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Cabral AM, Lora-Millán JS, Pereira AA, Rocon E, Andrade ADO. On the Effect of Vibrotactile Stimulation in Essential Tremor. Healthcare (Basel) 2024; 12:448. [PMID: 38391822 PMCID: PMC10888095 DOI: 10.3390/healthcare12040448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: Vibrotactile stimulation has been studied for tremor, but there is little evidence for Essential Tremor (ET). (2) Methods: This research employed a dataset from a previous study, with data collected from 18 individuals subjected to four vibratory stimuli. To characterise tremor changes before, during, and after stimuli, time and frequency domain features were estimated from the signals. Correlation and regression analyses verified the relationship between features and clinical tremor scores. (3) Results: Individuals responded differently to vibrotactile stimulation. The 250 Hz stimulus was the only one that reduced tremor amplitude after stimulation. Compared to the baseline, the 250 Hz and random frequency stimulation reduced tremor peak power. The clinical scores and amplitude-based features were highly correlated, yielding accurate regression models (mean squared error of 0.09). (4) Conclusions: The stimulation frequency of 250 Hz has the greatest potential to reduce tremors in ET. The accurate regression model and high correlation between estimated features and clinical scales suggest that prediction models can automatically evaluate and control stimulus-induced tremor. A limitation of this research is the relatively reduced sample size.
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Affiliation(s)
- Ariana Moura Cabral
- Centre for Innovation and Technology Assessment in Health, Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia 38400-902, Brazil
| | | | - Adriano Alves Pereira
- Centre for Innovation and Technology Assessment in Health, Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia 38400-902, Brazil
| | - Eduardo Rocon
- BioRobotics Group, Centre for Automation and Robotics (CAR), CSIC-UPM, 28500 Madrid, Spain
| | - Adriano de Oliveira Andrade
- Centre for Innovation and Technology Assessment in Health, Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia 38400-902, Brazil
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Lora-Millan JS, Sanchez-Cuesta FJ, Romero JP, Moreno JC, Rocon E. Robotic exoskeleton embodiment in post-stroke hemiparetic patients: an experimental study about the integration of the assistance provided by the REFLEX knee exoskeleton. Sci Rep 2023; 13:22908. [PMID: 38129592 PMCID: PMC10739721 DOI: 10.1038/s41598-023-50387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023] Open
Abstract
Hemiparetic gait is the most common motor-disorder after stroke and, in spite of rehabilitation efforts, it is persistent in 50% of community dwelling stroke-survivors. Robotic exoskeletons have been proposed as assistive devices to support impaired joints. An example of these devices is the REFLEX knee exoskeleton, which assists the gait of hemiparetic subjects and whose action seems to be properly embodied by stroke survivors, who were able to adapt the motion of their non-assisted limbs and, therefore, reduce their compensation mechanisms. This paper presents an experimental validation carried out to deepen into the effects of REFLEX's assistance in hemiparetic subjects. Special attention was paid to the effect produced in the muscular activity as a metric to evaluate the embodiment of this technology. Significant differences were obtained at the subject level due to the assistance; however, the high dispersion of the measured outcomes avoided extracting global effects at the group level. These results highlight the need of individually tailoring the action of the robot to the individual needs of each patient to maximize the beneficial outcomes. Extra research effort should be done to elucidate the neural mechanisms involved in the embodiment of external devices by stroke survivors.
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Affiliation(s)
| | - Francisco José Sanchez-Cuesta
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
| | - Juan Pablo Romero
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
- Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica, Spanish National Research Council (CSIC), Madrid, Spain
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Pinto-Fernandez D, Gomez M, Rodrigues C, Rojo A, Raya R, Rocon E, Moreno JC, Torricelli D. Augmented Reality Feedback for Exoskeleton-Assisted Walking. A Feasibility Study. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941171 DOI: 10.1109/icorr58425.2023.10304606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Powered lower limb exoskeletons have been used in recent decades to support and improve conventional gait rehabilitation programs. In this context, visual feedback is considered a valuable tool to facilitate patient learning and engagement. Treadmill-based lower limb robotic exoskeletons are commonly incorporated with traditional screens or virtual reality (VR) devices. However, these modalities are incompatible with over-ground robotic exoskeletons, in which users should pay attention to multiple elements of the open environment and more complex tasks. Recent advances in augmented reality (AR) technology have unlocked a new way of displaying 3D graphics in untethered wearable devices like Microsoft's Hololens 2 without occluding the rest of the user's field of view. These advances can be crucial in certain situations and position AR as an excellent candidate to improve visual feedback when using robotic exoskeletons. In this work, we present the development of an AR-based audio-visual feedback system that tracks the trunk rotation from an Inertial Measurement Unit (IMU) to aid in walking tasks assisted by a lower limb robotic exoskeleton. A preliminary study was done integrating the H3 robotic exoskeleton with Hololens 2. We observed that displaying posture information is feasible and could help mitigate the unnatural posture often imposed by a robotic exoskeleton.
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Romero-Sorozabal P, Delgado-Oleas G, Gutierrez A, Rocon E. Individualized Three-Dimensional Gait Pattern Generator for Lower Limbs Rehabilitation Robots. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941191 DOI: 10.1109/icorr58425.2023.10304753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
In the field of robotic gait rehabilitation, controlling robotic devices to follow specific human-like trajectories is often required. In recent years, various gait generator models have been proposed, providing customized gait patterns adjustable to a range of heights and gait speeds. However, these models were developed with a focus on gait rehabilitation devices designed to control the angular trajectories of the subject's joints, e.g. exoskeletons. Similar devices, e.g. end-effector robots, control the orientation and also the 3D position of the subject's joints and cannot easily implement these models. In this study, it is proposed a new individualized three-dimensional gait pattern generator for gait rehabilitation robots. The generator employs multi-variable regression models to predict the joint angular trajectories of the pelvis, hip, and ankle along the gait cycle. The 3D joints positions are then reconstructed by applying the predicted angular trajectories over a human model inspired on the inverted pendulum analogy using inverse kinematics. The generator's performance was statistically evaluated against real gait patterns from 42 participants walking at 8 different velocities. The predicted trajectories matched the measured ones with an average Root Mean Squared Error of 25.73 mm for all joints at all Cartesian axes, with better results between 3.3 - 5.4 km/h. Suggesting to be a good solution to be applied in end-effector gait robotic rehabilitation devices.
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Bayon C, Van Crey N, Rocon E, Rouse E, van Asseldonk E. Comparison of Two Design Principles of Unpowered Ankle-Foot Orthoses for Supporting Push-Off: A Case Study. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941264 DOI: 10.1109/icorr58425.2023.10304603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Ankle propulsion is essential for efficient human walking. In recent years, several working principles have been investigated and applied to ankle-foot orthoses (AFOs) to enhance the work of the plantarflexor muscles and achieve proper propulsion during gait. Comparing the performance and effectiveness of different designs is difficult because researchers do not have a standardized set of criteria and procedures to follow. This leads to a wide range of tests being conducted, with variations in important factors such as walking speed and assistance provided, which greatly affect users' kinematics and kinetics. In this work, we investigate the possibilities and potential benefits of two of the most important design principles for supporting ankle propulsion with unpowered AFOs. To this end, we present and evaluate two AFO prototypes with springs parallel to the Achilles tendon based on: (i) a linear compression spring, and (ii) a customized leaf spring-cam transmission with a non-linear ankle torque-angle curve. The effects of both AFOs are reported for a case study with one healthy participant using both prototypes at two walking speeds under the same experimental conditions. Large reductions in muscular activity were found when the user received assistance, and ankle kinematics were influenced by the different assistance approaches. This case study was intended as a first step to provide insights on how two promising principles can passively support push-off during gait.
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Bayón C, Hoorn MV, Barrientos A, Rocon E, Trost JP, Asseldonk EHFV. Perspectives on ankle-foot technology for improving gait performance of children with Cerebral Palsy in daily-life: requirements, needs and wishes. J Neuroeng Rehabil 2023; 20:44. [PMID: 37046284 PMCID: PMC10099972 DOI: 10.1186/s12984-023-01162-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are extensively used as a primary management method to assist ambulation of children with Cerebral Palsy (CP). However, there are certain barriers that hinder their prescription as well as their use as a mobility device in all kinds of daily-life activities. This exploratory research attempts to further understand the existing limitations of current AFOs to promote a better personalization of new design solutions. METHODS Stakeholders' (professionals in CP and end-users with CP) perspectives on AFO technology were collected by two online surveys. Respondents evaluated the limitations of current assistive solutions and assessment methods, provided their expectations for a new AFO design, and analyzed the importance of different design features and metrics to enrich the gait performance of these patients in daily-life. Quantitative responses were rated and compared with respect to their perceived importance. Qualitative responses were classified into themes by using content analysis. RESULTS 130 survey responses from ten countries were analyzed, 94 from professionals and 36 from end-users with CP. The most highly rated design features by both stakeholder groups were the comfort and the ease of putting on and taking off the assistive device. In general, professionals preferred new features to enrich the independence of the patient by improving gait at functional levels. End-users also considered their social acceptance and participation. Health care professionals reported a lack of confidence concerning decision-making about AFO prescription. To some degree, this may be due to the reported inconsistent understanding of the type of assistance required for each pathological gait. Thus, they indicated that more information about patients' day-to-day walking performance would be beneficial to assess patients' capabilities. CONCLUSION This study emphasizes the importance of developing new approaches to assess and treat CP gait in daily-life situations. The stakeholders' needs and criteria reported here may serve as insights for the design of future assistive devices and for the follow-up monitoring of these patients.
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Affiliation(s)
- Cristina Bayón
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands.
- Centro de Automática y Robótica, Universidad Politécnica de Madrid, Consejo Superior de Investigaciones Científicas, Madrid, Spain.
| | - Marleen van Hoorn
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Antonio Barrientos
- Centro de Automática y Robótica, Universidad Politécnica de Madrid, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica, Universidad Politécnica de Madrid, Consejo Superior de Investigaciones Científicas, Madrid, Spain
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Nóbrega LR, Rocon E, Pereira AA, Andrade ADO. A Novel Physical Mobility Task to Assess Freezers in Parkinson's Disease. Healthcare (Basel) 2023; 11:healthcare11030409. [PMID: 36766984 PMCID: PMC9914147 DOI: 10.3390/healthcare11030409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
Freezing of gait (FOG), one of the most disabling features of Parkinson's disease (PD), is a brief episodic absence or marked reduction in stride progression despite the intention to walk. Progressively more people who experience FOG restrict their walking and reduce their level of physical activity. The purpose of this study is to develop and validate a physical mobility task that induces freezing of gait in a controlled environment, employing known triggers of FOG episodes according to the literature. To validate the physical mobility tasks, we recruited 10 volunteers that suffered PD-associated freezing (60.6 ± 7.29 years-old) with new FOG-Q ranging from 12 to 26. The validation of the proposed method was carried out using inertial sensors and video recordings. All subjects were assessed during the OFF and ON medication states. The total number of FOG occurrences during data collection was 144. The proposed tasks were able to trigger 120 FOG episodes, while the TUG test caused 24. The Inertial Measurement Unit (IMU) with accelerometer and gyroscope could not only detect FOG episodes but also allowed us to visualize the three types of FOG: akinesia, festination and trembling in place.
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Affiliation(s)
- Lígia Reis Nóbrega
- Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia 38400-902, MG, Brazil
| | - Eduardo Rocon
- Centre for Automation and Robotics (CAR), Spanish National Research Council and Higher Technical School of Industrial Engineering (CSIC-UPM), 28500 Madrid, Spain
| | - Adriano Alves Pereira
- Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia 38400-902, MG, Brazil
- Correspondence: ; Tel.: +55-34-3239-4711
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Pais-Vieira M, Ramakrishnan A, Rocon E, Lebedev M, Cruz-e-Silva OABD. Editorial: Digital health and neuroscience: Recent history, current trends, and future developments. Front Integr Neurosci 2022; 16:1073682. [DOI: 10.3389/fnint.2022.1073682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
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Lora-Millan JS, Sanchez-Cuesta FJ, Romero JP, Moreno JC, Rocon E. A unilateral robotic knee exoskeleton to assess the role of natural gait assistance in hemiparetic patients. J Neuroeng Rehabil 2022; 19:109. [PMID: 36209096 PMCID: PMC9548210 DOI: 10.1186/s12984-022-01088-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 09/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Hemiparetic gait is characterized by strong asymmetries that can severely affect the quality of life of stroke survivors. This type of asymmetry is due to motor deficits in the paretic leg and the resulting compensations in the nonparetic limb. In this study, we aimed to evaluate the effect of actively promoting gait symmetry in hemiparetic patients by assessing the behavior of both paretic and nonparetic lower limbs. This paper introduces the design and validation of the REFLEX prototype, a unilateral active knee–ankle–foot orthosis designed and developed to naturally assist the paretic limbs of hemiparetic patients during gait. Methods REFLEX uses an adaptive frequency oscillator to estimate the continuous gait phase of the nonparetic limb. Based on this estimation, the device synchronically assists the paretic leg following two different control strategies: (1) replicating the movement of the nonparetic leg or (2) inducing a healthy gait pattern for the paretic leg. Technical validation of the system was implemented on three healthy subjects, while the effect of the generated assistance was assessed in three stroke patients. The effects of this assistance were evaluated in terms of interlimb symmetry with respect to spatiotemporal gait parameters such as step length or time, as well as the similarity between the joint’s motion in both legs. Results Preliminary results proved the feasibility of the REFLEX prototype to assist gait by reinforcing symmetry. They also pointed out that the assistance of the paretic leg resulted in a decrease in the compensatory strategies developed by the nonparetic limb to achieve a functional gait. Notably, better results were attained when the assistance was provided according to a standard healthy pattern, which initially might suppose a lower symmetry but enabled a healthier evolution of the motion of the nonparetic limb. Conclusions This work presents the preliminary validation of the REFLEX prototype, a unilateral knee exoskeleton for gait assistance in hemiparetic patients. The experimental results indicate that assisting the paretic leg of a hemiparetic patient based on the movement of their nonparetic leg is a valuable strategy for reducing the compensatory mechanisms developed by the nonparetic limb.
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Affiliation(s)
- Julio Salvador Lora-Millan
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas - Universidad Politécnica de Madrid, Madrid, Spain. .,Electronic Technology Department, Universidad Rey Juan Carlos, Madrid, Spain.
| | | | - Juan Pablo Romero
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain.,Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas - Universidad Politécnica de Madrid, Madrid, Spain
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Lora-Millan JS, Moreno JC, Rocon E. Coordination Between Partial Robotic Exoskeletons and Human Gait: A Comprehensive Review on Control Strategies. Front Bioeng Biotechnol 2022; 10:842294. [PMID: 35694226 PMCID: PMC9174608 DOI: 10.3389/fbioe.2022.842294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Lower-limb robotic exoskeletons have become powerful tools to assist or rehabilitate the gait of subjects with impaired walking, even when they are designed to act only partially over the locomotor system, as in the case of unilateral or single-joint exoskeletons. These partial exoskeletons require a proper method to synchronize their assistive actions and ensure correct inter-joint coordination with the user’s gait. This review analyzes the state of the art of control strategies to coordinate the assistance provided by these partial devices with the actual gait of the wearers. We have analyzed and classified the different approaches independently of the hardware implementation, describing their basis and principles. We have also reviewed the experimental validations of these devices for impaired and unimpaired walking subjects to provide the reader with a clear view of their technology readiness level. Eventually, the current state of the art and necessary future steps in the field are summarized and discussed.
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Affiliation(s)
- Julio S. Lora-Millan
- Centre for Automation and Robotics, Consejo Superior de Investigaciones Científicas-Universidad Politécnica de Madrid, CSIC-UPM, Madrid, Spain
- Electronic Technology Department, Universidad Rey Juan Carlos, Madrid, Spain
| | - Juan C. Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - E. Rocon
- Centre for Automation and Robotics, Consejo Superior de Investigaciones Científicas-Universidad Politécnica de Madrid, CSIC-UPM, Madrid, Spain
- *Correspondence: E. Rocon,
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Costa V, Ramirez O, Perea L, Velasquez A, Otero A, Rocon E, Raya R. Development and clinical validation of a rehabilitation platform for hip fracture in elderly population. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1340-1349. [PMID: 35580104 DOI: 10.1109/tnsre.2022.3175688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hip fracture is one of the most common traumatisms associated with falls in the elderly, severely affecting the patient's mobility and independence. In recent years, the use of robotic technology has proven to be effective in gait rehabilitation, especially for neurological disorders. However, there is a lack of research validating these devices for hip fracture in elderly patients. This paper presents the design and evaluation of a novel assistive platform for hip rehabilitation, SWalker, aimed at improving the rehabilitation of this condition. Functional validation of the SWalker platform was carried out with five healthy elderly subjects and two physiotherapists. Clinical validation was conducted with 34 patients with hip fracture. The control group (n=24, age=86.38±6.16 years, 75% female) followed conventional therapy, while the intervention group (n=10, age=86.80±6.32 years, 90% female) was rehabilitated using SWalker. The functional validation of the device reported good acceptability (System Usability Scale >85). In the clinical validation, the control group required 68.09±27.38 rehabilitation sessions compared to 22.60±16.75 in the intervention group (p<0.001). Patients in the control group needed 120.33±53.64 days to reach ambulation, while patients rehabilitated with SWalker achieved that stage in 67.11±51.07 days (p=0.021). FAC and Tinetti indexes presented a larger improvement in the intervention group when compared with the control group (p=0.007 and p=0.01, respectively). The SWalker platform can be considered an effective tool to enhance autonomous gait and shorten rehabilitation therapy in elderly hip fracture patients. This result encourages further research on robotic rehabilitation platforms for hip fracture.
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Avellar L, Stefano Filho C, Delgado G, Frizera A, Rocon E, Leal-Junior A. AI-enabled photonic smart garment for movement analysis. Sci Rep 2022; 12:4067. [PMID: 35260746 PMCID: PMC8904460 DOI: 10.1038/s41598-022-08048-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Smart textiles are novel solutions for remote healthcare monitoring which involve non-invasive sensors-integrated clothing. Polymer optical fiber (POF) sensors have attractive features for smart textile technology, and combined with Artificial Intelligence (AI) algorithms increase the potential of intelligent decision-making. This paper presents the development of a fully portable photonic smart garment with 30 multiplexed POF sensors combined with AI algorithms to evaluate the system ability on the activity classification of multiple subjects. Six daily activities are evaluated: standing, sitting, squatting, up-and-down arms, walking and running. A k-nearest neighbors classifier is employed and results from 10 trials of all volunteers presented an accuracy of 94.00 (0.14)%. To achieve an optimal amount of sensors, the principal component analysis is used for one volunteer and results showed an accuracy of 98.14 (0.31)% using 10 sensors, 1.82% lower than using 30 sensors. Cadence and breathing rate were estimated and compared to the data from an inertial measurement unit located on the garment back and the highest error was 2.22%. Shoulder flexion/extension was also evaluated. The proposed approach presented feasibility for activity recognition and movement-related parameters extraction, leading to a system fully optimized, including the number of sensors and wireless communication, for Healthcare 4.0.
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Affiliation(s)
- Leticia Avellar
- Graduate Program in Electrical Engineering, Federal University of Espírito Santo (UFES), Fernando Ferrari Avenue, Vitória, 29075-910, Brazil.
| | - Carlos Stefano Filho
- Neurophysics Group, "Gleb Wataghin" Institute of Physics, University of Campinas, Campinas, Brazil
| | - Gabriel Delgado
- Centro de Automática y Robótica, Ctra. Campo Real, 28500, Arganda del Rey, Madrid, Spain
| | - Anselmo Frizera
- Graduate Program in Electrical Engineering, Federal University of Espírito Santo (UFES), Fernando Ferrari Avenue, Vitória, 29075-910, Brazil
| | - Eduardo Rocon
- Centro de Automática y Robótica, Ctra. Campo Real, 28500, Arganda del Rey, Madrid, Spain
| | - Arnaldo Leal-Junior
- Graduate Program in Electrical Engineering, Federal University of Espírito Santo (UFES), Fernando Ferrari Avenue, Vitória, 29075-910, Brazil
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Cifuentes CA, Veneman JF, Rocon E, Rodriguez-Guerrero C. Editorial: Interfacing Humans and Machines for Rehabilitation and Assistive Devices. Front Robot AI 2022; 8:796431. [PMID: 35047569 PMCID: PMC8762109 DOI: 10.3389/frobt.2021.796431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlos A Cifuentes
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota, Colombia
| | | | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas-Universidad Politécnica de Madrid (CSIC-UPM), Madrid, Spain
| | - Carlos Rodriguez-Guerrero
- Robotics and Multibody Mechanics Research Group, Department of Mechanical Engineering, Vrije Universiteit Brussel and Flanders Make, Brussels, Belgium
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Bayón C, Delgado-Oleas G, Avellar L, Bentivoglio F, Di Tommaso F, Tagliamonte NL, Rocon E, van Asseldonk EHF. Development and Evaluation of BenchBalance: A System for Benchmarking Balance Capabilities of Wearable Robots and Their Users. Sensors (Basel) 2021; 22:119. [PMID: 35009661 PMCID: PMC8747156 DOI: 10.3390/s22010119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Abstract
Recent advances in the control of overground exoskeletons are being centered on improving balance support and decreasing the reliance on crutches. However, appropriate methods to quantify the stability of these exoskeletons (and their users) are still under development. A reliable and reproducible balance assessment is critical to enrich exoskeletons' performance and their interaction with humans. In this work, we present the BenchBalance system, which is a benchmarking solution to conduct reproducible balance assessments of exoskeletons and their users. Integrating two key elements, i.e., a hand-held perturbator and a smart garment, BenchBalance is a portable and low-cost system that provides a quantitative assessment related to the reaction and capacity of wearable exoskeletons and their users to respond to controlled external perturbations. A software interface is used to guide the experimenter throughout a predefined protocol of measurable perturbations, taking into account antero-posterior and mediolateral responses. In total, the protocol is composed of sixteen perturbation conditions, which vary in magnitude and location while still controlling their orientation. The data acquired by the interface are classified and saved for a subsequent analysis based on synthetic metrics. In this paper, we present a proof of principle of the BenchBalance system with a healthy user in two scenarios: subject not wearing and subject wearing the H2 lower-limb exoskeleton. After a brief training period, the experimenter was able to provide the manual perturbations of the protocol in a consistent and reproducible way. The balance metrics defined within the BenchBalance framework were able to detect differences in performance depending on the perturbation magnitude, location, and the presence or not of the exoskeleton. The BenchBalance system will be integrated at EUROBENCH facilities to benchmark the balance capabilities of wearable exoskeletons and their users.
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Affiliation(s)
- Cristina Bayón
- Department of Biomechanical Engineering, University of Twente, 7522 NB Enschede, The Netherlands;
- Centro de Automática y Robótica, Universidad Politécnica de Madrid, 28500 Madrid, Spain; (G.D.-O.); (L.A.); (E.R.)
| | - Gabriel Delgado-Oleas
- Centro de Automática y Robótica, Universidad Politécnica de Madrid, 28500 Madrid, Spain; (G.D.-O.); (L.A.); (E.R.)
| | - Leticia Avellar
- Centro de Automática y Robótica, Universidad Politécnica de Madrid, 28500 Madrid, Spain; (G.D.-O.); (L.A.); (E.R.)
| | | | - Francesco Di Tommaso
- Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.B.); (F.D.T.); (N.L.T.)
| | - Nevio L. Tagliamonte
- Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (F.B.); (F.D.T.); (N.L.T.)
- Fondazione Santa Lucia, 00179 Rome, Italy
| | - Eduardo Rocon
- Centro de Automática y Robótica, Universidad Politécnica de Madrid, 28500 Madrid, Spain; (G.D.-O.); (L.A.); (E.R.)
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15
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López-Blanco R, Benito-León J, Llamas-Velasco S, Del Castillo MD, Serrano JI, Rocon E, Romero JP, Velasco MA. Interaction with touchscreen smartphones in patients with essential tremor and healthy individuals. Neurologia (Engl Ed) 2021; 36:657-665. [PMID: 34752343 DOI: 10.1016/j.nrleng.2018.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/27/2018] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Smartphone use in biomedical research is becoming more prevalent in different clinical settings. We performed a pilot study to obtain information on smartphone use by patients with essential tremor (ET) and healthy controls, with a view to determining whether performance of touchscreen tasks is different between these groups and describing touchscreen interaction factors. METHOD A total of 31 patients with ET and 40 sex- and age-matched healthy controls completed a descriptive questionnaire about the use of smartphones. Participants subsequently interacted with an under-development Android application, and performed 4 tests evaluating typical touchscreen interaction gestures; each test was performed 5 times. RESULT The type of smartphone use and touchscreen interaction were not significantly different between patients and controls. Age and frequency of smartphone use are key factors in touchscreen interaction. CONCLUSION Our results support the use of smartphone touchscreens for research into ET, although further studies are required.
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Affiliation(s)
- R López-Blanco
- Instituto de Investigación (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - J Benito-León
- Instituto de Investigación (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain; Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - S Llamas-Velasco
- Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - M D Del Castillo
- Centro de Automática y Robótica (CAR) CSIC-UPM, Arganda del Rey, Madrid, Spain
| | - J I Serrano
- Centro de Automática y Robótica (CAR) CSIC-UPM, Arganda del Rey, Madrid, Spain
| | - E Rocon
- Centro de Automática y Robótica (CAR) CSIC-UPM, Arganda del Rey, Madrid, Spain
| | - J P Romero
- Facultad de Ciencias de la Salud, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain; Unidad de Daño Cerebral, Hospital Beata Maria Ana, Madrid, Spain
| | - M A Velasco
- Centro de Automática y Robótica (CAR) CSIC-UPM, Arganda del Rey, Madrid, Spain
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16
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Lora-Millan JS, Delgado-Oleas G, Benito-León J, Rocon E. A Review on Wearable Technologies for Tremor Suppression. Front Neurol 2021; 12:700600. [PMID: 34434161 PMCID: PMC8380769 DOI: 10.3389/fneur.2021.700600] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022] Open
Abstract
Tremor is defined as a rhythmic, involuntary oscillatory movement of a body part. Although everyone exhibits a certain degree of tremor, some pathologies lead to very disabling tremors. These pathological tremors constitute the most prevalent movement disorder, and they imply severe difficulties in performing activities of daily living. Although tremors are currently managed through pharmacotherapy or surgery, these treatments present significant associated drawbacks: drugs often induce side effects and show decreased effectiveness over years of use, while surgery is a hazardous procedure for a very low percentage of eligible patients. In this context, recent research demonstrated the feasibility of managing upper limb tremors through wearable technologies that suppress tremors by modifying limb biomechanics or applying counteracting forces. Furthermore, recent experiments with transcutaneous afferent stimulation showed significant tremor attenuation. In this regard, this article reviews the devices developed following these tremor management paradigms, such as robotic exoskeletons, soft robotic exoskeletons, and transcutaneous neurostimulators. These works are presented, and their effectiveness is discussed. The article also evaluates the different metrics used for the validation of these devices and the lack of a standard validation procedure that allows the comparison among them.
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Affiliation(s)
- Julio S. Lora-Millan
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
| | - Gabriel Delgado-Oleas
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
- Ingeniería Electrónica, Universidad del Azuay, Cuenca, Ecuador
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas – Universidad Politécnica de Madrid, Madrid, Spain
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17
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Di Natali C, Sadeghi A, Mondini A, Bottenberg E, Hartigan B, De Eyto A, O'Sullivan L, Rocon E, Stadler K, Mazzolai B, Caldwell DG, Ortiz J. Pneumatic Quasi-Passive Actuation for Soft Assistive Lower Limbs Exoskeleton. Front Neurorobot 2020; 14:31. [PMID: 32714175 PMCID: PMC7344163 DOI: 10.3389/fnbot.2020.00031] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/06/2020] [Indexed: 12/20/2022] Open
Abstract
There is a growing international interest in developing soft wearable robotic devices to improve mobility and daily life autonomy as well as for rehabilitation purposes. Usability, comfort and acceptance of such devices will affect their uptakes in mainstream daily life. The XoSoft EU project developed a modular soft lower-limb exoskeleton to assist people with low mobility impairments. This paper presents the bio-inspired design of a soft, modular exoskeleton for lower limb assistance based on pneumatic quasi-passive actuation. The design of a modular reconfigurable prototype and its performance are presented. This actuation centers on an active mechanical element to modulate the assistance generated by a traditional passive component, in this case an elastic belt. This study assesses the feasibility of this type of assistive device by evaluating the energetic outcomes on a healthy subject during a walking task. Human-exoskeleton interaction in relation to task-based biological power assistance and kinematics variations of the gait are evaluated. The resultant assistance, in terms of overall power ratio (Λ) between the exoskeleton and the assisted joint, was 26.6% for hip actuation, 9.3% for the knee and 12.6% for the ankle. The released maximum power supplied on each articulation, was 113.6% for the hip, 93.2% for the knee, and 150.8% for the ankle.
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Affiliation(s)
- Christian Di Natali
- XoLab, Department of ADVR-IIT Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Ali Sadeghi
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Alessio Mondini
- Department of CMBR-IIT Center for Micro-BioRobotics, Istituto Italiano di Tecnologia, Pontedera, Italy
| | - Eliza Bottenberg
- Smart Functional Materials Research Group, Saxion University of Applied Sciences, Enschede, Netherlands
| | | | - Adam De Eyto
- Design Factors Group, University of Limerick, Limerick, Ireland
| | | | - Eduardo Rocon
- Consejo Superior de Investigaciones Cientificas (CSIC), Madrid, Spain
| | - Konrad Stadler
- Institute of Mechatronic Systems, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Barbara Mazzolai
- Department of CMBR-IIT Center for Micro-BioRobotics, Istituto Italiano di Tecnologia, Pontedera, Italy
| | - Darwin G Caldwell
- XoLab, Department of ADVR-IIT Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Jesús Ortiz
- XoLab, Department of ADVR-IIT Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
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18
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Hidalgo AF, Lora-Millan JS, Rocon E. IMU-Based Knee Angle Estimation using an Extended Kalman Filter. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:570-573. [PMID: 31945963 DOI: 10.1109/embc.2019.8857614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Several robotic-based rehabilitation therapies for hemiparetic patients need from monitoring the healthy leg using ambulatory systems such as Inertial Measurement Units (IMUs). However the use of these sensors involves several drawbacks like numerical drift, instable measurements in presence of magnetic fields or crucial alignment of the sensors. Based on a recursive paradigm to estimate the rotational axis, we present in this paper an algorithm to estimate the knee angle based on geometrical constrains using an Extended Kalman Filter. We tested this algorithm in five heathy subjects and were able to reconstruct the waveform of the knee angle with an average rms error lower than 2°.
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Benito-León J, Sanz-Morales E, Melero H, Louis ED, Romero JP, Rocon E, Malpica N. Graph theory analysis of resting-state functional magnetic resonance imaging in essential tremor. Hum Brain Mapp 2019; 40:4686-4702. [PMID: 31332912 DOI: 10.1002/hbm.24730] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 11/10/2022] Open
Abstract
Essential tremor (ET) is a neurological disease with both motor and nonmotor manifestations; however, little is known about its underlying brain basis. Furthermore, the overall organization of the brain network in ET remains largely unexplored. We investigated the topological properties of brain functional network, derived from resting-state functional magnetic resonance imaging (MRI) data, in 23 ET patients versus 23 healthy controls. Graph theory analysis was used to assess the functional network organization. At the global level, the functional network of ET patients was characterized by lower small-worldness values than healthy controls-less clustered functionality of the brain. At the regional level, compared with the healthy controls, ET patients showed significantly higher values of global efficiency, cost and degree, and a shorter average path length in the left inferior frontal gyrus (pars opercularis), right inferior temporal gyrus (posterior division and temporo-occipital part), right inferior lateral occipital cortex, left paracingulate, bilateral precuneus bilaterally, left lingual gyrus, right hippocampus, left amygdala, nucleus accumbens bilaterally, and left middle temporal gyrus (posterior part). In addition, ET patients showed significant higher local efficiency and clustering coefficient values in frontal medial cortex bilaterally, subcallosal cortex, posterior cingulate cortex, parahippocampal gyri bilaterally (posterior division), right lingual gyrus, right cerebellar flocculus, right postcentral gyrus, right inferior semilunar lobule of cerebellum and culmen of vermis. Finally, the right intracalcarine cortex and the left orbitofrontal cortex showed a shorter average path length in ET patients, while the left frontal operculum and the right planum polare showed a higher betweenness centrality in ET patients. In conclusion, the efficiency of the overall brain functional network in ET is disrupted. Further, our results support the concept that ET is a disorder that disrupts widespread brain regions, including those outside of the brain regions responsible for tremor.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain.,Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Emilio Sanz-Morales
- Medical Image Analysis Laboratory (LAIMBIO), Rey Juan Carlos University, Madrid, Spain
| | - Helena Melero
- Medical Image Analysis Laboratory (LAIMBIO), Rey Juan Carlos University, Madrid, Spain
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Juan P Romero
- Faculty of Biosanitary Sciences, Francisco de Vitoria University, Madrid, Spain.,Brain Damage Unit, Hospital Beata Maria Ana, Madrid, Spain
| | - Eduardo Rocon
- Neural and Cognitive Engineering group, Center for Automation and Robotics (CAR) CSIC-UPM, Arganda del Rey, Spain
| | - Norberto Malpica
- Medical Image Analysis Laboratory (LAIMBIO), Rey Juan Carlos University, Madrid, Spain
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20
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López-Blanco R, Velasco MA, Méndez-Guerrero A, Romero JP, Del Castillo MD, Serrano JI, Rocon E, Benito-León J. Smartwatch for the analysis of rest tremor in patients with Parkinson's disease. J Neurol Sci 2019; 401:37-42. [PMID: 31005763 DOI: 10.1016/j.jns.2019.04.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
Abstract
Wearable technology used in Parkinson's disease (PD) research has become an increasing focus of interest in this field. Our group assessed the feasibility, clinical correlation, reliability, and acceptance of smartwatches in order to quantify arm resting tremors in PD patients. An Android application on a smartwatch was used to obtain raw data from the smartwatch's gyroscopes. Twenty-two PD patients were consecutively recruited and followed for 1 year. Arm rest tremors were video filmed and scored by two independent raters using the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRS-III). The tremor intensity parameter was defined by the root mean square of the angular speed measured by the smartwatch at the wrist. Sixty-four smartwatch evaluations were completed. The Spearman coefficient among the mean of the resting tremor (UPDRS-III) scores and smartwatch measurements for tremor intensity was 0.81 (p < .001); smartwatch reliability to quantify tremors was checked by intraclass reliability coefficient with a resting tremor = 0.89, minimum detectable change = 59.03%. Good acceptance of the system was shown. Smartwatch use for PD tremor analysis is possible, reliable, well-correlated with clinical scores, and well-accepted by patients for clinical follow-up. The results from these experiments suggest that this commodity hardware has the potential to quantify PD patients' tremors objectively in a consulting-room.
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Affiliation(s)
- Roberto López-Blanco
- Healthcare Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; Neurology Section, Hospital Virgen de la Poveda, Villa del Prado, Madrid, Spain; Medicine Department, Faculty of Medicine, Universidad Complutense Madrid (UCM), Spain.
| | - Miguel A Velasco
- Neural and Cognitive Engineering Group, Centro de Automática y Robótica (CAR), CSIC-UPM, Madrid, Spain
| | | | - Juan Pablo Romero
- Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain; Brain Damage Service, Hospital Beata Maria Ana, Madrid, Spain
| | | | - J Ignacio Serrano
- Neural and Cognitive Engineering Group, Centro de Automática y Robótica (CAR), CSIC-UPM, Madrid, Spain
| | - Eduardo Rocon
- Neural and Cognitive Engineering Group, Centro de Automática y Robótica (CAR), CSIC-UPM, Madrid, Spain
| | - Julián Benito-León
- Medicine Department, Faculty of Medicine, Universidad Complutense Madrid (UCM), Spain; Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
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21
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Aycardi LF, Cifuentes CA, Múnera M, Bayón C, Ramírez O, Lerma S, Frizera A, Rocon E. Evaluation of biomechanical gait parameters of patients with Cerebral Palsy at three different levels of gait assistance using the CPWalker. J Neuroeng Rehabil 2019; 16:15. [PMID: 30691493 PMCID: PMC6350321 DOI: 10.1186/s12984-019-0485-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral Palsy (CP) is the most common cause of permanent serious physical disability in childhood. Although many platforms have been developed, so far there are still not precise guidelines for the rehabilitation of the population with CP. The CPWalker is a robotic platform for the rehabilitation of children with CP, through which they can start experiencing autonomous locomotion in the rehabilitation environment. It allows the possibility of free movement and includes physical and cognitive interfaces into the therapy. The main objective of this work is to evaluate the effects of the CPWalker-based rehabilitation intervention in children with CP by comparing different gait parameters before, during and after the use of the platform. FINDINGS The evaluation was divided in three stages where the gait parameters and symmetry indexes of eight subjects with CP were evaluated. In the first stage patients walked only with the help they receive normally in daily life. During the second stage they walked with the CPWalker and finally, in the third stage, they repeated their gait without the platform. In all stages they wore an inertial G-Sensor Ⓡ while walking through the hospital facilities. The results showed statistical significant differences in several spatio-temporal parameters, pelvic angles and general gait cycle parameters, with and without the use of the robotic device. For the eight patients: cadence, speed and stride length presented similar values when comparing before and after the therapy. However, they decreased during the intervention (both means and standard deviations). No significant differences were found in the symmetry indexes with the use of the platform. In spite of this, a reduction in the pelvic angles ranges and propulsion was observed. CONCLUSIONS The effect of using the device was analyzed for spatio-temporal parameters, pelvic girdle angles and general gait cycle parameters. Among the eighteen initial parameters, seven presented a statistical significant difference when comparing stage 2 of the intervention with stages 1 and 3. Those changes showed the potential of the CPWalker to improve muscular strength and gait patterns of the patients with CP in the long term and to provide useful information for the design of the future generations of rehabilitation robotic devices.
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Affiliation(s)
- Luis Felipe Aycardi
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Carlos Andrés Cifuentes
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Marcela Múnera
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Cristina Bayón
- Neural and Cognitive Engineering Group, CAR of the Spanish National Research Council (CSIC), Arganda del Rey, Madrid, 28500, Spain
| | - Oscar Ramírez
- Neural and Cognitive Engineering Group, CAR of the Spanish National Research Council (CSIC), Arganda del Rey, Madrid, 28500, Spain
| | | | - Anselmo Frizera
- Department of Electrical Engineering, Federal University of Espirito Santo, ES, Vitória, 29075-910, Brazil
| | - Eduardo Rocon
- Neural and Cognitive Engineering Group, CAR of the Spanish National Research Council (CSIC), Arganda del Rey, Madrid, 28500, Spain.
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Benito-León J, Serrano JI, Louis ED, Holobar A, Romero JP, Povalej-Bržan P, Kranjec J, Bermejo-Pareja F, Del Castillo MD, Posada IJ, Rocon E. Essential tremor severity and anatomical changes in brain areas controlling movement sequencing. Ann Clin Transl Neurol 2018; 6:83-97. [PMID: 30656186 PMCID: PMC6331315 DOI: 10.1002/acn3.681] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 01/11/2023] Open
Abstract
Objective Although the cerebello‐thalamo‐cortical network has often been suggested to be of importance in the pathogenesis of essential tremor (ET), the origins of tremorgenic activity in this disease are not fully understood. We used a combination of cortical thickness imaging and neurophysiological studies to analyze whether the severity of tremor was associated with anatomical changes in the brain in ET patients. Methods Magnetic resonance imaging (MRI) and a neurophysiological assessment were performed in 13 nondemented ET patients. High field structural brain MRI images acquired in a 3T scanner and analyses of cortical thickness and surface were carried out. Cortical reconstruction and volumetric segmentation was performed with the FreeSurfer image analysis software. We used high‐density surface electromyography (hdEMG) and inertial measurement units (IMUs) to quantify the tremor severity in upper extrimities of patients. In particular, advanced computer tool was used to reliably identify discharge patterns of individual motor units from surface hdEMG and quantify motor unit synchronization. Results We found significant association between increased motor unit synchronization (i.e., more severe tremor) and cortical changes (i.e., atrophy) in widespread cerebral cortical areas, including the left medial orbitofrontal cortex, left isthmus of the cingulate gyrus, right paracentral lobule, right lingual gyrus, as well as reduced left supramarginal gyrus (inferior parietal cortex), right isthmus of the cingulate gyrus, left thalamus, and left amygdala volumes. Interpretation Given that most of these brain areas are involved in controlling movement sequencing, ET tremor could be the result of an involuntary activation of a program of motor behavior used in the genesis of voluntary repetitive movements.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology University Hospital 12 de Octubre Madrid Spain.,Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED) Madrid Spain.,Department of Medicine Faculty of Medicine Complutense University Madrid Spain
| | - José Ignacio Serrano
- Neural and Cognitive Engineering group Centre for Automation and Robotics (CAR) CSIC-UPM Arganda del Rey Spain
| | - Elan D Louis
- Department of Neurology Yale School of Medicine New Haven Connecticut.,Department of Chronic Disease Epidemiology Yale School of Public Health New Haven Connecticut.,Center for Neuroepidemiology and Clinical Neurological Research Yale School of Medicine and Yale School of Public Health New Haven Connecticut
| | - Ales Holobar
- Faculty of Electrical Engineering and Computer Science University of Maribor Maribor Slovenia
| | - Juan P Romero
- Faculty of Biosanitary Sciences Francisco de Vitoria University Pozuelo de Alarcón, Madrid Spain.,Brain Damage Service Hospital Beata Maria Ana Madrid Spain
| | - Petra Povalej-Bržan
- Faculty of Electrical Engineering and Computer Science University of Maribor Maribor Slovenia.,Faculty of Health Sciences University of Maribor Maribor Slovenia
| | - Jernej Kranjec
- Faculty of Electrical Engineering and Computer Science University of Maribor Maribor Slovenia
| | - Félix Bermejo-Pareja
- Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED) Madrid Spain.,Department of Medicine Faculty of Medicine Complutense University Madrid Spain.,Clinical Research Unit University Hospital 12 de Octubre Madrid Spain
| | - María Dolores Del Castillo
- Neural and Cognitive Engineering group Centre for Automation and Robotics (CAR) CSIC-UPM Arganda del Rey Spain
| | - Ignacio Javier Posada
- Department of Neurology University Hospital 12 de Octubre Madrid Spain.,Department of Medicine Faculty of Medicine Complutense University Madrid Spain
| | - Eduardo Rocon
- Neural and Cognitive Engineering group Centre for Automation and Robotics (CAR) CSIC-UPM Arganda del Rey Spain
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Holobar A, Gallego JA, Kranjec J, Rocon E, Romero JP, Benito-León J, Pons JL, Glaser V. Motor Unit-Driven Identification of Pathological Tremor in Electroencephalograms. Front Neurol 2018; 9:879. [PMID: 30420827 PMCID: PMC6215829 DOI: 10.3389/fneur.2018.00879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/28/2018] [Indexed: 01/03/2023] Open
Abstract
Background: Traditional studies on the neural mechanisms of tremor use coherence analysis to investigate the relationship between cortical and muscle activity, measured by electroencephalograms (EEG) and electromyograms (EMG). This methodology is limited by the need of relatively long signal recordings, and it is sensitive to EEG artifacts. Here, we analytically derive and experimentally validate a new method for automatic extraction of the tremor-related EEG component in pathological tremor patients that aims to overcome these limitations. Methods: We exploit the coupling between the tremor-related cortical activity and motor unit population firings to build a linear minimum mean square error estimator of the tremor component in EEG. We estimated the motor unit population activity by decomposing surface EMG signals into constituent motor unit spike trains, which we summed up into a cumulative spike train (CST). We used this CST to initialize our tremor-related EEG component estimate, which we optimized using a novel approach proposed here. Results: Tests on simulated signals demonstrate that our new method is robust to both noise and motor unit firing variability, and that it performs well across a wide range of spectral characteristics of the tremor. Results on 9 essential (ET) and 9 Parkinson's disease (PD) patients show a ~2-fold increase in amplitude of the coherence between the estimated EEG component and the CST, compared to the classical EEG-EMG coherence analysis. Conclusions: We have developed a novel method that allows for more precise and robust estimation of the tremor-related EEG component. This method does not require artifact removal, provides reliable results in relatively short datasets, and tracks changes in the tremor-related cortical activity over time.
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Affiliation(s)
- Aleš Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Juan A Gallego
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council, Arganda del Rey, Spain
| | - Jernej Kranjec
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Eduardo Rocon
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council, Arganda del Rey, Spain
| | - Juan P Romero
- Neurorehabilitation and Brain Damage Research Group, Experimental Sciences School, Universidad Francisco de Vitoria, Madrid, Spain.,Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain
| | - Julián Benito-León
- Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain.,Center of Biomedical Network Research on Neurodegenerative Diseases, Madrid, Spain.,Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - José L Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
| | - Vojko Glaser
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
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Serrano JI, del Castillo MD, Cortés V, Mendes N, Arroyo A, Andreo J, Rocon E, del Valle M, Herreros J, Romero JP. EEG Microstates Change in Response to Increase in Dopaminergic Stimulation in Typical Parkinson's Disease Patients. Front Neurosci 2018; 12:714. [PMID: 30374285 PMCID: PMC6196245 DOI: 10.3389/fnins.2018.00714] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives: Characterizing pharmacological response in Parkinson's Disease (PD) patients may be a challenge in early stages but gives valuable clues for diagnosis. Neurotropic drugs may modulate Electroencephalography (EEG) microstates (MS). We investigated EEG-MS default-mode network changes in response to dopaminergic stimulation in PD. Methods: Fourteen PD subjects in HY stage III or less were included, and twenty-one healthy controls. All patients were receiving dopaminergic stimulation with levodopa or dopaminergic agonists. Resting EEG activity was recorded before the first daily PD medication dose and 1 h after drug intake resting EEG activity was again recorded. Time and frequency variables for each MS were calculated. Results: Parkinson's disease subjects MS A duration decreases after levodopa intake, MS B appears more often than before levodopa intake. MS E was not present, but MS G was. There were no significant differences between control subjects and patients after medication intake. Conclusion: Clinical response to dopaminergic drugs in PD is characterized by clear changes in MS profile. Significance: This work demonstrates that there are clear EEG MS markers of PD dopaminergic stimulation state. The characterization of the disease and its response to dopaminergic medication may be of help for early therapeutic diagnosis.
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Affiliation(s)
- J. Ignacio Serrano
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council – Technical University of Madrid, Madrid, Spain
| | - María Dolores del Castillo
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council – Technical University of Madrid, Madrid, Spain
| | - Verónica Cortés
- Faculty of Experimental Sciences, Francisco de Vitoria University, Madrid, Spain
| | - Nuno Mendes
- Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Aida Arroyo
- Faculty of Experimental Sciences, Francisco de Vitoria University, Madrid, Spain
| | - Jorge Andreo
- Faculty of Experimental Sciences, Francisco de Vitoria University, Madrid, Spain
| | - Eduardo Rocon
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council – Technical University of Madrid, Madrid, Spain
| | - María del Valle
- Department of Neurology, Fuenlabrada University Hospital, Madrid, Spain
| | - Jaime Herreros
- Department of Neurology, Infanta Leonor University Hospital, Madrid, Spain
| | - Juan Pablo Romero
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics, Spanish National Research Council – Technical University of Madrid, Madrid, Spain
- Brain Damage Unit, Hospital Beata Maria Ana, Madrid, Spain
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López-Blanco R, Benito-León J, Llamas-Velasco S, Del Castillo MD, Serrano JI, Rocon E, Romero JP, Velasco MA. Interaction with touchscreen smartphones in patients with essential tremor and healthy individuals. Neurologia 2018; 36:S0213-4853(18)30178-6. [PMID: 30100094 DOI: 10.1016/j.nrl.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/17/2018] [Accepted: 05/27/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Smartphones use in biomedical research is becoming more prevalent in different clinical settings. We performed a pilot study to obtain information on smartphone use by patients with essential tremor (ET) and healthy controls, with a view to determining whether performance of touchscreen tasks is different between these groups and describing touchscreen interaction factors. METHOD A total of 31 patients with ET and 40 sex- and age-matched healthy controls completed a descriptive questionnaire about the use of smartphones. Participants subsequently interacted with an under-development Android application, and performed 4 tests evaluating typical touchscreen interaction gestures; each test was performed 5 times. RESULT The type of smartphone use and touchscreen interaction were not significantly different between patients and controls. Age and frequency of smartphone use are key factors in touchscreen interaction. CONCLUSION Our results support the use of smartphone touchscreens for research into ET, although further studies are required.
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Affiliation(s)
- R López-Blanco
- Instituto de Investigación (i+12), Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - J Benito-León
- Instituto de Investigación (i+12), Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
| | - S Llamas-Velasco
- Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
| | - M D Del Castillo
- Centro de Automática y Robótica (CAR) CSIC-UPM, Arganda del Rey, Madrid, España
| | - J I Serrano
- Centro de Automática y Robótica (CAR) CSIC-UPM, Arganda del Rey, Madrid, España
| | - E Rocon
- Centro de Automática y Robótica (CAR) CSIC-UPM, Arganda del Rey, Madrid, España
| | - J P Romero
- Facultad de Ciencias de la Salud, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, España; Unidad de Daño Cerebral, Hospital Beata Maria Ana, Madrid, España
| | - M A Velasco
- Centro de Automática y Robótica (CAR) CSIC-UPM, Arganda del Rey, Madrid, España
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Bayón C, Martín-Lorenzo T, Moral-Saiz B, Ramírez Ó, Pérez-Somarriba Á, Lerma-Lara S, Martínez I, Rocon E. A robot-based gait training therapy for pediatric population with cerebral palsy: goal setting, proposal and preliminary clinical implementation. J Neuroeng Rehabil 2018; 15:69. [PMID: 30053857 PMCID: PMC6063005 DOI: 10.1186/s12984-018-0412-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of robotic trainers has increased with the aim of improving gait function in patients with limitations. Nevertheless, there is an absence of studies that deeply describe detailed guidelines of how to correctly implement robot-based treatments for gait rehabilitation. This contribution proposes an accurate robot-based training program for gait rehabilitation of pediatric population with Cerebral Palsy (CP). METHODS The program is focused on the achievement of some specifications defined by the International Classification of Functioning, Disability and Health framework, Children and Youth version (ICF-CY). It is framed on 16 non-consecutive sessions where motor control, strength and power exercises of lower limbs are performed in parallel with a postural control strategy. A clinical evaluation with four pediatric patients with CP using the CPWalker robotic platform is presented. RESULTS The preliminary evaluation with patients with CP shows improvements in several aspects as strength (74.03 ± 40.20%), mean velocity (21.46 ± 33.79%), step length (17.95 ± 20.45%) or gait performance (e.g. 66 ± 63.54% in Gross Motor Function Measure-88 items, E and D dimensions). CONCLUSIONS The improvements achieved in the short term show the importance of working strength and power functions meanwhile over-ground training with postural control. This research could serve as preliminary support for future clinical implementations in any robotic device. TRIAL REGISTRATION The study was carried out with the number R-0032/12 from Local Ethical Committee of the Hospital Infantil Niño Jesús. Public trial registered on March 23, 2017: ISRCTN18254257 .
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Affiliation(s)
- Cristina Bayón
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain
| | - Teresa Martín-Lorenzo
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Universidad Rey Juan Carlos, Madrid, Spain
| | - Beatriz Moral-Saiz
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Universidad de La Salle, Madrid, Spain
| | - Óscar Ramírez
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain
| | | | - Sergio Lerma-Lara
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Universidad de La Salle, Madrid, Spain
| | | | - Eduardo Rocon
- Centre for Automation and Robotics (CAR), CSIC-UPM, Ctra Campo Real km 0.2 - La Poveda-Arganda del Rey, 28500, Madrid, Spain.
- Universidade Federal do Espírito Santo, Vitória, Brazil.
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Martín Lorenzo T, Rocon E, Martínez Caballero I, Lerma Lara S. Medial gastrocnemius structure and gait kinetics in spastic cerebral palsy and typically developing children: A cross-sectional study. Medicine (Baltimore) 2018; 97:e10776. [PMID: 29794756 PMCID: PMC6392514 DOI: 10.1097/md.0000000000010776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare medial gastrocnemius muscle-tendon structure, gait propulsive forces, and ankle joint gait kinetics between typically developing children and those with spastic cerebral palsy, and to describe significant associations between structure and function in children with spastic cerebral palsy.A sample of typically developing children (n = 9 /16 limbs) and a sample of children with spastic cerebral palsy (n = 29 /43 limbs) were recruited. Ultrasound and 3-dimensional motion capture were used to assess muscle-tendon structure, and propulsive forces and ankle joint kinetics during gait, respectively.Children with spastic cerebral palsy had shorter fascicles and muscles, and longer Achilles tendons than typically developing children. Furthermore, total negative power and peak negative power at the ankle were greater, while total positive power, peak positive power, net power, total vertical ground reaction force, and peak vertical and anterior ground reaction forces were smaller compared to typically developing children. Correlation analyses revealed that smaller resting ankle joint angles and greater maximum dorsiflexion in children with spastic cerebral palsy accounted for a significant decrease in peak negative power. Furthermore, short fascicles, small fascicle to belly ratios, and large tendon to fascicle ratios accounted for a decrease in propulsive force generation.Alterations observed in the medial gastrocnemius muscle-tendon structure of children with spastic cerebral palsy may impair propulsive mechanisms during gait. Therefore, conventional treatments should be revised on the basis of muscle-tendon adaptations.
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Affiliation(s)
- Teresa Martín Lorenzo
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Arganda del Rey
| | | | - Sergio Lerma Lara
- Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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Benito-León J, Serrano JI, Louis ED, Holobar A, Romero JP, Povalej-Bržan P, Bermejo-Pareja F, Del Castillo MD, Posada IJ, Rocon E. Tremor severity in Parkinson's disease and cortical changes of areas controlling movement sequencing: A preliminary study. J Neurosci Res 2018; 96:1341-1352. [PMID: 29660812 DOI: 10.1002/jnr.24248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/24/2018] [Accepted: 03/26/2018] [Indexed: 11/07/2022]
Abstract
There remains much to learn about the changes in cortical anatomy that are associated with tremor severity in Parkinson's disease (PD). For this reason, we used a combination of structural neuroimaging to measure cortical thickness and neurophysiological studies to analyze whether PD tremor was associated with cortex integrity. Magnetic resonance imaging and neurophysiological assessment were performed in 13 nondemented PD patients (9 women, 69.2%) with a clearly tremor-dominant phenotype. Cortical reconstruction and volumetric segmentation were performed with the Freesurfer image analysis software. Assessment of tremor was performed by means of high-density surface electromyography (hdEMG) and inertial measurement units (IMUs). Individual motor unit discharge patterns were identified from surface hdEMG and tremor metrics quantifying motor unit synchronization from IMUs. Increased motor unit synchronization (i.e., more severe tremor) was associated with cortical changes (i.e., atrophy) in wide-spread cortical areas, including caudal middle frontal regions bilaterally (dorsal premotor cortices), left inferior parietal lobe (posterior parietal cortex), left lateral orbitofrontal cortex, cingulate cortex bilaterally, left posterior and transverse temporal cortex, and left occipital lobe, as well as reduced left middle temporal volume. Given that the majority of these areas are involved in controlling movement sequencing, our results support Albert's classic hypothesis that PD tremor may be the result of an involuntary activation of a program of motor behavior used in the genesis of rapid voluntary alternating movements.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain
- Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), Spain
- Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - J Ignacio Serrano
- Neural and Cognitive Engineering group, Centre for Automation and Robotics (CAR) CSIC-UPM, Arganda del Rey, Spain
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Medicine and Yale School of Public Health, Center for Neuroepidemiology and Clinical Neurological Research, New Haven, Connecticut, USA
| | - Ales Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Juan P Romero
- Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
- Brain Damage Service, Hospital Beata Maria Ana, Madrid, Spain
| | - P Povalej-Bržan
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
- Faculty of Health Sciences, Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Félix Bermejo-Pareja
- Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), Spain
- Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
- Clinical Research Unit, University Hospital 12 de Octubre, Madrid, Spain
| | - M Dolores Del Castillo
- Neural and Cognitive Engineering group, Centre for Automation and Robotics (CAR) CSIC-UPM, Arganda del Rey, Spain
| | - Ignacio J Posada
- Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Eduardo Rocon
- Neural and Cognitive Engineering group, Centre for Automation and Robotics (CAR) CSIC-UPM, Arganda del Rey, Spain
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López-Blanco R, Velasco MA, Méndez-Guerrero A, Romero JP, Del Castillo MD, Serrano JI, Benito-León J, Bermejo-Pareja F, Rocon E. Essential tremor quantification based on the combined use of a smartphone and a smartwatch: The NetMD study. J Neurosci Methods 2018; 303:95-102. [PMID: 29481820 DOI: 10.1016/j.jneumeth.2018.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The use of wearable technology is an emerging field of research in movement disorders. This paper introduces a clinical study to evaluate the feasibility, clinical correlation and reliability of using a system based in smartwatches to quantify tremor in essential tremor (ET) patients and check its acceptance as clinical monitoring tool. NEW METHOD The system is based on a commercial smartwatch and an Android smartphone. An investigational Android application controls the process of recording raw data from the smartwatch three-dimensional gyroscopes. Thirty-four ET patients were consecutively enrolled in the experiments and assessed along one year. Arm tremor was videofilmed and scored using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). Tremor intensity was quantified with the root mean square of angular velocity measured in the patients' wrists. RESULTS Eighty-two assessments with smartwatches were performed. Spearman's correlation coefficients (ρ) between clinical tremor (FTM-TRS) scores and smartwatch measures for tremor intensity were 0.590 at rest; ρ = 0.738 in steady posture; ρ = 0.189 in finger-to-nose maneuvers; and ρ = 0.652 in pouring water task. Smartwatch reliability was checked by intraclass realiability coefficients: 0.85, 0.95, 0.91, 0.95 respectively. Most of patients showed good acceptance of the system. COMPARISON WITH EXISTING METHOD(S) This commodity hardware contributes to quantify tremor objectively in a consulting-room by customized Android smart devices as clinical monitoring tool. CONCLUSIONS The NetMD system for tremor analysis is feasible, well-correlated with clinical scores, reliable and well-accepted by patients to tremor follow-up. Therefore, it could be an option to objectively quantify tremor in ET patients during their regular follow-up.
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Affiliation(s)
- Roberto López-Blanco
- Healthcare Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; Neurology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares Madrid, Spain.
| | | | | | - Juan Pablo Romero
- Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain; Brain Damage Service, Hospital Beata Maria Ana, Madrid, Spain
| | | | | | - Julián Benito-León
- Healthcare Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Center of Biomedical Network Research on Neurodegenerative Dseases (CIBERNED), Spain; Medicine Department, Faculty of Medicine, Universidad Complutense Madrid (UCM), Spain
| | - Félix Bermejo-Pareja
- Medicine Department, Faculty of Medicine, Universidad Complutense Madrid (UCM), Spain; Clinical Research Unit, University Hospital, "12 de Octubre", Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica (CAR), CSIC-UPM, Madrid, Spain
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Delisle-Rodriguez D, Villa-Parra AC, Bastos-Filho T, López-Delis A, Frizera-Neto A, Krishnan S, Rocon E. Adaptive Spatial Filter Based on Similarity Indices to Preserve the Neural Information on EEG Signals during On-Line Processing. Sensors (Basel) 2017; 17:s17122725. [PMID: 29186848 PMCID: PMC5751387 DOI: 10.3390/s17122725] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/13/2017] [Accepted: 11/19/2017] [Indexed: 12/20/2022]
Abstract
This work presents a new on-line adaptive filter, which is based on a similarity analysis between standard electrode locations, in order to reduce artifacts and common interferences throughout electroencephalography (EEG) signals, but preserving the useful information. Standard deviation and Concordance Correlation Coefficient (CCC) between target electrodes and its correspondent neighbor electrodes are analyzed on sliding windows to select those neighbors that are highly correlated. Afterwards, a model based on CCC is applied to provide higher values of weight to those correlated electrodes with lower similarity to the target electrode. The approach was applied to brain computer-interfaces (BCIs) based on Canonical Correlation Analysis (CCA) to recognize 40 targets of steady-state visual evoked potential (SSVEP), providing an accuracy (ACC) of 86.44 ± 2.81%. In addition, also using this approach, features of low frequency were selected in the pre-processing stage of another BCI to recognize gait planning. In this case, the recognition was significantly (p<0.01) improved for most of the subjects (ACC≥74.79%), when compared with other BCIs based on Common Spatial Pattern, Filter Bank-Common Spatial Pattern, and Riemannian Geometry.
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Affiliation(s)
- Denis Delisle-Rodriguez
- Postgraduate Program in Electrical Engineering, Federal University of Espirito Santo, 29075-910 Vitoria, Brazil.
- Center of Medical Biophysics, University of Oriente, 90500 Santiago de Cuba, Cuba.
| | - Ana Cecilia Villa-Parra
- Postgraduate Program in Electrical Engineering, Federal University of Espirito Santo, 29075-910 Vitoria, Brazil.
- Biomedical Engineering Research Group GIIB, Universidad Politécnica Salesiana, 010105 Cuenca, Ecuador.
| | - Teodiano Bastos-Filho
- Postgraduate Program in Electrical Engineering, Federal University of Espirito Santo, 29075-910 Vitoria, Brazil.
| | - Alberto López-Delis
- Center of Medical Biophysics, University of Oriente, 90500 Santiago de Cuba, Cuba.
| | - Anselmo Frizera-Neto
- Postgraduate Program in Electrical Engineering, Federal University of Espirito Santo, 29075-910 Vitoria, Brazil.
| | - Sridhar Krishnan
- Department of Electrical and Computer Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada.
| | - Eduardo Rocon
- Centre for Automation and Robotics, CSIC-UPM, 28500 Madrid, Spain.
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Martín Lorenzo T, Rocon E, Martínez Caballero I, Ramírez Barragán A, Lerma Lara S. Prolonged stretching of the ankle plantarflexors elicits muscle-tendon adaptations relevant to ankle gait kinetics in children with spastic cerebral palsy. Med Hypotheses 2017; 109:65-69. [DOI: 10.1016/j.mehy.2017.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 12/21/2022]
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Domingues MF, Tavares C, Leitão C, Frizera-Neto A, Alberto N, Marques C, Radwan A, Rodriguez J, Postolache O, Rocon E, André P, Antunes P. Insole optical fiber Bragg grating sensors network for dynamic vertical force monitoring. J Biomed Opt 2017; 22:91507. [PMID: 28243676 DOI: 10.1117/1.jbo.22.9.091507] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/08/2017] [Indexed: 06/06/2023]
Abstract
In an era of unprecedented progress in technology and increase in population age, continuous and close monitoring of elder citizens and patients is becoming more of a necessity than a luxury. Contributing toward this field and enhancing the life quality of elder citizens and patients with disabilities, this work presents the design and implementation of a noninvasive platform and insole fiber Bragg grating sensors network to monitor the vertical ground reaction forces distribution induced in the foot plantar surface during gait and body center of mass displacements. The acquired measurements are a reliable indication of the accuracy and consistency of the proposed solution in monitoring and mapping the vertical forces active on the foot plantar sole, with a sensitivity up to 11.06 ?? pm / N . The acquired measurements can be used to infer the foot structure and health condition, in addition to anomalies related to spine function and other pathologies (e.g., related to diabetes); also its application in rehabilitation robotics field can dramatically reduce the computational burden of exoskeletons’ control strategy. The proposed technology has the advantages of optical fiber sensing (robustness, noninvasiveness, accuracy, and electromagnetic insensitivity) to surpass all drawbacks verified in traditionally used sensing systems (fragility, instability, and inconsistent feedback).
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Affiliation(s)
- Maria Fátima Domingues
- Instituto de Telecomunicações, Campus Universitário de Santiago, Aveiro, PortugalbCentro de Automática y Robótica, CSIC-UPM, Arganda del Rey, Madrid, SpaincUniversity of Aveiro, Department of Physics and I3N, Campus Universitário de Santiago, Aveiro, Portugal
| | - Cátia Tavares
- Instituto de Telecomunicações, Campus Universitário de Santiago, Aveiro, Portugal
| | - Cátia Leitão
- Instituto de Telecomunicações, Campus Universitário de Santiago, Aveiro, PortugalcUniversity of Aveiro, Department of Physics and I3N, Campus Universitário de Santiago, Aveiro, Portugal
| | - Anselmo Frizera-Neto
- Federal University of Espírito Santo, Department of Electrical Engineering, Goiabeiras, Vitória, Brazil
| | - Nélia Alberto
- Instituto de Telecomunicações, Campus Universitário de Santiago, Aveiro, PortugaleUniversity of Aveiro, Centre for Mechanical Technology and Automation, Department of Mechanical Engineering, Aveiro, Portugal
| | - Carlos Marques
- Instituto de Telecomunicações, Campus Universitário de Santiago, Aveiro, PortugalcUniversity of Aveiro, Department of Physics and I3N, Campus Universitário de Santiago, Aveiro, Portugal
| | - Ayman Radwan
- Instituto de Telecomunicações, Campus Universitário de Santiago, Aveiro, Portugal
| | - Jonathan Rodriguez
- Instituto de Telecomunicações, Campus Universitário de Santiago, Aveiro, Portugal
| | - Octavian Postolache
- Lisbon University Institute, ISCTE-IUL, Instituto de Telecomunicações, Lisbon, Portugal
| | - Eduardo Rocon
- Centro de Automática y Robótica, CSIC-UPM, Arganda del Rey, Madrid, Spain
| | - Paulo André
- University of Lisbon, Instituto Superior Técnico, Instituto de Telecomunicações and Department of Electrical and Computer Engineering, Lisbon, Portugal
| | - Paulo Antunes
- Instituto de Telecomunicações, Campus Universitário de Santiago, Aveiro, PortugalcUniversity of Aveiro, Department of Physics and I3N, Campus Universitário de Santiago, Aveiro, Portugal
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Velasco MA, Raya R, Muzzioli L, Morelli D, Otero A, Iosa M, Cincotti F, Rocon E. Evaluation of cervical posture improvement of children with cerebral palsy after physical therapy based on head movements and serious games. Biomed Eng Online 2017; 16:74. [PMID: 28830552 PMCID: PMC5568605 DOI: 10.1186/s12938-017-0364-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This paper presents the preliminary results of a novel rehabilitation therapy for cervical and trunk control of children with cerebral palsy (CP) based on serious videogames and physical exercise. MATERIALS The therapy is based on the use of the ENLAZA Interface, a head mouse based on inertial technology that will be used to control a set of serious videogames with movements of the head. METHODS Ten users with CP participated in the study. Whereas the control group (n = 5) followed traditional therapies, the experimental group (n = 5) complemented these therapies with a series of ten sessions of gaming with ENLAZA to exercise cervical flexion-extensions, rotations and inclinations in a controlled, engaging environment. RESULTS The ten work sessions yielded improvements in head and trunk control that were higher in the experimental group for Visual Analogue Scale, Goal Attainment Scaling and Trunk Control Measurement Scale (TCMS). Significant differences (27% vs. 2% of percentage improvement) were found between the experimental and control groups for TCMS (p < 0.05). The kinematic assessment shows that there were some improvements in the active and the passive range of motion. However, no significant differences were found pre- and post-intervention. CONCLUSIONS Physical therapy that combines serious games with traditional rehabilitation could allow children with CP to achieve larger function improvements in the trunk and cervical regions. However, given the limited scope of this trial (n = 10) additional studies are needed to corroborate this hypothesis.
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Affiliation(s)
- Miguel A Velasco
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics (CAR) CSIC-UPM, Ctra. Campo Real Km 0.2, 28500, Arganda del Rey, Spain.
| | - Rafael Raya
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics (CAR) CSIC-UPM, Ctra. Campo Real Km 0.2, 28500, Arganda del Rey, Spain.,Department of Information Technologies, Universidad CEU San Pablo, Urbanización Montepríncipe, 28668, Boadilla del Monte, Spain
| | - Luca Muzzioli
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Daniela Morelli
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Abraham Otero
- Department of Information Technologies, Universidad CEU San Pablo, Urbanización Montepríncipe, 28668, Boadilla del Monte, Spain
| | - Marco Iosa
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Febo Cincotti
- Fondazione Santa Lucia, FSL, Via Ardeatina, 306, 00142, Rome, Italy
| | - Eduardo Rocon
- Neural and Cognitive Engineering Group, Centre for Automation and Robotics (CAR) CSIC-UPM, Ctra. Campo Real Km 0.2, 28500, Arganda del Rey, Spain
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Martín Lorenzo T, Albi Rodríguez G, Rocon E, Martínez Caballero I, Lerma Lara S. Relationship of medial gastrocnemius relative fascicle excursion and ankle joint power and work performance during gait in typically developing children: A cross-sectional study. Medicine (Baltimore) 2017; 96:e7572. [PMID: 28723790 PMCID: PMC5521930 DOI: 10.1097/md.0000000000007572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Muscle fascicles lengthen in response to chronic passive stretch through in-series sarcomere addition in order to maintain an optimum sarcomere length. In turn, the muscles' force generating capacity, maximum excursion, and contraction velocity is enhanced. Thus, longer fascicles suggest a greater capacity to develop joint power and work. However, static fascicle length measurements may not be taking sarcomere length differences into account. Thus, we considered relative fascicle excursions through passive ankle dorsiflexion may better correlate with the capacity to generate joint power and work than fascicle length. Therefore, the aim of the present study was to determine if medial gastrocnemius relative fascicle excursions correlate with ankle joint power and work generation during gait in typically developing children. A sample of typically developing children (n = 10) were recruited for this study and data analysis was carried out on 20 legs. Medial gastrocnemius relative fascicle excursion from resting joint angle to maximum dorsiflexion was estimated from trigonometric relations of medial gastrocnemius pennation angle and thickness obtained from B-mode real-time ultrasonography. Furthermore, a three-dimensional motion capture system was used to obtain ankle joint work and power during the stance phase of gait. Significant correlations were found between relative fascicle excursion and peak power absorption (-) r(14) = -0.61, P = .012 accounting for 31% variability, positive work r(18) = 0.56, P = .021 accounting for 31% variability, and late stance positive work r(15) = 0.51, P = .037 accounting for 26% variability. The large unexplained variance may be attributed to mechanics of neighboring structures (e.g., soleus or Achilles tendon mechanics) and proximal joint kinetics which may also contribute to ankle joint power and work performance, and were not taken into account. Further studies are encouraged to provide greater insight on the relationship between relative fascicle excursions and joint function.
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Affiliation(s)
- Teresa Martín Lorenzo
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón
| | - Gustavo Albi Rodríguez
- Servicio de Radiodiagnóstico, Hospital Infantil Universitario Niño Jesús
- Departamento de Anatomía, Histología y Neurociencia, Facultad de Medicina, Universidad Autónoma de Madrid
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Arganda del Rey
| | | | - Sergio Lerma Lara
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, CSEU La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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Serrano JI, Romero JP, Castillo MDD, Rocon E, Louis ED, Benito-León J. A data mining approach using cortical thickness for diagnosis and characterization of essential tremor. Sci Rep 2017; 7:2190. [PMID: 28526878 PMCID: PMC5438396 DOI: 10.1038/s41598-017-02122-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/06/2017] [Indexed: 01/22/2023] Open
Abstract
Essential tremor (ET) is one of the most prevalent movement disorders. Being that it is a common disorder, its diagnosis is considered routine. However, misdiagnoses may occur regularly. Over the past decade, several studies have identified brain morphometric changes in ET, but these changes remain poorly understood. Here, we tested the informativeness of measuring cortical thickness for the purposes of ET diagnosis, applying feature selection and machine learning methods to a study sample of 18 patients with ET and 18 age- and sex-matched healthy control subjects. We found that cortical thickness features alone distinguished the two, ET from controls, with 81% diagnostic accuracy. More specifically, roughness (i.e., the standard deviation of cortical thickness) of the right inferior parietal and right fusiform areas was shown to play a key role in ET characterization. Moreover, these features allowed us to identify subgroups of ET patients as well as healthy subjects at risk for ET. Since treatment of tremors is disease specific, accurate and early diagnosis plays an important role in tremor management. Supporting the clinical diagnosis with novel computer approaches based on the objective evaluation of neuroimage data, like the one presented here, may represent a significant step in this direction.
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Affiliation(s)
- J Ignacio Serrano
- Neural and Cognitive Engineering group, Automation and Robotics Center (CAR), CSIC-UPM, Arganda del Rey, Spain.
| | - Juan P Romero
- Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
- Brain Damage Service, Hospital Beata Maria Ana, Madrid, Spain
| | - Ma Dolores Del Castillo
- Neural and Cognitive Engineering group, Automation and Robotics Center (CAR), CSIC-UPM, Arganda del Rey, Spain
| | - Eduardo Rocon
- Neural and Cognitive Engineering group, Automation and Robotics Center (CAR), CSIC-UPM, Arganda del Rey, Spain
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine and Yale School of Public Health, New Haven, CT, USA
| | - Julián Benito-León
- Department of Neurology, Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), University Hospital 12 de Octubre, Madrid, Spain.
- Department of Medicine, Faculty of Medicine Complutense University, Madrid, Spain.
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Nogueira SL, Lambrecht S, Inoue RS, Bortole M, Montagnoli AN, Moreno JC, Rocon E, Terra MH, Siqueira AAG, Pons JL. Global Kalman filter approaches to estimate absolute angles of lower limb segments. Biomed Eng Online 2017; 16:58. [PMID: 28511658 PMCID: PMC5434567 DOI: 10.1186/s12938-017-0346-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/06/2017] [Indexed: 11/29/2022] Open
Abstract
Background In this paper we propose the use of global Kalman filters (KFs) to estimate absolute angles of lower limb segments. Standard approaches adopt KFs to improve the performance of inertial sensors based on individual link configurations. In consequence, for a multi-body system like a lower limb exoskeleton, the inertial measurements of one link (e.g., the shank) are not taken into account in other link angle estimations (e.g., foot). Global KF approaches, on the other hand, correlate the collective contribution of all signals from lower limb segments observed in the state-space model through the filtering process. We present a novel global KF (matricial global KF) relying only on inertial sensor data, and validate both this KF and a previously presented global KF (Markov Jump Linear Systems, MJLS-based KF), which fuses data from inertial sensors and encoders from an exoskeleton. We furthermore compare both methods to the commonly used local KF. Results The results indicate that the global KFs performed significantly better than the local KF, with an average root mean square error (RMSE) of respectively 0.942° for the MJLS-based KF, 1.167° for the matrical global KF, and 1.202° for the local KFs. Including the data from the exoskeleton encoders also resulted in a significant increase in performance. Conclusion The results indicate that the current practice of using KFs based on local models is suboptimal. Both the presented KF based on inertial sensor data, as well our previously presented global approach fusing inertial sensor data with data from exoskeleton encoders, were superior to local KFs. We therefore recommend to use global KFs for gait analysis and exoskeleton control. Electronic supplementary material The online version of this article (doi:10.1186/s12938-017-0346-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samuel L Nogueira
- Department of Electrical Engineering, Federal University of São Carlos, São Carlos, Brazil.
| | - Stefan Lambrecht
- Division PMA, Department of Mechanical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Biomedical Kinesiology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Roberto S Inoue
- Department of Electrical Engineering, Federal University of São Carlos, São Carlos, Brazil
| | - Magdo Bortole
- Neural Rehabilitation Group, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Arlindo N Montagnoli
- Department of Electrical Engineering, Federal University of São Carlos, São Carlos, Brazil
| | - Juan C Moreno
- Neural Rehabilitation Group, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Eduardo Rocon
- Group of Neural and Cognitive Engineering of the Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Marco H Terra
- Department of Electrical Engineering of the University of São Paulo, São Carlos, Brazil
| | - Adriano A G Siqueira
- Department of Mechanical Engineering of the University of São Paulo, São Carlos, Brazil
| | - Jose L Pons
- Neural Rehabilitation Group, Consejo Superior de Investigaciones Científicas, Madrid, Spain
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Dideriksen JL, Laine CM, Dosen S, Muceli S, Rocon E, Pons JL, Benito-Leon J, Farina D. Electrical Stimulation of Afferent Pathways for the Suppression of Pathological Tremor. Front Neurosci 2017; 11:178. [PMID: 28420958 PMCID: PMC5378793 DOI: 10.3389/fnins.2017.00178] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Pathological tremors are involuntary oscillatory movements which cannot be fully attenuated using conventional treatments. For this reason, several studies have investigated the use of neuromuscular electrical stimulation for tremor suppression. In a recent study, however, we found that electrical stimulation below the motor threshold also suppressed tremor, indicating involvement of afferent pathways. In this study, we further explored this possibility by systematically investigating how tremor suppression by afferent stimulation depends on the stimulation settings. In this way, we aimed at identifying the optimal stimulation strategy, as well as to elucidate the underlying physiological mechanisms of tremor suppression. Stimulation strategies varying the stimulation intensity and pulse timing were tested in nine tremor patients using either intramuscular or surface stimulation. Significant tremor suppression was observed in six patients (tremor suppression > 75% was observed in three patients) and the average optimal suppression level observed across all subjects was 52%. The efficiency for each stimulation setting, however, varied substantially across patients and it was not possible to identify a single set of stimulation parameters that yielded positive results in all patients. For example, tremor suppression was achieved both with stimulation delivered in an out-of-phase pattern with respect to the tremor, and with random timing of the stimulation. Overall, these results indicate that low-current stimulation of afferent fibers is a promising approach for tremor suppression, but that further research is required to identify how the effect can be maximized in the individual patient.
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Affiliation(s)
- Jakob L Dideriksen
- SMI, Department of Health Science and Technology, Aalborg UniversityAalborg, Denmark
| | - Christopher M Laine
- Brain-Body Dynamics Lab, University of Southern CaliforniaLos Angeles, CA, USA
| | - Strahinja Dosen
- Institute of Neurorehabilitation Systems, University Medical Center GöttingenGöttingen, Germany.,Clinic for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center GöttingenGöttingen, Germany
| | - Silvia Muceli
- Institute of Neurorehabilitation Systems, University Medical Center GöttingenGöttingen, Germany.,Clinic for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center GöttingenGöttingen, Germany
| | - Eduardo Rocon
- Center for Automation and Robotics, Consejo Superior de Investigaciones CientíficasArganda del Rey, Spain
| | - José L Pons
- Neural Rehabilitation Group, Instituto Cajal, Consejo Superior de Investigaciones CientíficasMadrid, Spain
| | | | - Dario Farina
- Department of Bioengineering, Imperial College LondonLondon, UK
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Bayón C, Lerma S, Ramírez O, Serrano J, Del Castillo M, Raya R, Belda-Lois J, Martínez I, Rocon E. Locomotor training through a novel robotic platform for gait rehabilitation in pediatric population: short report. J Neuroeng Rehabil 2016; 13:98. [PMID: 27842562 PMCID: PMC5109815 DOI: 10.1186/s12984-016-0206-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 10/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral Palsy (CP) is a disorder of posture and movement due to a defect in the immature brain. The use of robotic devices as alternative treatment to improve the gait function in patients with CP has increased. Nevertheless, current gait trainers are focused on controlling complete joint trajectories, avoiding postural control and the adaptation of the therapy to a specific patient. This paper presents the applicability of a new robotic platform called CPWalker in children with spastic diplegia. FINDINGS CPWalker consists of a smart walker with body weight and autonomous locomotion support and an exoskeleton for joint motion support. Likewise, CPWalker enables strategies to improve postural control during walking. The integrated robotic platform provides means for testing novel gait rehabilitation therapies in subjects with CP and similar motor disorders. Patient-tailored therapies were programmed in the device for its evaluation in three children with spastic diplegia for 5 weeks. After ten sessions of personalized training with CPWalker, the children improved the mean velocity (51.94 ± 41.97 %), cadence (29.19 ± 33.36 %) and step length (26.49 ± 19.58 %) in each leg. Post-3D gait assessments provided kinematic outcomes closer to normal values than Pre-3D assessments. CONCLUSIONS The results show the potential of the novel robotic platform to serve as a rehabilitation tool. The autonomous locomotion and impedance control enhanced the children's participation during therapies. Moreover, participants' postural control was substantially improved, which indicates the usefulness of the approach based on promoting the patient's trunk control while the locomotion therapy is executed. Although results are promising, further studies with bigger sample size are required.
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Affiliation(s)
- C. Bayón
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
| | - S. Lerma
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - O. Ramírez
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
| | - J.I. Serrano
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
| | - M.D. Del Castillo
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
| | - R. Raya
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
| | | | - I. Martínez
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - E. Rocon
- Neural and Cognitive Engineering group, Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Ctra Campo Real km 0.2, Arganda del Rey, Madrid, 28500 Spain
- Postgraduate Program, Universidade Federal do Espírito Santo, Vitória, Brazil
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Koutsou AD, Moreno JC, del Ama AJ, Rocon E, Pons JL. Advances in selective activation of muscles for non-invasive motor neuroprostheses. J Neuroeng Rehabil 2016; 13:56. [PMID: 27296478 PMCID: PMC4907085 DOI: 10.1186/s12984-016-0165-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
Abstract
Non-invasive neuroprosthetic (NP) technologies for movement compensation and rehabilitation remain with challenges for their clinical application. Two of those major challenges are selective activation of muscles and fatigue management. This review discusses how electrode arrays improve the efficiency and selectivity of functional electrical stimulation (FES) applied via transcutaneous electrodes. In this paper we review the principles and achievements during the last decade on techniques for artificial motor unit recruitment to improve the selective activation of muscles. We review the key factors affecting the outcome of muscle force production via multi-pad transcutaneous electrical stimulation and discuss how stimulation parameters can be set to optimize external activation of body segments. A detailed review of existing electrode array systems proposed by different research teams is also provided. Furthermore, a review of the targeted applications of existing electrode arrays for control of upper and lower limb NPs is provided. Eventually, last section demonstrates the potential of electrode arrays to overcome the major challenges of NPs for compensation and rehabilitation of patient-specific impairments.
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Affiliation(s)
- Aikaterini D. Koutsou
- />Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
| | - Juan C. Moreno
- />Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
| | | | - Eduardo Rocon
- />Neural and Cognitive Engineering group, Centro de Automática y Robótica, CAR, Spanish National Research Council, CSIC-UPM, Madrid, Spain
| | - José L. Pons
- />Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
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Benito-León J, Louis ED, Romero JP, Hernández-Tamames JA, Manzanedo E, Álvarez-Linera J, Bermejo-Pareja F, Posada I, Rocon E. Altered Functional Connectivity in Essential Tremor: A Resting-State fMRI Study. Medicine (Baltimore) 2015; 94:e1936. [PMID: 26656325 PMCID: PMC5008470 DOI: 10.1097/md.0000000000001936] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Essential tremor (ET) has been associated with a spectrum of clinical features, with both motor and nonmotor elements, including cognitive deficits. We employed resting-state functional magnetic resonance imaging (fMRI) to assess whether brain networks that might be involved in the pathogenesis of nonmotor manifestations associated with ET are altered, and the relationship between abnormal connectivity and ET severity and neuropsychological function.Resting-state fMRI data in 23 ET patients (12 women and 11 men) and 22 healthy controls (HC) (12 women and 10 men) were analyzed using independent component analysis, in combination with a "dual-regression" technique, to identify the group differences of resting-state networks (RSNs) (default mode network [DMN] and executive, frontoparietal, sensorimotor, cerebellar, auditory/language, and visual networks). All participants underwent a neuropsychological and neuroimaging session, where resting-state data were collected.Relative to HC, ET patients showed increased connectivity in RSNs involved in cognitive processes (DMN and frontoparietal networks) and decreased connectivity in the cerebellum and visual networks. Changes in network integrity were associated not only with ET severity (DMN) and ET duration (DMN and left frontoparietal network), but also with cognitive ability. Moreover, in at least 3 networks (DMN and frontoparietal networks), increased connectivity was associated with worse performance on different cognitive domains (attention, executive function, visuospatial ability, verbal memory, visual memory, and language) and depressive symptoms. Further, in the visual network, decreased connectivity was associated with worse performance on visuospatial ability.ET was associated with abnormal brain connectivity in major RSNs that might be involved in both motor and nonmotor symptoms. Our findings underscore the importance of examining RSNs in this population as a biomarker of disease.
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Affiliation(s)
- Julián Benito-León
- From the Department of Neurology, University Hospital "12 de Octubre", Madrid (JB-L, FB-P, IP); Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (JB-L, FB-P); Department of Medicine, Complutense University, Madrid, Spain (JB-L, FB-P, IP); Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA (EDL); Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón (JPR); Neuroimaging Laboratory, Center for Biomedical Technology, Rey Juan Carlos University, Móstoles (JAH-T, EM); Department of Radiology, Hospital Ruber International, Madrid (JA-L); and Neural and Cognitive Engineering group, CAR, UPM-CSIC, CSIC, La Poveda - Arganda del Rey, Spain (ER)
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Martín Lorenzo T, Lerma Lara S, Martínez-Caballero I, Rocon E. Relative fascicle excursion effects on dynamic strength generation during gait in children with cerebral palsy. Med Hypotheses 2015; 85:385-90. [PMID: 26138625 DOI: 10.1016/j.mehy.2015.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/17/2015] [Indexed: 02/06/2023]
Abstract
Evaluation of muscle structure gives us a better understanding of how muscles contribute to force generation which is significantly altered in children with cerebral palsy (CP). While most muscle structure parameters have shown to be significantly correlated to different expressions of strength development in children with CP and typically developing (TD) children, conflicting results are found for muscle fascicle length. Muscle fascicle length determines muscle excursion and velocity, and contrary to what might be expected, correlations of fascicle length to rate of force development have not been found for children with CP. The lack of correlation between muscle fascicle length and rate of force development in children with CP could be due, on the one hand, to the non-optimal joint position adopted for force generation on the isometric strength tests as compared to the position of TD children. On the other hand, the lack of correlation could be due to the erroneous assumption that muscle fascicle length is representative of sarcomere length. Thus, the relationship between muscle architecture parameters reflecting sarcomere length, such as relative fascicle excursions and dynamic power generation, should be assessed. Understanding of the underlying mechanisms of weakness in children with CP is key for individualized prescription and assessment of muscle-targeted interventions. Findings could imply the detection of children operating on the descending limb of the sarcomere length-tension curve, which in turn might be at greater risk of developing crouch gait. Furthermore, relative muscle fascicle excursions could be used as a predictive variable of outcomes related to crouch gait prevention treatments such as strength training.
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Affiliation(s)
- T Martín Lorenzo
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009 Madrid, Spain; Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.
| | - S Lerma Lara
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009 Madrid, Spain; CSEU La Salle-UAM, Madrid, Spain
| | - I Martínez-Caballero
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009 Madrid, Spain
| | - E Rocon
- Centro de Automática y Robótica CSIC, Madrid, Spain
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Dideriksen JL, Gallego JA, Holobar A, Rocon E, Pons JL, Farina D. One central oscillatory drive is compatible with experimental motor unit behaviour in essential and Parkinsonian tremor. J Neural Eng 2015; 12:046019. [DOI: 10.1088/1741-2560/12/4/046019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lambrecht S, Romero JP, Benito-León J, Rocon E, Pons JL. Task independent identification of sensor location on upper limb from orientation data. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:6627-30. [PMID: 25571515 DOI: 10.1109/embc.2014.6945147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this paper we describe a novel method for sensor placement identification, and demonstrate the effectiveness of this method on an upper limb neuroprothesis for tremor suppression under a variety of tasks. Our objective is to facilitate long-term tremor monitoring; tremor is the most prevalent movement disorder. Two assumptions are made: 1) movement and tremor demonstrate an additive effect further down the kinematic chain; 2) most applications have chained or fixed sensor locations. These assumptions justify obtaining absolute location through identifying relative location and thus to allow us to simplify the classification algorithm. Seventeen tasks were performed by patients suffering from essential tremor or Parkinson's disease. Ten features were found that resulted in 98.30% average accuracy (min: 92.31%; max: 100%) for the best configuration, irrespective of the task being performed. The method presented here is an important step towards more user-friendly and context-aware neuroprostheses for tremor suppression and monitoring, and facilitates the use of wearable sensors by non-trained personnel.
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Poppendieck W, Muceli S, Dideriksen J, Rocon E, Pons JL, Farina D, Hoffmann KP. A new generation of double-sided intramuscular electrodes for multi-channel recording and stimulation. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2015:7135-7138. [PMID: 26737937 DOI: 10.1109/embc.2015.7320037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this work, a new generation of intramuscular multi-channel electrode for EMG recording and muscle stimulation is presented. The electrode is based on double-sided polyimide microtechnology, and features electrode contacts on both sides of a thin polyimide filament. The structure is attached to a cannula, allowing insertion and application of the electrode system similar to conventional intramuscular wire electrodes. In the presented design, the electrode has 12 small recording sites on one side of the structure, and 3 large stimulation sites on the other side. Applications of the system include diagnosis and treatment of tremor. To this end, the electrode has been successfully tested in tremor patients. In the future, the concept will be extended to other fields of application including intraneural electrodes.
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Gallego JA, Dideriksen JL, Holobar A, Ibáñez J, Pons JL, Louis ED, Rocon E, Farina D. Influence of common synaptic input to motor neurons on the neural drive to muscle in essential tremor. J Neurophysiol 2014; 113:182-91. [PMID: 25274343 DOI: 10.1152/jn.00531.2014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Tremor in essential tremor (ET) is generated by pathological oscillations at 4-12 Hz, likely originating at cerebello-thalamo-cortical pathways. However, the way in which tremor is represented in the output of the spinal cord circuitries is largely unknown because of the difficulties in identifying the behavior of individual motor units from tremulous muscles. By using novel methods for the decomposition of multichannel surface EMG, we provide a systematic analysis of the discharge properties of motor units in nine ET patients, with concurrent recordings of EEG activity. This analysis allowed us to infer the contribution of common synaptic inputs to motor neurons in ET. Motor unit short-term synchronization was significantly greater in ET patients than in healthy subjects. Furthermore, the strong association between the degree of synchronization and the peak in coherence between motor unit spike trains at the tremor frequency indicated that the high synchronization levels were generated mainly by common synaptic inputs specifically at the tremor frequency. The coherence between EEG and motor unit spike trains demonstrated the presence of common cortical input to the motor neurons at the tremor frequency. Nonetheless, the strength of this input was uncorrelated to the net common synaptic input at the tremor frequency, suggesting a contribution of spinal afferents or secondary supraspinal pathways in projecting common input at the tremor frequency. These results provide the first systematic analysis of the neural drive to the muscle in ET and elucidate some of its characteristics that determine pathological tremulous muscle activity.
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Affiliation(s)
- Juan A Gallego
- Neuroengineering and Cognitive Science Group, Centre for Automation and Robotics, Consejo Superior de Investigaciones Científicas, Arganda del Rey, Spain
| | - Jakob L Dideriksen
- Department of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology Göttingen, Bernstein Center for Computational Neuroscience, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Ales Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Jaime Ibáñez
- Neural Rehabilitation Group, Cajal Institute, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - José L Pons
- Neural Rehabilitation Group, Cajal Institute, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Elan D Louis
- Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; and
| | - Eduardo Rocon
- Neuroengineering and Cognitive Science Group, Centre for Automation and Robotics, Consejo Superior de Investigaciones Científicas, Arganda del Rey, Spain; Postgraduate Program, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Dario Farina
- Department of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology Göttingen, Bernstein Center for Computational Neuroscience, University Medical Center Göttingen, Georg-August University, Göttingen, Germany;
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Lambrecht S, Gallego JA, Rocon E, Pons JL. Automatic real-time monitoring and assessment of tremor parameters in the upper limb from orientation data. Front Neurosci 2014; 8:221. [PMID: 25120424 PMCID: PMC4110507 DOI: 10.3389/fnins.2014.00221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 07/07/2014] [Indexed: 11/13/2022] Open
Abstract
Upper limb tremor is the most prevalent movement disorder and, unfortunately, it is not effectively managed in a large proportion of the patients. Neuroprostheses that stimulate the sensorimotor pathways are one of the most promising alternatives although they are still under development. To enrich the interpretation of data recorded during long-term tremor monitoring and to increase the intelligence of tremor suppression neuroprostheses we need to be aware of the context. Context awareness is a major challenge for neuroprostheses and would allow these devices to react more quickly and appropriately to the changing demands of the user and/or task. Traditionally kinematic features are used to extract context information, with most recently the use of joint angles as highly potential features. In this paper we present two algorithms that enable the robust extraction of joint angle and related features to enable long-term continuous monitoring of tremor with context awareness. First, we describe a novel relative sensor placement identification technique based on orientation data. We focus on relative rather than absolute sensor location, because in many medical applications magnetic and inertial measurement units (MIMU) are used in a chain stretching over adjacent segments, or are always placed on a fixed set of locations. Subsequently we demonstrate how tremor parameters can be extracted from orientation data using an adaptive estimation algorithm. Relative sensor location was detected with an accuracy of 94.12% for the 4 MIMU configuration, and 100% for the 3 MIMU configurations. Kinematic tracking error values with an average deviation of 8% demonstrate our ability to estimate tremor from orientation data. The methods presented in this study constitute an important step toward more user-friendly and context-aware neuroprostheses for tremor suppression and monitoring.
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Affiliation(s)
- Stefan Lambrecht
- Neurorehabilitation group, Cajal Institute, Spanish National Research Council (CSIC) Madrid, Spain
| | - Juan A Gallego
- Neurorehabilitation group, Cajal Institute, Spanish National Research Council (CSIC) Madrid, Spain
| | - Eduardo Rocon
- Neurorehabilitation group, Cajal Institute, Spanish National Research Council (CSIC) Madrid, Spain
| | - Jose L Pons
- Neurorehabilitation group, Cajal Institute, Spanish National Research Council (CSIC) Madrid, Spain
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Dosen S, Muceli S, Dideriksen JL, Romero JP, Rocon E, Pons J, Farina D. Online tremor suppression using electromyography and low-level electrical stimulation. IEEE Trans Neural Syst Rehabil Eng 2014; 23:385-95. [PMID: 25051555 DOI: 10.1109/tnsre.2014.2328296] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tremor is one of the most prevalent movement disorders. There is a large proportion of patients (around 25%) in whom current treatments do not attain a significant tremor reduction. This paper proposes a tremor suppression strategy that detects tremor from the electromyographic signals of the muscles from which tremor originates and counteracts it by delivering electrical stimulation to the antagonist muscles in an out of phase manner. The detection was based on the iterative Hilbert transform and stimulation was delivered above the motor threshold (motor stimulation) and below the motor threshold (sensory stimulation). The system was tested on six patients with predominant wrist flexion/extension tremor (four with Parkinson disease and two with Essential tremor) and led to an average tremor reduction in the range of 46%-81% and 35%-48% across five patients when using the motor and sensory stimulation, respectively. In one patient, the system did not attenuate tremor. These results demonstrate that tremor attenuation might be achieved by delivering electrical stimulation below the motor threshold, preventing muscle fatigue and discomfort for the patients, which sets the basis for the development of an alternative treatment for tremor.
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Ibáñez J, Serrano J, del Castillo M, Gallego J, Rocon E. Online detector of movement intention based on EEG—Application in tremor patients. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2013.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Gallego JÁ, Rocon E, Belda-Lois JM, Pons JL. A neuroprosthesis for tremor management through the control of muscle co-contraction. J Neuroeng Rehabil 2013; 10:36. [PMID: 23587119 PMCID: PMC3661364 DOI: 10.1186/1743-0003-10-36] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 03/25/2013] [Indexed: 11/16/2022] Open
Abstract
Background Pathological tremor is the most prevalent movement disorder. Current treatments do not attain a significant tremor reduction in a large proportion of patients, which makes tremor a major cause of loss of quality of life. For instance, according to some estimates, 65% of those suffering from upper limb tremor report serious difficulties during daily living. Therefore, novel forms for tremor management are required. Since muscles intrinsically behave as a low pass filter, and tremor frequency is above that of volitional movements, the authors envisioned the exploitation of these properties as a means of developing a novel treatment alternative. This treatment would rely on muscle co-contraction for tremor management, similarly to the strategy employed by the intact central nervous system to stabilize a limb during certain tasks. Methods We implemented a neuroprosthesis that regulated the level of muscle co-contraction by injecting current at a pair of antagonists through transcutaneous neurostimulation. Co-contraction was adapted to the instantaneous parameters of tremor, which were estimated from the raw recordings of a pair of solid state gyroscopes with a purposely designed adaptive algorithm. For the experimental validation, we enrolled six patients suffering from parkinsonian or essential tremor of different severity, and evaluated the effect of the neuroprosthesis during standard tasks employed for neurological examination. Results The neuroprosthesis attained significant attenuation of tremor (p<0.001), and reduced its amplitude up to a 52.33±25.48%. Furthermore, it alleviated both essential and parkinsonian tremor in spite of their different etiology and symptomatology. Tremor severity was not a limiting factor on the performance of the neuroprosthesis, although there was a subtle trend towards larger attenuation of more severe tremors. Tremor frequency was not altered during neurostimulation, as expected from the central origin of Parkinson’s disease and essential tremor. All patients showed a good tolerance to neurostimulation in terms of comfort and absence of pain, and some spontaneously reported that they felt that tremor was reduced when the neuroprosthesis was activated. Conclusions The results presented herein demonstrate that the neuroprosthesis provides systematic attenuation of the two major types of tremor, irrespectively from their severity. This study sets the basis for the validation of the neuroprosthesis as an alternative, non-invasive means for tremor management.
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Affiliation(s)
- Juan Álvaro Gallego
- Bioengineering Group, Consejo Superior de Investigaciones Científicas (CSIC), Ctra Campo Real km 0.2-La Poveda, 28500 Arganda del Rey, Spain.
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Gallego JA, Rocon E, Belda-Lois JM, Koutsou AD, Mena S, Castillo A, Pons JL. Design and validation of a neuroprosthesis for the treatment of upper limb tremor. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:3606-3609. [PMID: 24110510 DOI: 10.1109/embc.2013.6610323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pathological tremor is the most prevalent movement disorder. In spite of the existence of various treatments for it, tremor poses a functional problem to a large proportion of patients. This paper presents the design and implementation of a novel neuroprosthesis for tremor management. The paper starts by reviewing a series of design criteria that were established after analyzing users needs and the expected functionality of the system. Then, it summarizes the design of the neuroprosthesis, which was built to meet the criteria defined previously. Experimental results with a representative group of 12 patients show that the neuroprosthesis provided significant (p < 0.001) and systematic tremor attenuation (in average 52.33 ± 25.48 %), and encourage its functional evaluation as a potential new treatment for tremor in a large cohort of patients.
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