a small set of likely movement targets, potentially identified by gaze; (2) reaches are produced at varying speeds. We decoded natural reaching movements using EMGs of muscles that might be available from an individual with spinal cord injury. Target estimates found from tracking eye movements were incorporated into the trajectory model, while a mixture model accounted for the inherent uncertainty in these estimates. Warping the trajectory model in time using a continuous estimate of the reach speed enabled accurate decoding of faster reaches. We found that the choice of richer trajectory models, such as those incorporating target or speed, improves decoding particularly when there is a small number of EMGs available.

Feasibility of EMG-based neural network controller for an upper extremity neuroprosthesis

The overarching goal of this project is to provide shoulder and elbow function to individuals with C5/C6 spinal cord injury (SCI) using functional electrical stimulation (FES), increasing the functional outcomes currently provided by a hand neuroprosthesis. The specific goal of this study was to design a controller based on an artificial neural network (ANN) that extracts information from the activity of muscles that remain under voluntary control sufficient to predict appropriate stimulation levels for several paralyzed muscles in the upper extremity. The ANN was trained with activation data obtained from simulations using a musculoskeletal model of the arm that was modified to reflect C5 SCI and FES capabilities. Several arm movements were recorded from able-bodied subjects and these kinematics served as the inputs to inverse dynamic simulations that predicted muscle activation patterns corresponding to the movements recorded. A system identification procedure was used to identify an optimal reduced set of voluntary input muscles from the larger set that are typically under voluntary control in C5 SCI. These voluntary activations were used as the inputs to the ANN and muscles that are typically paralyzed in C5 SCI were the outputs to be predicted. The neural network controller was able to predict the needed FES paralyzed muscle activations from "voluntary" activations with less than a 3.6% RMS prediction error.

Evaluation of head orientation and neck muscle EMG signals as command inputs to a human-computer interface for individuals with high tetraplegia

We investigated the performance of three user interfaces for restoration of cursor control in individuals with tetraplegia: head orientation, electromyography (EMG) from face and neck muscles, and a standard computer mouse (for comparison). Subjects engaged in a 2-D, center-out, Fitts' Law style task and performance was evaluated using several measures. Overall, head orientation commanded motion resembled mouse commanded cursor motion (smooth, accurate movements to all targets), although with somewhat lower performance. EMG commanded movements exhibited a higher average speed, but other performance measures were lower, particularly for diagonal targets. Compared to head orientation, EMG as a cursor command source was less accurate, was more affected by target direction and was more prone to overshoot the target. In particular, EMG commands for diagonal targets were more sequential, moving first in one direction and then the other rather than moving simultaneous in the two directions. While the relative performance of each user interface differs, each has specific advantages depending on the application.

Musculoskeletal model-guided, customizable selection of shoulder and elbow muscles for a C5 SCI neuroprosthesis

Individuals with C5/C6 spinal cord injury (SCI) have a number of paralyzed muscles in their upper extremities that can be electrically activated in a coordinated manner to restore function. The selection of a practical subset of paralyzed muscles for stimulation depends on the specific condition of the individual, the functions targeted for restoration, and surgical considerations. This paper presents a musculoskeletal model-based approach for optimizing the muscle set used for functional electrical stimulation (FES) of the shoulder and elbow in this population. Experimentally recorded kinematics from able-bodied subjects served as inputs to a musculoskeletal model of the shoulder and elbow, which was modified to reflect the reduced muscle force capacities of an individual with C5 SCI but also the potential of using FES to activate paralyzed muscles. A large number of inverse dynamic simulations mimicking typical activities of daily living were performed that included 1) muscles with retained voluntary control and 2) many different combinations of stimulated paralyzed muscles. These results indicate that a muscle set consisting of the serratus anterior, infraspinatus and triceps would enable the greatest range of relevant movements. This set will become the initial target in a C5SCI neuroprosthesis to restore shoulder and elbow function.

Joint angle control by FES using a feedback error learning controller

The feedback error learning (FEL) scheme was studied for a functional electrical stimulation (FES) controller. This FEL controller was a hybrid regulator with a feedforward and a feedback controller. The feedforward controller learned the inverse dynamics of a controlled object from feedback controller outputs while control. A four-layered neural network and the proportional-integral-derivative (PID) controller were used for each controller. The palmar/dorsi-flexion angle of the wrist was controlled in both computer simulation and FES experiments. Some controller parameters, such as the learning speed coefficient and the number of neurons, were determined in simulation using an artificial forward model of the wrist. The forward model was prepared by using a neural network that can imitate responses of subject's wrist to electrical stimulation. Then, six able-bodied subjects' wrist was controlled with the FEL controller by delivering stimuli to one antagonistic muscle pair. Results showed that the FEL controller functioned as expected and performed better than the conventional PID controller adjusted by the Chien, Hrones and Reswick method for a fast movement with the cycle period of 2 s, resulting in decrease of the average tracking error and shortened delay in the response. Furthermore, learning iteration was shortened if the feedforward controller had been trained in advance with the artificial forward model.

Alkanethiolate self-assembled monolayers as functional spacers to resist protein adsorption upon Au-coated nerve microelectrode

Alkanethiolate self-assembled monolayers (SAMs) of varied chain lengths were adsorbed upon Au-coated nerve microelectrodes and employed as protein-resistant spacers. The microelectrode spiraled as a cuff type can be used for restoring motor function via electrical stimulation on the peripheral nerve system; however, an increase of electrode impedance might occur during implantation. In this work, a thin-film SAMs treatment upon Au/polyimide (PI) surface of the microelectrode provided a hydrophobic characteristic, which retarded protein adsorption at the initial stage and subsequent pileup (or thickening) process. The protein-resistant effect exhibited comparable SAMs of different chain lengths adsorbed upon Au/PI surfaces. The increase of electrode impedance as a function of protein deposition time was mainly correlated with the addition of reactance that was associated with the pileup thickness of the deposited protein. Particularly, the SAMs-modified surface was capable to detach a significant portion of the accumulated protein from the protein-deposited SAMs/Au/PI, whereas the protein-deposited layers exhibited firm adhesion upon Au/PI surface. It is therefore very promising to apply thin-film SAMs adsorbed upon Au-coated surface for bioinvasive devices that have the need of functional electrical stimulations or sensing nerve signals during chronic implantation.

Control of neural prostheses for grasping and reaching

In recent years several neural prostheses have been developed and tested as orthoses or as therapeutic systems for hemiplegic and tetraplegic subjects aiming to improve the upper extremities function. The use of neural prostheses demonstrated that the targeted group of subjects could significantly benefit from functional electrical stimulation that is integrated in goal directed movements. In this paper the control for neural prostheses is explained using available systems that apply either surface or implantable interfaces to sensory-motor systems. Further more, a new strategy that has been tested for control of reaching and grasping within a neural prosthesis especially designed for neurorehabilitation is described. This, so-called, coordination strategy was based on mimicking the output space model of natural control determined in reach/grasp/release movements of healthy humans.

A motion of forearm supination with maintenance of elbow flexion produced by electrical stimulation to two elbow flexors in humans

Motions of the forearm induced by electrical stimulation to two elbow flexors (brachioradialis: BR, biceps brachii: BB) were examined in five healthy human subjects. Stainless steel wire electrodes were implanted percutaneously into each motor point of the muscles. The muscles were stimulated separately with a computer-controlled multi-channel stimulator. The motions were taken with a digital video system. Angular changes of the motions in elbow flexion/extension and forearm pronation/supination were measured. Electromyograms (EMG) of BR, BB, and the triceps brachii (TB) were recorded. Electrical stimulation to BR induced a motion of flexion and that to BB motions of flexion and supination. The stimulation to BR with an adequate intensity provided holding of flexion with the prone forearm in all the subjects. In this situation, additional stimulation to BB resulted in motions of flexion and supination. However, the additional stimulation accompanied with a decrease of the stimulation intensity for BR provided a motion of supination with maintenance of the flexion in all the subjects. Since during the stimulation BR, BB, and TB showed no voluntary contraction in EMG, it is suggested that modulation of contraction between BR and BB by the stimulation can produce force in supination with keeping constant force in flexion to support the weight below the elbow.

Efficacy of an implanted neuroprosthesis for restoring hand grasp in tetraplegia: a multicenter study

OBJECTIVE

To evaluate an implanted neuroprosthesis that allows tetraplegic users to control grasp and release in 1 hand.

DESIGN

Multicenter cohort trial with at least 3 years of follow-up. Function for each participant was compared before and after implantation, and with and without the neuroprosthesis activated.

SETTING

Tertiary spinal cord injury (SCI) care centers, 8 in the United States, 1 in the United Kingdom, and 1 in Australia.

PARTICIPANTS

Fifty-one tetraplegic adults with C5 or C6 SCIs.

INTERVENTION

An implanted neuroprosthetic system, in which electric stimulation of the grasping muscles of 1 arm are controlled by using contralateral shoulder movements, and concurrent tendon transfer surgery. Assessed participants' ability to grasp, move, and release standardized objects; degree of assistance required to perform activities of daily living (ADLs), device usage; and user satisfaction.

MAIN OUTCOME MEASURES

Pinch force; grasp and release tests; ADL abilities test and ADL assessment test; and user satisfaction survey.

RESULTS

Pinch force was significantly greater with the neuroprosthesis in all available 50 participants, and grasp-release abilities were improved in 49. All tested participants (49/49) were more independent in performing ADLs with the neuroprosthesis than they were without it. Home use of the device for regular function and exercise was reported by over 90% of the participants, and satisfaction with the neuroprosthesis was high.

CONCLUSIONS

The grasping ability provided by the neuroprosthesis is substantial and lasting. The neuroprosthesis is safe, well accepted by users, and offers improved independence for a population without comparable alternatives.

Metabolic and cardiopulmonary responses to acute progressive resistive exercise in a person with C4 spinal cord injury

STUDY DESIGN

Single-subject (female, 38 years of age) case.

OBJECTIVES

To describe metabolic and cardiopulmonary responses to progressive resistive exercise in an individual with C4 ASIA A tetraplegia, and to review the relationship between level of spinal cord injury (SCI) and exercise responses.

SETTING

Large, urban mid-western city rehabilitation hospital in United States of America.

METHODS

Bilateral shoulder elevation/depression (shoulder shrug) exercise with two different resistances (0.7 kg/shoulder, 1.4 kg/shoulder) at two different frequencies (20 min., 40 min.), for 2 min per bout, deployed in a discontinuous protocol.

RESULTS

Compared to rest heart rate (HR), exercise HR increased the greatest (13 bpm) for the 1.4 kg resistance at 40 min. and the least (6 bpm) during the 0.7 kg at 20 min. Blood pressure (BP) response was lower than resting BP for all four exercise conditions with the lowest (74/56 mmHg) at 1.4 kg at 40 min. Oxygen uptake was highest (4.6 ml.kg(-1) min(-1)) during 1.4 kg at 20 min and V(E) was greatest (18.2 L/min) during 1.4 kg at 40 min. Rate of perceived exertion (RPE) was the highest (17) during the 1.4 kg at 40 min.

CONCLUSIONS

Progressive resistance exercise provoked intense perceived physical effort, but only small metabolic and cardiopulmonary increases in a person with C4 SCI. Exercise recommended at a 'somewhat hard' intensity should avoid significant hypotension and still impressively increase oxygen uptake and ventilation compared to rest. An inverse relation between level of injury and aerobic responses may extend rostrally to the C4 level.

An artificial grasping evaluation system for the paralysed hand

Neuromuscular electrical stimulation (NMES) has been used in upper limb rehabilitation towards restoring motor hand function. Quantitative evaluation of the artificially generated movement is necessary to achieve proper muscle activation. Custom-made gloves instrumented with force and position transducers were used to evaluate artificial quadriplegic grasping for a drinking activity. In spite of different sensor position, stimulation parameter dependence and lack of repeatability, grasp patterns achieved with the application of NMES follow the same patterns previously obtained with normal subjects, regarding force distribution among fingers and the shape of force curves. Larger forces were exerted by the thumb (average ranged from 2.8 to 4.5 N) following by index or long finger (average ranged from 1.8 to 3 N). The forces exerted ranged within the same interval as those previously measured and were sufficient to grasp an object of 10 N. Finger position achieved by interphalangeal joint status indicated the opening size of the hand throughout the range of movement. The instrumented gloves offer an alternative force and position feedback system for use in cylindrical grasp evaluation. The gloves can be used in a closed-loop control system, allowing on-line adjustment or in a clinical application to evaluate the results of a rehabilitation programme.

Artificial grasping system for the paralyzed hand

Neuromuscular electrical stimulation has been used in upper limb rehabilitation towards restoring motor hand function. In this work, an 8 channel microcomputer controlled stimulator with monophasic square voltage output was used. Muscle activation sequences were defined to perform palmar and lateral prehension and power grip (index finger extension type). The sequences used allowed subjects to demonstrate their ability to hold and release objects that are encountered in daily living, permitting activities such as drinking, eating, writing, and typing.

A study of shoulder motions as a control source for adolescents with C4 level SCI

This study quantitatively examined and compared the shoulder motions of C4 level spinal cord injury (SCI), C5 level SCI, and able-bodied persons as a command source. The study was motivated by both the success of shoulder control in functional electrical stimulation (FES) systems designed for C5 level SCI people and the lack of quantitative information on the shoulder motion of persons with C4 level SCI. A dual-axis transducer was used to monitor the elevation/depression and protraction/retraction angles of each subject's shoulder while they performed three experimental sections which examined: the range of active shoulder motion; the ability to move incrementally to discrete positions with the aid of visual feedback; and the ability to hold discrete shoulder positions for an extended period without visual feedback. Results indicated that each group had the largest average shoulder displacements (abled = 23 degrees +/- 4 degrees, C5's = 14 degrees +/- 3 degrees, and C4's = 9 degrees +/- 3 degrees) while attempting to elevate and that on average the C4 group had the smallest range of active shoulder motion. No statistically significant differences between the groups were found in either the accuracy or stability of reaching discrete positions with the aid of visual feedback or in the accuracy of holding discrete shoulder positions for an extended period without visual feedback. The results suggest that within their limited range of motion the individuals with C4 level SCI retained shoulder control sufficient for use as an neuroprosthetic command interface.