Automatic determination of parameters for multipad functional electrical stimulation: application to hand opening and closing

User-centered practicability analysis of two identification strategies in electrode arrays for FES induced hand motion in early stroke rehabilitation

BACKGROUND

Surface electrode arrays have become popular in the application of functional electrical stimulation (FES) on the forearm. Arrays consist of multiple, small elements, which can be activated separately or in groups, forming virtual electrodes (VEs). As technology progress yields rising numbers of possible elements, an effective search strategy for suitable VEs in electrode arrays is of increasing importance. Current methods can be time-consuming, lack user integration, and miss an evaluation regarding clinical acceptance and practicability.

METHODS

Two array identification procedures with different levels of user integration-a semi-automatic and a fully automatic approach-are evaluated. The semi-automatic method allows health professionals to continuously modify VEs via a touchscreen while the stimulation intensities are automatically controlled to maintain sufficient wrist extension. The automatic approach evaluates stimulation responses of various VEs for different intensities using a cost function and joint-angles recordings. Both procedures are compared in a clinical setup with five sub-acute stroke patients with moderate hand disabilities. The task was to find suitable VEs in two arrays with 59 elements in total to generate hand opening and closing for a grasp-and-release task. Practicability and acceptance by patients and health professionals were investigated using questionnaires and interviews.

RESULTS

Both identification methods yield suitable VEs for hand opening and closing in patients who could tolerate the stimulation. However, the resulting VEs differed for both approaches. The average time for a complete search was 25% faster for the semi-automatic approach (semi-automatic: 7.3min, automatic: 10.5min). User acceptance was high for both methods, while no clear preference could be identified.

CONCLUSIONS

The semi-automatic approach should be preferred as the search strategy in arrays on the forearm. The observed faster search duration will further reduce when applying the system repeatedly on a patient as only small position adjustments for VEs are required. However, the setup time will significantly increase for generation of various grasp types and adaptation to different arm postures. We recommend different levels of user integration in FES systems such that the search strategy can be chosen based on the users' preferences and application scenario.

Influence of Elbow Flexion and Stimulation Site on Neuromuscular Electrical Stimulation of the Biceps Brachii

Functional electrical stimulation (FES) can help individuals with physical disabilities by assisting limb movement; however, the change in muscle geometry associated with limb movement may affect the response to stimulation. The aim of this paper was to quantify the effects of elbow flexion and stimulation site on muscle torque production. Contraction torque about the elbow was measured in 12 healthy individuals using a custom elbow flexion testbed and a transcutaneous electrode array. Stimulation was delivered to six distinct sites along the biceps brachii over 11 elbow flexion angles. Flexion angle was found to significantly influence the optimal (i.e., torque-maximizing) stimulation site ( ), with post hoc analysis indicating a proximal shift in optimal stimulation site with increased flexion. Similarly, the biceps stimulation site was found to significantly influence the flexion angle at which peak torque occurred ( ), with post hoc analysis indicating an increase in peak-torque flexion angle as stimulation site is moved proximally up the biceps. Since maximizing muscle force per unit stimulation is a common goal in rehabilitative FES, future efforts could examine methods which compensate for the shift in optimal stimulation site during FES-induced limb movement.

A New Semi-Automatic Approach to Find Suitable Virtual Electrodes in Arrays Using an Interpolation Strategy

Functional Electrical Stimulation via electrode arrays enables the user to form virtual electrodes (VEs) of dynamic shape, size, and position. We developed a feedback-control-assisted manual search strategy which allows the therapist to conveniently and continuously modify VEs to find a good stimulation area. This works for applications in which the desired movement consists of at least two degrees of freedom. The virtual electrode can be moved to arbitrary locations within the array, and each involved element is stimulated with an individual intensity. Meanwhile, the applied global stimulation intensity is controlled automatically to meet a predefined angle for one degree of freedom. This enables the therapist to concentrate on the remaining degree(s) of freedom while changing the VE position. This feedback-control-assisted approach aims to integrate the user’s opinion and the patient’s sensation. Therefore, our method bridges the gap between manual search and fully automatic identification procedures for array electrodes. Measurements in four healthy volunteers were performed to demonstrate the usefulness of our concept, using a 24-element array to generate wrist and hand extension.