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Koelewijn AD, Audu M, del-Ama AJ, Colucci A, Font-Llagunes JM, Gogeascoechea A, Hnat SK, Makowski N, Moreno JC, Nandor M, Quinn R, Reichenbach M, Reyes RD, Sartori M, Soekadar S, Triolo RJ, Vermehren M, Wenger C, Yavuz US, Fey D, Beckerle P. Adaptation Strategies for Personalized Gait Neuroprosthetics. Front Neurorobot 2021; 15:750519. [PMID: 34975445 PMCID: PMC8716811 DOI: 10.3389/fnbot.2021.750519] [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: 07/30/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Personalization of gait neuroprosthetics is paramount to ensure their efficacy for users, who experience severe limitations in mobility without an assistive device. Our goal is to develop assistive devices that collaborate with and are tailored to their users, while allowing them to use as much of their existing capabilities as possible. Currently, personalization of devices is challenging, and technological advances are required to achieve this goal. Therefore, this paper presents an overview of challenges and research directions regarding an interface with the peripheral nervous system, an interface with the central nervous system, and the requirements of interface computing architectures. The interface should be modular and adaptable, such that it can provide assistance where it is needed. Novel data processing technology should be developed to allow for real-time processing while accounting for signal variations in the human. Personalized biomechanical models and simulation techniques should be developed to predict assisted walking motions and interactions between the user and the device. Furthermore, the advantages of interfacing with both the brain and the spinal cord or the periphery should be further explored. Technological advances of interface computing architecture should focus on learning on the chip to achieve further personalization. Furthermore, energy consumption should be low to allow for longer use of the neuroprosthesis. In-memory processing combined with resistive random access memory is a promising technology for both. This paper discusses the aforementioned aspects to highlight new directions for future research in gait neuroprosthetics.
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Affiliation(s)
- Anne D. Koelewijn
- Biomechanical Data Analysis and Creation (BIOMAC) Group, Machine Learning and Data Analytics Lab, Faculty of Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Musa Audu
- Department of Veterans Affairs, Louis Stokes Clevel and Veterans Affairs Medical Center, Advanced Platform Technology Center, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Antonio J. del-Ama
- Applied Mathematics, Materials Science and Technology and Electronic Technology Department, Rey Juan Carlos University, Mostoles, Spain
| | - Annalisa Colucci
- Clinical Neurotechnology Lab, Neuroscience Research Center (NWFZ), Department of Psychiatry and Neurosciences, Charité - Universita¨tsmedizin Berlin, Berlin, Germany
| | - Josep M. Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Antonio Gogeascoechea
- Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, Enschede, Netherlands
| | - Sandra K. Hnat
- Department of Veterans Affairs, Louis Stokes Clevel and Veterans Affairs Medical Center, Advanced Platform Technology Center, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Nathan Makowski
- Department of Veterans Affairs, Louis Stokes Clevel and Veterans Affairs Medical Center, Advanced Platform Technology Center, Cleveland, OH, United States
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH, United States
| | - Juan C. Moreno
- Neural Rehabilitation Group, Department of Translational Neuroscience, Cajal Institute, CSIC, Madrid, Spain
| | - Mark Nandor
- Department of Veterans Affairs, Louis Stokes Clevel and Veterans Affairs Medical Center, Advanced Platform Technology Center, Cleveland, OH, United States
- Department of Mechanical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Roger Quinn
- Department of Veterans Affairs, Louis Stokes Clevel and Veterans Affairs Medical Center, Advanced Platform Technology Center, Cleveland, OH, United States
- Department of Mechanical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Marc Reichenbach
- Chair of Computer Engineering, Brandenburg University of Technology Cottbus-Senftenberg, Cottbus, Germany
- Chair for Computer Architecture, Department of Computer Science, Faculty of Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ryan-David Reyes
- Department of Veterans Affairs, Louis Stokes Clevel and Veterans Affairs Medical Center, Advanced Platform Technology Center, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Massimo Sartori
- Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, Enschede, Netherlands
| | - Surjo Soekadar
- Clinical Neurotechnology Lab, Neuroscience Research Center (NWFZ), Department of Psychiatry and Neurosciences, Charité - Universita¨tsmedizin Berlin, Berlin, Germany
| | - Ronald J. Triolo
- Department of Veterans Affairs, Louis Stokes Clevel and Veterans Affairs Medical Center, Advanced Platform Technology Center, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Mareike Vermehren
- Clinical Neurotechnology Lab, Neuroscience Research Center (NWFZ), Department of Psychiatry and Neurosciences, Charité - Universita¨tsmedizin Berlin, Berlin, Germany
| | - Christian Wenger
- IHP-Leibniz Institut Fuer Innovative Mikroelektronik, Frankfurt (Oder), Germany
| | - Utku S. Yavuz
- Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Dietmar Fey
- Chair for Computer Architecture, Department of Computer Science, Faculty of Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Beckerle
- Chair of Autonomous Systems and Mechatronics, Department of Electrical Engineering, Artificial Intelligence in Biomedical Engineering, Faculty of Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Makowski NS, Lombardo LM, Foglyano KM, Kobetic R, Pinault G, Selkirk SM, Triolo RJ. Walking after incomplete spinal cord injury with an implanted neuromuscular electrical stimulation system and a hinged knee replacement: a single-subject study. Spinal Cord Ser Cases 2020; 6:86. [PMID: 32934207 DOI: 10.1038/s41394-020-00336-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Single-subject repeated measures study. OBJECTIVES Neuromuscular electrical stimulation (NMES) can enhance walking for people with partial paralysis from incomplete spinal cord injury (iSCI). This single-subject study documents an individual's experience who both received an experimental implanted NMES system and underwent clinical bilateral hinged total knee arthroplasty (TKA). She walked in the community with knee pain prior to either intervention. Walking performance improved with an implanted NMES system. Knee pain and instability continued to worsen over time and eventually required TKA. This study evaluates the effects of these interventions. SETTING Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland OH, USA. METHODS The differential and combined effects of NMES and hinged knee replacement were assessed in terms of walking speed, toe clearance, knee angle, and participant perceptions with and without stimulation assistance both before and after TKA. RESULTS The combined approach both reduced pain and restored walking ability to levels achieved prior to developing significant knee pain that prevented walking without NMES. There was an interaction effect between NMES and TKA on walking speed. Toe clearance consistently improved with stimulation assistance and TKA prevented significant knee hyperextension. The greatest impact was on endurance. Knee replacement re-enabled long distance walking with the addition of stimulation again more than doubling her maximum walking distance from 214 to 513 m. CONCLUSIONS These data support further research of combined implantable interventions that may benefit people with iSCI. Furthermore, joint laxity and pain may not necessarily be contraindications to NMES if addressed with conventional clinical treatments.
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Affiliation(s)
- Nathaniel S Makowski
- MetroHealth Medical Center, Cleveland, OH, USA. .,Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA. .,Case Western Reserve University, Cleveland, OH, USA.
| | - Lisa M Lombardo
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Kevin M Foglyano
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Rudi Kobetic
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Gilles Pinault
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Stephen M Selkirk
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Ronald J Triolo
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
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Lombardo LM, Kobetic R, Pinault G, Foglyano KM, Bailey SN, Selkirk S, Triolo RJ. Impact of an implanted neuroprosthesis on community ambulation in incomplete SCI. J Spinal Cord Med 2018; 41:165-173. [PMID: 28155591 PMCID: PMC5901452 DOI: 10.1080/10790268.2016.1275448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Test the effect of a multi-joint control with implanted electrical stimulation on walking after spinal cord injury (SCI). DESIGN Single subject research design with repeated measures. SETTING Hospital-based biomechanics laboratory and user assessment of community use. PARTICIPANTS Female with C6 AIS C SCI 30 years post injury. INTERVENTIONS Lower extremity muscle activation with an implanted pulse generator and gait training. OUTCOME MEASURES Walking speed, maximum distance, oxygen consumption, upper extremity (UE) forces, kinematics and self-assessment of technology. RESULTS Short distance walking speed at one-year follow up with or without stimulation was not significantly different from baseline. However, average walking speed was significantly faster (0.22 m/s) with stimulation over longer distances than volitional walking (0.12 m/s). In addition, there was a 413% increase in walking distance from 95 m volitionally to 488 m with stimulation while oxygen consumption and maximum upper extremity forces decreased by 22 and 16%, respectively. Stimulation also produced significant (P ≤ 0.001) improvements in peak hip and knee flexion, ankle angle at foot off and at mid-swing. CONCLUSION An implanted neuroprosthesis enabled a subject with incomplete SCI to walk longer distances with improved hip and knee flexion and ankle dorsiflexion resulting in decreased oxygen consumption and UE support. Further research is required to determine the robustness, generalizability and functional implications of implanted neuroprostheses for community ambulation after incomplete SCI.
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Affiliation(s)
- Lisa M. Lombardo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Rudolf Kobetic
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Gilles Pinault
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Kevin M. Foglyano
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Stephanie N. Bailey
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Stephen Selkirk
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ronald J. Triolo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Orthopaedics and Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Delafontaine A, Fourcade P, Honeine JL, Ditcharles S, Yiou E. Postural adaptations to unilateral knee joint hypomobility induced by orthosis wear during gait initiation. Sci Rep 2018; 8:830. [PMID: 29339773 PMCID: PMC5770397 DOI: 10.1038/s41598-018-19151-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/13/2017] [Indexed: 12/22/2022] Open
Abstract
Balance control and whole-body progression during gait initiation (GI) involve knee-joint mobility. Single knee-joint hypomobility often occurs with aging, orthopedics or neurological conditions. The goal of the present study was to investigate the capacity of the CNS to adapt GI organization to single knee-joint hypomobility induced by the wear of an orthosis. Twenty-seven healthy adults performed a GI series on a force-plate in the following conditions: without orthosis ("control"), with knee orthosis over the swing leg ("orth-swing") and with the orthosis over the contralateral stance leg ("orth-stance"). In orth-swing, amplitude of mediolateral anticipatory postural adjustments (APAs) and step width were larger, execution phase duration longer, and anteroposterior APAs smaller than in control. In orth-stance, mediolateral APAs duration was longer, step width larger, and amplitude of anteroposterior APAs smaller than in control. Consequently, step length and progression velocity (which relate to the "motor performance") were reduced whereas stability was enhanced compared to control. Vertical force impact at foot-contact did not change across conditions, despite a smaller step length in orthosis conditions compared to control. These results show that the application of a local mechanical constraint induced profound changes in the global GI organization, altering motor performance but ensuring greater stability.
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Affiliation(s)
- A Delafontaine
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, 91405, Orsay, France.
- CIAMS, Université d'Orléans, 45067, Orléans, France.
| | - P Fourcade
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, 91405, Orsay, France
- CIAMS, Université d'Orléans, 45067, Orléans, France
| | - J L Honeine
- CSAM Laboratory, Department of Public Health, University of Pavia, Pavia, Italy
| | - S Ditcharles
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, 91405, Orsay, France
- CIAMS, Université d'Orléans, 45067, Orléans, France
| | - E Yiou
- CIAMS, Univ. Paris-Sud., Université Paris-Saclay, 91405, Orsay, France
- CIAMS, Université d'Orléans, 45067, Orléans, France
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