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Nakagawa K, Fok KL, Masani K. Neuromuscular recruitment pattern in motor point stimulation. Artif Organs 2023; 47:537-546. [PMID: 36305730 DOI: 10.1111/aor.14445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transcutaneous electrical stimulation on the motor points over muscle belly, i.e., motor point stimulation (MPS), is widely used in clinical settings, however it is not fully understood how MPS recruits motor nerves. Here we investigated the recruitment pattern of the motor nerve and twitch force during MPS and compared to the recruitment during peripheral nerve stimulation (PNS). METHODS Ten healthy individuals participated in this study. Using MPS on the soleus muscle and PNS on the tibial nerve, a single pulse stimulation was applied with various stimulation intensities from subthreshold to the maximum intensity. We measured the evoked potentials in the lower leg muscles and twitch force. Between MPS and PNS, we compared the recruitment curves of M-waves and the dynamics of twitch force such as duration from force onset to peak (time-to-peak). RESULTS The maximum M-wave was not different between MPS and PNS in the soleus muscle, while it was much smaller in MPS than in PNS in the other lower leg muscles. This reflected the smaller twitch force of plantarflexion in MPS than PNS. In addition, the slope of the recruitment curve for the soleus M-wave was smaller in MPS than PNS. CONCLUSION Therefore, unlike PNS, MPS can efficiently and selectively recruit motor nerves of the target muscle and gradually increase the recruitment of the motor nerve.
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Affiliation(s)
- Kento Nakagawa
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Japan Society for the Promotion of Science, Tokyo, Japan.,Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Kai Lon Fok
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Kei Masani
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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S. Baptista R, C. C. Moreira M, D. M. Pinheiro L, R. Pereira T, G. Carmona G, P. D. Freire J, A. I. Bastos J, Padilha Lanari Bo A. User-centered design and spatially-distributed sequential electrical stimulation in cycling for individuals with paraplegia. J Neuroeng Rehabil 2022; 19:45. [PMID: 35527249 PMCID: PMC9080548 DOI: 10.1186/s12984-022-01014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In this work, we share the enhancements made in our system to take part in the CYBATHLON 2020 Global Edition Functional Electrical Stimulation (FES) Bike Race. Among the main improvements, firstly an overhaul, an overhaul of the system and user interface developed with User-centered design principles with remote access to enable telerehabilitation. Secondly, the implementation and experimental comparison between the traditional single electrode stimulation (SES) and spatially distributed sequential stimulation (SDSS) applied for FES Cycling.
Methods
We report on the main aspects of the developed system. To evaluate the user perception of the system, we applied a System Usability Scale (SUS) questionnaire. In comparing SDSS and SES, we collected data from one subject in four sessions, each simulating one race in the CYBATHLON format.
Results
User perception measured with SUS indicates a positive outcome in the developed system. The SDSS trials were superior in absolute and average values to SES regarding total distance covered and velocity. We successfully competed in the CYBATHLON 2020 Global Edition, finishing in 6th position in the FES Bike Race category.
Conclusions
The CYBATHLON format induced us to put the end-user in the center of our system design principle, which was well perceived. However, further improvements are required if the intention is to progress to a commercial product. FES Cycling performance in SDSS trials was superior when compared to SES trials, indicating that this technique may enable faster and possibly longer FES cycling sessions for individuals with paraplegia. More extensive studies are required to assess these aspects.
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Coelho-Magalhães T, Fachin-Martins E, Silva A, Azevedo Coste C, Resende-Martins H. Development of a High-Power Capacity Open Source Electrical Stimulation System to Enhance Research into FES-Assisted Devices: Validation of FES Cycling. SENSORS 2022; 22:s22020531. [PMID: 35062492 PMCID: PMC8778229 DOI: 10.3390/s22020531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 02/04/2023]
Abstract
Since the first Cybathlon 2016, when twelve teams competed in the FES bike race, we have witnessed a global effort towards the development of stimulation and control strategies to improve FES-assisted devices, particularly for cycling, as a means to practice a recreational physical activity. As a result, a set of technical notes and research paved the way for many other studies and the potential behind FES-assisted cycling has been consolidated. However, engineering research needs instrumented devices to support novel developments and enable precise assessment. Therefore, some researchers struggle to develop their own FES-assisted devices or find it challenging to implement their instrumentation using commercial devices, which often limits the implementation of advanced control strategies and the possibility to connect different types of sensor. In this regard, we hypothesize that it would be advantageous for some researchers in our community to enjoy access to an entire open-source FES platform that allows different control strategies to be implemented, offers greater adaptability and power capacity than commercial devices, and can be used to assist different functional activities in addition to cycling. Hence, it appears to be of interest to make our proprietary electrical stimulation system an open-source device and to prove its capabilities by addressing all the aspects necessary to implement a FES cycling system. The high-power capacity stimulation device is based on a constant current topology that allows the creation of biphasic electrical pulses with amplitude, width, and frequency up to 150 mA, 1000 µs, and 100 Hz, respectively. A mobile application (Android) was developed to set and modify the stimulation parameters of up to eight stimulation channels. A proportional-integral controller was implemented for cadence tracking with the aim to improve the overall cycling performance. A volunteer with complete paraplegia participated in the functional testing of the system. He was able to cycle indoors for 45 min, accomplish distances of more than 5 km using a passive cycling trainer, and pedal 2400 m overground in 32 min. The results evidenced the capacity of our FES cycling system to be employed as a cycling tool for individuals with spinal cord injury. The methodological strategies used to improve FES efficiency suggest the possibility of maximizing pedaling duration through more advanced control techniques.
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Affiliation(s)
- Tiago Coelho-Magalhães
- Graduate Program in Electrical Engineering, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte 31270-901, Brazil;
- Correspondence:
| | - Emerson Fachin-Martins
- Plataforma de Serviços Tecnológicos BEMTEVI, Parque Científico e Tecnológico, Universidade de Brasília, Brasília 70910-900, Brazil;
| | - Andressa Silva
- Centro de Treinamento Esportivo da Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte 31310-000, Brazil;
| | - Christine Azevedo Coste
- National Institute for Research in Computer Science and Automation (Inria), Camin Team, 34090 Montpellier, France;
| | - Henrique Resende-Martins
- Graduate Program in Electrical Engineering, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte 31270-901, Brazil;
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de Sousa ACC, Sousa FSC, de S Baptista R, Bo APL. Passive Knee Orthoses Assistance in Functional Electrical Stimulation Cycling in an Individual With Spinal Cord Injury. IEEE Trans Neural Syst Rehabil Eng 2021; 29:690-698. [PMID: 33793403 DOI: 10.1109/tnsre.2021.3070468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Functional Electrical Stimulation (FES) may be used in rehabilitation and assistance of people with Spinal Cord Injury (SCI). One significant application is facilitating physical exercise, mainly when combining FES with mechanical platforms, such as tricycles. However, there are still technical challenges in FES cycling protocols, such as improving control and cycling performance. Here we show how passive elements in knee orthoses during FES cycling could increase the average cadence, taking advantage of the cycling movement. Our approach is twofold. First, we simulated the forward dynamics of a detailed musculoskeletal model with passive elements over the knees. Simulations showed that specific spring stiffness ranges increased the crankset speed during cycling by more than 50%. Using parameters found in simulations, we built a pair of passive orthoses and performed experiments with one individual with SCI. During two days, the volunteer cycled with similar stimulation magnitude with and without the passive elements. We observed that the average crankset speed was higher by more than 10% when the springs were attached to the passive orthoses. These results show the potential of using passive elements to increase cycling speed for FES cycling with similar or even lower stimulation magnitude, leading to longer exercise duration.
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Abstract
In this Editor's Review, articles published in 2017 are organized by category and summarized. We provide a brief reflection of the research and progress in artificial organs intended to advance and better human life while providing insight for continued application of these technologies and methods. Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. Peer-reviewed Special Issues this year included contributions from the 12th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Undar, Artificial Oxygen Carriers edited by Drs. Akira Kawaguchi and Jan Simoni, the 24th Congress of the International Society for Mechanical Circulatory Support edited by Dr. Toru Masuzawa, Challenges in the Field of Biomedical Devices: A Multidisciplinary Perspective edited by Dr. Vincenzo Piemonte and colleagues and Functional Electrical Stimulation edited by Dr. Winfried Mayr and colleagues. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.
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Rabelo M, de Moura Jucá RVB, Lima LAO, Resende-Martins H, Bó APL, Fattal C, Azevedo-Coste C, Fachin-Martins E. Overview of FES-Assisted Cycling Approaches and Their Benefits on Functional Rehabilitation and Muscle Atrophy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:561-583. [DOI: 10.1007/978-981-13-1435-3_26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Leung KW, Tong RK, Wang X, Lee GT, Pang PM, Wai HW, Leung HC. The Effectiveness of Functional Electrical Stimulation (FES) in On-Off Mode for Enhancing the Cycling Performance of Team Phoenix at 2016 Cybathlon. Eur J Transl Myol 2017; 27:7132. [PMID: 29299224 PMCID: PMC5745388 DOI: 10.4081/ejtm.2017.7132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/01/2017] [Indexed: 12/17/2022] Open
Abstract
In this study we designed a Functional Electrical Stimulation (FES) trike for a female subject with spinal cord injury to exercise her lower limbs and improve her lower limb muscle condition for attending the 2016 Cybathlon FES bike competition. Our FES pilot was the only female participant, in the FES cycling competition and she rode for Team Phoenix from the Chinese University of Hong Kong. Due to the weakness of muscles in the lower limb of the subject, and due to scoliosis over her thoracolumbar aéra, the mechanical structure of the trike had to be tailor-made to ensure she sat on the bike in a safe and secure position. A six-phase angle-driven stimulation pattern was developed to stimulate quadriceps and hamstrings without gluteus muscles for contraction through four surface electrodes, thereby creating a cycling movement. To improve the cycling endurance and reduce the muscle fatigue, an on-off mode was developed for controlling the stimulation time that allowed the subject to cycle for 20s, then pause while the trike advanced without stimulation for 5s, followed by a subsequent 20 sec stimulation, to continue cycling. The pilot participated in the training procedure including training exercise at home, trike fitting in the trike by modifying the mechanical structure, and conducting the cycling exercise for six months. We observed significant improvements in the pilot’s lower limb condition. The on-off mode enabled our pilot to extend her cycling endurance effectively, from 1 min to 2.5 mins and the distance from 62m to 100m. Over the eight minutes time limit, our team successfully finished 100 m in the Cybathlon FES.
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Affiliation(s)
- Kenry Wc Leung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Raymond Ky Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Xiaojun Wang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Ginny Ty Lee
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Peter Mk Pang
- Industrial Centre, The Hong Kong Polytechnic University, Hong kong
| | - H W Wai
- Industrial Centre, The Hong Kong Polytechnic University, Hong kong
| | - H C Leung
- Industrial Centre, The Hong Kong Polytechnic University, Hong kong
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Guimarães JA, da Fonseca LO, de Sousa AC, Paredes MEG, Brindeiro GA, Bó APL, Fachin-Martins E. FES Bike Race preparation to Cybathlon 2016 by EMA team: a short case report. Eur J Transl Myol 2017; 27:7169. [PMID: 29299225 PMCID: PMC5745387 DOI: 10.4081/ejtm.2017.7169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 01/07/2023] Open
Abstract
FES-assisted cycling has been recommended to people struggling to emerge from a disability to more functioning life after spinal cord injury. Recommendations issued by a gowing number of scientific papershas promised toimprove body composition and physical activity levels, as well as to controlinvoluntary muscle response; favoring activity and participation which break new grounds in expanding locomotion, leisure and occupational options for people with paraplegia and tetraplegia. In this report we described our experience to select and prepare a pilot to compete in the FES Bike Race modality at Cybathlon 2016 in Kloten (Zurick). He was a man, 38 years old, with a complete spinal cord injury, level T9, three years of injury. He took part in a two preparation phases lasting respectively 18 and 12 weeks each: (1st) pre-FES-cycling and a (2nd) FES-cycling. The 1st phase aimed to explore electrical stimulation response in the quadricps, hamstrings and gluteus muscles; searching for a standard muscular recruitment enable to propel the pedals of a trike. Following, in the 2nd phase, stationary to mobile FES-cycling was performed at the same time the development of the automation and control systems were being incorporated in the trike. We adapted a commercial tadpole trycicle anda pilot controlled system. Although we had planned a three session by week protocol, for reasons of term and time to finish the trike development and be prepared to compete, in the last two weeks before the Cybatlhon an intense level of exercise was maintained. After the race, we noticedinflammatory signs on the left knee which later revealed a patella fracture. The video footage analysis confirmed ithappened during the race's first lap.
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Affiliation(s)
| | - Lucas Oliveira da Fonseca
- NTAAI, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
- LARA, Faculdade de Tecnologia, Universidade de Brasília, Brasília, Brazil
| | | | | | | | - Antônio Padilha Lanari Bó
- NTAAI, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
- LARA, Faculdade de Tecnologia, Universidade de Brasília, Brasília, Brazil
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Affiliation(s)
| | - Milos Popovic
- Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Winfried Mayr
- Medical University Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
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