1
|
Belalcazar-Bolaños EA, Torricelli D, Pons JL. Automatic Detection of Magnetic Disturbances in Magnetic Inertial Measurement Unit Sensors Based on Recurrent Neural Networks. Sensors (Basel) 2023; 23:9683. [PMID: 38139536 PMCID: PMC10747388 DOI: 10.3390/s23249683] [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] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
This paper proposes a new methodology for the automatic detection of magnetic disturbances from magnetic inertial measurement unit (MIMU) sensors based on deep learning. The proposed approach considers magnetometer data as input to a long short-term memory (LSTM) neural network and obtains a labeled time series output with the posterior probabilities of magnetic disturbance. We trained our algorithm on a data set that reproduces a wide range of magnetic perturbations and MIMU motions in a repeatable and reproducible way. The model was trained and tested using 15 folds, which considered independence in sensor, disturbance direction, and signal type. On average, the network can adequately detect the disturbances in 98% of the cases, which represents a significant improvement over current threshold-based detection algorithms.
Collapse
Affiliation(s)
- Elkyn Alexander Belalcazar-Bolaños
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), 28002 Madrid, Spain
- Department of Automation and Systems Engineering, Carlos III University, 28911 Madrid, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), 28002 Madrid, Spain
| | - José L. Pons
- Legs and Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Evanston, IL 60208, USA
| |
Collapse
|
2
|
San Agustín A, Crevillén D, Soto-León V, Moreno JC, Oliviero A, Pons JL. Transcranial magnetic stimulation combined with endogenous human hippocampal and motor cortical activity enhances memory. PLoS One 2023; 18:e0295413. [PMID: 38060602 PMCID: PMC10703210 DOI: 10.1371/journal.pone.0295413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
The hippocampus is a fundamental cortical structure in the memory process of encoding, retaining, and recalling information. Transcranial Magnetic Stimulation (TMS) following a Paired Associative Stimulation (PAS) enhances nervous system excitability and promotes cortical plasticity mechanisms by synchronizing two stimuli in the same neural pathway. However, PAS has not been shown to improve memorization capacity yet. Here, we present an innovative protocol stemming from the PAS paradigm, which combines single-pulse TMS to the hippocampus with endogenous hippocampal activity during a working memory (WM) task. 96 volunteers were randomized across one experimental group and three parallel groups (motor cortex stimulation, sham stimulation, and no stimulation) in a single session. This combined-stimuli configuration resulted in an increased memorization capacity in the WM task, which was dependent on the stimulated brain location and subjects' basal memory performance. These results are potentially significant for clinical research on memory dysfunction and its related neurological disorders. Future research on paired associative or combined stimulation is required to unveil stimulation-derived neural mechanisms that enhance the ability to memorize.
Collapse
Affiliation(s)
- Arantzazu San Agustín
- Neural Rehabilitation Group (NRG), Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
- PhD Program in Neuroscience, Universidad Autonoma de Madrid-Cajal Institute, Madrid, Spain
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Legs & Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, IL, United States of America
| | - David Crevillén
- Neural Rehabilitation Group (NRG), Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Vanesa Soto-León
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Juan C. Moreno
- Neural Rehabilitation Group (NRG), Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Center for Clinical Neuroscience, Hospital Los Madroños, Brunete, Spain
| | - José L. Pons
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Legs & Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, IL, United States of America
| |
Collapse
|
3
|
Gutiérrez-Muto AM, Bestmann S, Sánchez de la Torre R, Pons JL, Oliviero A, Tornero J. The complex landscape of TMS devices: A brief overview. PLoS One 2023; 18:e0292733. [PMID: 38015924 PMCID: PMC10684101 DOI: 10.1371/journal.pone.0292733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/27/2023] [Indexed: 11/30/2023] Open
Abstract
The increasing application of TMS in research and therapy has spawned an ever-growing number of commercial and non-commercial TMS devices and technology development. New CE-marked devices appear at a rate of approximately one every two years, with new FDA-approved application of TMS occurring at a similar rate. With the resulting complex landscape of TMS devices and their application, accessible information about the technological characteristics of the TMS devices, such as the type of their circuitry, their pulse characteristics, or permitted protocols would be beneficial. We here present an overview and open access database summarizing key features and applications of available commercial and non-commercial TMS devices (http://www.tmsbase.info). This may guide comparison and decision making about the use of these devices. A bibliometric analysis was performed by identifying commercial and non-commercial TMS devices from which a comprehensive database was created summarizing their publicly available characteristics, both from a technical and clinical point of view. In this document, we introduce both the commercial devices and prototypes found in the literature. The technical specifications that unify these devices are briefly analysed in two separate tables: power electronics, waveform, protocols, and coil types. In the prototype TMS systems, the proposed innovations are focused on improving the treatment regarding the patient: noise cancellation, controllable parameters, and multiple stimulation. This analysis shows that the landscape of TMS is becoming increasingly fragmented, with new devices appearing ever more frequently. The review provided here can support development of benchmarking frameworks and comparison between TMS systems, inform the choice of TMS platforms for specific research and therapeutic applications, and guide future technology development for neuromodulation devices. This standardisation strategy will allow a better end-user choice, with an impact on the TMS manufacturing industry and a homogenisation of patient samples in multi-centre clinical studies. As an open access repository, we envisage the database to grow along with the dynamic development of TMS devices and applications through community-lead curation.
Collapse
Affiliation(s)
| | - Sven Bestmann
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | | | - José L. Pons
- Legs and Walking Lab, Shirley Ryan Ability Laboratory (Formerly Rehabilitation Institute of Chicago), Chicago, IL, United States of America
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Antonio Oliviero
- Center for Clinical Neuroscience, Hospital Los Madroños, Brunete, Madrid, Spain
- Advanced Neurorehabilitation Unit, Hospital Los Madroños, Brunete, Madrid, Spain
| | - Jesús Tornero
- Center for Clinical Neuroscience, Hospital Los Madroños, Brunete, Madrid, Spain
| |
Collapse
|
4
|
Ferreira CL, Oliveira Barroso F, Torricelli D, Pons JL, Politti F, Lucareli PRG. Muscle synergies analysis shows altered neural strategies in women with patellofemoral pain during walking. PLoS One 2023; 18:e0292464. [PMID: 37796922 PMCID: PMC10553307 DOI: 10.1371/journal.pone.0292464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Abstract
Several studies suggest that the central nervous system coordinates muscle activation by modulating neural commands directed to groups of muscles combined to form muscle synergies. Individuals with patellofemoral pain (PFP) move differently from asymptomatic individuals. Understanding the neural strategies involved in the execution of tasks such as walking can help comprehend how the movement is planned and better understand this clinical condition. The objective of this study was to compare muscle synergies between women with and without PFP during walking. Eleven women with PFP and thirteen asymptomatic women were assessed using three-dimensional kinematics and electromyography (EMG) while walking at self-selected speed. Kinematics of the trunk, pelvis and lower limbs were analyzed through the Movement Deviation Profile. Muscle synergies were extracted from the EMG signals of eight lower limb muscles collected throughout the whole gait cycle. Kinematic differences between the two groups (p<0.001, z-score = 3.06) were more evident during loading response, terminal stance, and pre-swing. PFP group presented a lower number of muscle synergies (p = 0.037), and greater variability accounted for (VAFtotal) when using 3 (p = 0.017), 4 (p = 0.004), and 5 (p = 0.012) synergies to reconstruct all EMG signals. The PFP group also presented higher VAFmuscle for rectus femoris (p = 0.048) and gastrocnemius medialis (p = 0.019) when considering 4 synergies. Our results suggest that women with PFP show lower motor complexity and deficit in muscle coordination to execute gait, indicating that gait in PFP is the result of different neural commands compared to asymptomatic women.
Collapse
Affiliation(s)
- Cintia Lopes Ferreira
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - José L. Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
- Legs & Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, IL, United States of America
- Department Biomedical Engineering & Dept. Mechanical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, United States of America
- Department of PM&R, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Fabiano Politti
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| | - Paulo Roberto Garcia Lucareli
- Department of Rehabilitation Science, Human Motion Analysis Laboratory, Universidade Nove de Julho, São Paulo, Brazil
| |
Collapse
|
5
|
Levine J, Avrillon S, Farina D, Hug F, Pons JL. Two motor neuron synergies, invariant across ankle joint angles, activate the triceps surae during plantarflexion. J Physiol 2023; 601:4337-4354. [PMID: 37615253 PMCID: PMC10952824 DOI: 10.1113/jp284503] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/05/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
Recent studies have suggested that the nervous system generates movements by controlling groups of motor neurons (synergies) that do not always align with muscle anatomy. In this study, we determined whether these synergies are robust across tasks with different mechanical constraints. We identified motor neuron synergies using principal component analysis (PCA) and cross-correlations between smoothed discharge rates of motor neurons. In part 1, we used simulations to validate these methods. The results suggested that PCA can accurately identify the number of common inputs and their distribution across active motor neurons. Moreover, the results confirmed that cross-correlation can separate pairs of motor neurons that receive common inputs from those that do not receive common inputs. In part 2, 16 individuals performed plantarflexion at three ankle angles while we recorded EMG signals from the gastrocnemius lateralis (GL) and medialis (GM) and the soleus (SOL) with grids of surface electrodes. The PCA revealed two motor neuron synergies. These motor neuron synergies were relatively stable, with no significant differences in the distribution of motor neuron weights across ankle angles (P = 0.62). When the cross-correlation was calculated for pairs of motor units tracked across ankle angles, we observed that only 13.0% of pairs of motor units from GL and GM exhibited significant correlations of their smoothed discharge rates across angles, confirming the low level of common inputs between these muscles. Overall, these results highlight the modularity of movement control at the motor neuron level, suggesting a sensible reduction of computational resources for movement control. KEY POINTS: The CNS might generate movements by activating groups of motor neurons (synergies) with common inputs. We show here that two main sources of common inputs drive the motor neurons innervating the triceps surae muscles during isometric ankle plantarflexions. We report that the distribution of these common inputs is globally invariant despite changing the mechanical constraints of the tasks, i.e. the ankle angle. These results suggest the functional relevance of the modular organization of the CNS to control movements.
Collapse
Affiliation(s)
- Jackson Levine
- Legs + Walking LabShirley Ryan AbilityLabChicagoILUSA
- Department of Physical Medicine and RehabilitationFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
- Department of Biomedical EngineeringMcCormick School of EngineeringNorthwestern UniversityChicagoILUSA
| | - Simon Avrillon
- Legs + Walking LabShirley Ryan AbilityLabChicagoILUSA
- Department of Physical Medicine and RehabilitationFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
- Department of BioengineeringFaculty of Engineering, Imperial College LondonLondonUK
| | - Dario Farina
- Department of BioengineeringFaculty of Engineering, Imperial College LondonLondonUK
| | - François Hug
- Université Côte d'Azur, LAMHESSNiceFrance
- School of Biomedical SciencesThe University of QueenslandSt LuciaQueenslandAustralia
| | - José L. Pons
- Legs + Walking LabShirley Ryan AbilityLabChicagoILUSA
- Department of Physical Medicine and RehabilitationFeinberg School of MedicineNorthwestern UniversityChicagoILUSA
- Department of Biomedical EngineeringMcCormick School of EngineeringNorthwestern UniversityChicagoILUSA
| |
Collapse
|
6
|
Wen Y, Kim SJ, Avrillon S, Levine JT, Hug F, Pons JL. Toward a generalizable deep CNN for neural drive estimation across muscles and participants. J Neural Eng 2023; 20. [PMID: 36548991 DOI: 10.1088/1741-2552/acae0b] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/22/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
Objective.High-density electromyography (HD-EMG) decomposition algorithms are used to identify individual motor unit (MU) spike trains, which collectively constitute the neural code of movements, to predict motor intent. This approach has advanced from offline to online decomposition, from isometric to dynamic contractions, leading to a wide range of neural-machine interface applications. However, current online methods need offline retraining when applied to the same muscle on a different day or to a different person, which limits their applications in a real-time neural-machine interface. We proposed a deep convolutional neural network (CNN) framework for neural drive estimation, which takes in frames of HD-EMG signals as input, extracts general spatiotemporal properties of MU action potentials, and outputs the number of spikes in each frame. The deep CNN can generalize its application without retraining to HD-EMG data recorded in separate sessions, muscles, or participants.Approach.We recorded HD-EMG signals from the vastus medialis and vastus lateralis muscles from five participants while they performed isometric contractions during two sessions separated by ∼20 months. We identified MU spike trains from HD-EMG signals using a convolutive blind source separation (BSS) method, and then used the cumulative spike train (CST) of these MUs and the HD-EMG signals to train and validate the deep CNN.Main results.On average, the correlation coefficients between CST from the BSS and that from deep CNN were0.983±0.006for leave-one-out across-sessions-and-muscles validation and0.989±0.002for leave-one-out across-participants validation. When trained with more than four datasets, the performance of deep CNN saturated at0.984±0.001for cross validations across muscles, sessions, and participants.Significance.We can conclude that the deep CNN is generalizable across the aforementioned conditions without retraining. We could potentially generate a robust deep CNN to estimate neural drive to muscles for neural-machine interfaces.
Collapse
Affiliation(s)
- Yue Wen
- Legs and Walking Lab of Shirley Ryan AbilityLab and Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Sangjoon J Kim
- Legs and Walking Lab of Shirley Ryan AbilityLab and Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Simon Avrillon
- Legs and Walking Lab of Shirley Ryan AbilityLab and Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Jackson T Levine
- Legs and Walking Lab of Shirley Ryan AbilityLab and Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - François Hug
- Université Côte d'Azur, LAMHESS, Nice, France.,School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - José L Pons
- Legs and Walking Lab of Shirley Ryan AbilityLab, McCormick School of Engineering, and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| |
Collapse
|
7
|
Pascual-Valdunciel A, Lopo-Martínez V, Beltrán-Carrero AJ, Sendra-Arranz R, González-Sánchez M, Pérez-Sánchez JR, Grandas F, Farina D, Pons JL, Oliveira Barroso F, Gutiérrez Á. Classification of Kinematic and Electromyographic Signals Associated with Pathological Tremor Using Machine and Deep Learning. Entropy (Basel) 2023; 25:114. [PMID: 36673255 PMCID: PMC9858124 DOI: 10.3390/e25010114] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Peripheral Electrical Stimulation (PES) of afferent pathways has received increased interest as a solution to reduce pathological tremors with minimal side effects. Closed-loop PES systems might present some advantages in reducing tremors, but further developments are required in order to reliably detect pathological tremors to accurately enable the stimulation only if a tremor is present. This study explores different machine learning (K-Nearest Neighbors, Random Forest and Support Vector Machines) and deep learning (Long Short-Term Memory neural networks) models in order to provide a binary (Tremor; No Tremor) classification of kinematic (angle displacement) and electromyography (EMG) signals recorded from patients diagnosed with essential tremors and healthy subjects. Three types of signal sequences without any feature extraction were used as inputs for the classifiers: kinematics (wrist flexion-extension angle), raw EMG and EMG envelopes from wrist flexor and extensor muscles. All the models showed high classification scores (Tremor vs. No Tremor) for the different input data modalities, ranging from 0.8 to 0.99 for the f1 score. The LSTM models achieved 0.98 f1 scores for the classification of raw EMG signals, showing high potential to detect tremors without any processed features or preliminary information. These models may be explored in real-time closed-loop PES strategies to detect tremors and enable stimulation with minimal signal processing steps.
Collapse
Affiliation(s)
- Alejandro Pascual-Valdunciel
- E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), 28002 Madrid, Spain
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Víctor Lopo-Martínez
- E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Rafael Sendra-Arranz
- E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Miguel González-Sánchez
- Movement Disorders Unit, Department of Neurology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Javier Ricardo Pérez-Sánchez
- Movement Disorders Unit, Department of Neurology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Francisco Grandas
- Movement Disorders Unit, Department of Neurology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - José L. Pons
- Legs & Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of PM&R, Feinberg School of Medicine, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering and Mechanical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), 28002 Madrid, Spain
| | - Álvaro Gutiérrez
- E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| |
Collapse
|
8
|
San Agustín A, Asín-Prieto G, Moreno JC, Oliviero A, Pons JL. Transcranial Magnetic Stimulation Following a Paired Associative Stimulation Protocol Based on a Video Game Neuromodulates Cortical Excitability and Motor Behavior. Biomedicines 2022; 10:2632. [PMID: 36289893 PMCID: PMC9599957 DOI: 10.3390/biomedicines10102632] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2023] Open
Abstract
Transcranial Magnetic Stimulation (TMS) can be used to modulate cortico-spinal excitability following a paired associative stimulation (PAS) protocol. Movement-related cortical stimulation (MRCS) is a PAS protocol based on the synchronization of a single-pulse TMS with a movement task. However, plasticity and motor performance potentiation due to MRCS has been related exclusively to single-movement tasks. In order to unveil the effects of an MRCS protocol in complex movements, we applied PAS synchronized with a movement-related dynamic task (MRDT) with a customized video game. In 22 healthy subjects, we measured the reaction time (RT), trajectory error (TE), and the number of collected and avoided items when playing the custom video game to evaluate the task motor performance. Moreover, we assessed the recruitment curve of Motor Evoked Potentials (MEPs) with five different intensities to evaluate the motor corticospinal excitability. MEPs were recorded in Abductor Pollicis Brevis (APB) and Abductor Digiti Minimi (ADM), before, right after, and 30 min after the PAS intervention, in an active versus sham experimental design. The MRCS PAS intervention resulted in RT reduction, and motor corticospinal excitability was modulated, reflected as significant MEP amplitude change at 110% RMT intensity in ADM and at 130% RMT intensity in APB. RTs and ADM MEP amplitudes correlated positively in specific time and intensity assessments. We conclude that the proposed PAS protocol facilitated RT performance in a complex task. This phenomenon might be useful to develop neurorehabilitation strategies with complex movements, similar to activities of daily living.
Collapse
Affiliation(s)
- Arantzazu San Agustín
- Neural Rehabilitation Group (NRG), Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), 28002 Madrid, Spain
- PhD Program in Neuroscience, Cajal Institute, Autonoma de Madrid University, 28029 Madrid, Spain
- Legs & Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Biomedical Engineering Department, McCormick School of Engineering and Applied Science, Northwestern University, Evanston, IL 60208, USA
- Mechanical Engineering Department, McCormick School of Engineering and Applied Science, Northwestern University, Evanston, IL 60208, USA
| | - Guillermo Asín-Prieto
- Neural Rehabilitation Group (NRG), Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), 28002 Madrid, Spain
- Gogoa Mobility Robots S.L., 48220 Abadiño, Spain
| | - Juan C. Moreno
- Neural Rehabilitation Group (NRG), Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), 28002 Madrid, Spain
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004 Toledo, Spain
- Advanced Neurorehabilitation Unit, Hospital Los Madroños, 28690 Brunete, Spain
| | - José L. Pons
- Neural Rehabilitation Group (NRG), Cajal Institute, Consejo Superior de Investigaciones Científicas (CSIC), 28002 Madrid, Spain
- Legs & Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Biomedical Engineering Department, McCormick School of Engineering and Applied Science, Northwestern University, Evanston, IL 60208, USA
- Mechanical Engineering Department, McCormick School of Engineering and Applied Science, Northwestern University, Evanston, IL 60208, USA
| |
Collapse
|
9
|
Longatelli V, Torricelli D, Tornero J, Pedrocchi A, Molteni F, Pons JL, Gandolla M. A unified scheme for the benchmarking of upper limb functions in neurological disorders. J Neuroeng Rehabil 2022; 19:102. [PMID: 36167552 PMCID: PMC9513990 DOI: 10.1186/s12984-022-01082-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/13/2022] [Accepted: 09/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In neurorehabilitation, we are witnessing a growing awareness of the importance of standardized quantitative assessment of limb functions. Detailed assessments of the sensorimotor deficits following neurological disorders are crucial. So far, this assessment has relied mainly on clinical scales, which showed several drawbacks. Different technologies could provide more objective and repeatable measurements. However, the current literature lacks practical guidelines for this purpose. Nowadays, the integration of available metrics, protocols, and algorithms into one harmonized benchmarking ecosystem for clinical and research practice is necessary. METHODS This work presents a benchmarking framework for upper limb capacity. The scheme resulted from a multidisciplinary and iterative discussion among several partners with previous experience in benchmarking methodology, robotics, and clinical neurorehabilitation. We merged previous knowledge in benchmarking methodologies for human locomotion and direct clinical and engineering experience in upper limb rehabilitation. The scheme was designed to enable an instrumented evaluation of arm capacity and to assess the effectiveness of rehabilitative interventions with high reproducibility and resolution. It includes four elements: (1) a taxonomy for motor skills and abilities, (2) a list of performance indicators, (3) a list of required sensor modalities, and (4) a set of reproducible experimental protocols. RESULTS We proposed six motor primitives as building blocks of most upper-limb daily-life activities and combined them into a set of functional motor skills. We identified the main aspects to be considered during clinical evaluation, and grouped them into ten motor abilities categories. For each ability, we proposed a set of performance indicators to quantify the proposed ability on a quantitative and high-resolution scale. Finally, we defined the procedures to be followed to perform the benchmarking assessment in a reproducible and reliable way, including the definition of the kinematic models and the target muscles. CONCLUSIONS This work represents the first unified scheme for the benchmarking of upper limb capacity. To reach a consensus, this scheme should be validated with real experiments across clinical conditions and motor skills. This validation phase is expected to create a shared database of human performance, necessary to have realistic comparisons of treatments and drive the development of new personalized technologies.
Collapse
Affiliation(s)
- Valeria Longatelli
- Neuroengineering and Medical Robotics Laboratory and WE-COBOT Laboratory, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy.
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Jesús Tornero
- Advanced Neurorehabilitation Unit, Hospital Los Madroños, Madrid, Spain
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotics Laboratory and WE-COBOT Laboratory, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Italy
| | | | - Marta Gandolla
- WE-COBOT Laboratory, Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy
| |
Collapse
|
10
|
Pascual-Valdunciel A, Hoo GW, Avrillon S, Barroso FO, Goldman JG, Hernandez-Pavon JC, Pons JL. Peripheral electrical stimulation to reduce pathological tremor: a review. J Neuroeng Rehabil 2021; 18:33. [PMID: 33588841 PMCID: PMC7885254 DOI: 10.1186/s12984-021-00811-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Received: 08/14/2020] [Accepted: 01/11/2021] [Indexed: 01/02/2023] Open
Abstract
Interventions to reduce tremor in essential tremor (ET) and Parkinson’s disease (PD) clinical populations often utilize pharmacological or surgical therapies. However, there can be significant side effects, decline in effectiveness over time, or clinical contraindications for these interventions. Therefore, alternative approaches must be considered and developed. Some non-pharmacological strategies include assistive devices, orthoses and mechanical loading of the tremorgenic limb, while others propose peripheral electrical stimulation. Specifically, peripheral electrical stimulation encompasses strategies that activate motor and sensory pathways to evoke muscle contractions and impact sensorimotor function. Numerous studies report the efficacy of peripheral electrical stimulation to alter tremor generation, thereby opening new perspectives for both short- and long-term tremor reduction. Therefore, it is timely to explore this promising modality in a comprehensive review. In this review, we analyzed 27 studies that reported the use of peripheral electrical stimulation to reduce tremor and discuss various considerations regarding peripheral electrical stimulation: the stimulation strategies and parameters, electrodes, experimental designs, results, and mechanisms hypothesized to reduce tremor. From our review, we identified a high degree of disparity across studies with regard to stimulation patterns, experimental designs and methods of assessing tremor. Having standardized experimental methodology is a critical step in the field and is needed in order to accurately compare results across studies. With this review, we explore peripheral electrical stimulation as an intervention for tremor reduction, identify the limitations and benefits of the current state-of-the-art studies, and provide ideas to guide the development of novel approaches based on the neural circuitries and mechanical properties implied in tremor generation.
Collapse
Affiliation(s)
- Alejandro Pascual-Valdunciel
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain.,E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Grace W Hoo
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Simon Avrillon
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Jennifer G Goldman
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julio C Hernandez-Pavon
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - José L Pons
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Department of Biomedical Engineering and Mechanical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA.
| |
Collapse
|
11
|
Avrillon S, Del Vecchio A, Farina D, Pons JL, Vogel C, Umehara J, Hug F. Individual differences in the neural strategies to control the lateral and medial head of the quadriceps during a mechanically constrained task. J Appl Physiol (1985) 2021; 130:269-281. [DOI: 10.1152/japplphysiol.00653.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We observed that the distribution of the strength of neural drive between the vastus lateralis and vastus medialis during a single-joint isometric task varied across participants. Also, we observed that the proportion of neural drive that was shared within and between these muscles also varied across participants. These results provide evidence that the neural strategies to control the vastus lateralis and vastus medialis muscles widely vary across individuals, even during a mechanically constrained task.
Collapse
Affiliation(s)
- Simon Avrillon
- Legs + Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, Illinois
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois
- Laboratory Movement, Interactions, Performance, Université de Nantes, Nantes, France
| | - Alessandro Del Vecchio
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander University, Erlangen-Nürnberg, Erlangen, Germany
- Neuromechanics and Rehabilitation Technology Group, Department of Bioengineering, Faculty of Engineering, Imperial College, London, United Kingdom
| | - Dario Farina
- Neuromechanics and Rehabilitation Technology Group, Department of Bioengineering, Faculty of Engineering, Imperial College, London, United Kingdom
| | - José L. Pons
- Legs + Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, Illinois
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois
| | - Clément Vogel
- Laboratory Movement, Interactions, Performance, Université de Nantes, Nantes, France
| | - Jun Umehara
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - François Hug
- Laboratory Movement, Interactions, Performance, Université de Nantes, Nantes, France
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Institut Universitaire de France, Paris, France
| |
Collapse
|
12
|
Lopes Ferreira C, Barroso FO, Torricelli D, Pons JL, Politti F, Lucareli PRG. Women with patellofemoral pain show altered motor coordination during lateral step down. J Biomech 2020; 110:109981. [DOI: 10.1016/j.jbiomech.2020.109981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/19/2020] [Accepted: 08/01/2020] [Indexed: 12/29/2022]
|
13
|
Gil-Agudo A, Del Ama-Espinosa AJ, Lozano-Berrio V, Fernández-López A, Megía García-Carpintero A, Benito-Penalva J, Pons JL. [Robot therapy with the H2 exoskeleton for gait rehabilitation in patients with incomplete spinal cord injry. A clinical experience]. Rehabilitacion (Madr) 2020; 54:87-95. [PMID: 32370833 DOI: 10.1016/j.rh.2019.10.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Robotic exoskeletons have emerged as a promising tool in gait rehabilitation in patients with a spinal cord injury. The aim of this study was to assess the clinical applicability of a new robotic exoskeleton model (Exo H2) in the rehabilitation of people with incomplete spinal cord injury. MATERIAL AND METHODS Exo H2 exoskeleton training was performed for 15 sessions in patients with incomplete subacute spinal cord injury. We analysed the appearance of undesirable events and the patient's perception of pain, fatigue and comfort. In addition, a pilot test was carried out on the possible effectiveness of the device by analysing gait characteristics before and after treatment measured by the 10mWT, the 6mWT, the TUG, the WISCI-II, and the impact on the SCIM III scale. RESULTS Of a group of 8 patients recruited, we were able to analyse data from 4. No undesirable effects were reported. The VAS value was 2.28±1.55 for pain, 3.75±1.55 for fatigue and 4.17±1.68 for comfort. All values improved on the WISCI-I and the TUG and almost all in the 10MWT and in the 6MWT. CONCLUSIONS The performance of the Exo H2 exoskeleton was robust during a clinical protocol for gait rehabilitation. The treatment was safe, without undesirable effects and with good patient tolerance. These results might justify the performance of clinical trials with an adequate sample size.
Collapse
Affiliation(s)
- A Gil-Agudo
- Servicio de Rehabilitación, Hospital Nacional de Parapléjicos de Toledo, Toledo, España; Unidad de Neurorrehabilitación, Biomecánica y Función Sensitivo-Motora (HNP-SESCAM, Unidad asociada al CSIC).
| | - A J Del Ama-Espinosa
- Unidad de Biomecánica, Hospital Nacional de Parapléjicos de Toledo, Toledo, España; Área de Tecnología Electrónica, Universidad Rey Juan Carlos, Madrid, España
| | - V Lozano-Berrio
- Unidad de Biomecánica, Hospital Nacional de Parapléjicos de Toledo, Toledo, España
| | - A Fernández-López
- Servicio de Rehabilitación, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | | | | | - J L Pons
- Grupo de Neuro-Rehabilitación, Instituto Cajal, CSIC, Madrid, España
| |
Collapse
|
14
|
Affiliation(s)
- José L Pons
- Legs + Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, IL, USA. .,Department of Physical Medicine and Rehabilitation, Department of Biomedical Engineering, and Department of Mechanical Engineering, Northwestern University, Chicago, IL, USA.,Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain
| |
Collapse
|
15
|
Tamburella F, Moreno JC, Herrera Valenzuela DS, Pisotta I, Iosa M, Cincotti F, Mattia D, Pons JL, Molinari M. Influences of the biofeedback content on robotic post-stroke gait rehabilitation: electromyographic vs joint torque biofeedback. J Neuroeng Rehabil 2019; 16:95. [PMID: 31337400 PMCID: PMC6652021 DOI: 10.1186/s12984-019-0558-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 04/30/2019] [Accepted: 06/25/2019] [Indexed: 01/05/2023] Open
Abstract
Background Add-on robot-mediated therapy has proven to be more effective than conventional therapy alone in post-stroke gait rehabilitation. Such robot-mediated interventions routinely use also visual biofeedback tools. A better understanding of biofeedback content effects when used for robotic locomotor training may improve the rehabilitation process and outcomes. Methods This randomized cross-over pilot trial aimed to address the possible impact of different biofeedback contents on patients’ performance and experience during Lokomat training, by comparing a novel biofeedback based on online biological electromyographic information (EMGb) versus the commercial joint torque biofeedback (Rb) in sub-acute non ambulatory patients. 12 patients were randomized into two treatment groups, A and B, based on two different biofeedback training. For both groups, study protocol consisted of 12 Lokomat sessions, 6 for each biofeedback condition, 40 min each, 3 sessions per week of frequency. All patients performed Lokomat trainings as an add-on therapy to the conventional one that was the same for both groups and consisted of 40 min per day, 5 days per week. The primary outcome was the Modified Ashworth Spasticity Scale, and secondary outcomes included clinical, neurological, mechanical, and personal experience variables collected before and after each biofeedback training. Results Lokomat training significantly improved gait/daily living activity independence and trunk control, nevertheless, different effects due to biofeedback content were remarked. EMGb was more effective to reduce spasticity and improve muscle force at the ankle, knee and hip joints. Robot data suggest that Rb induces more adaptation to robotic movements than EMGb. Furthermore, Rb was perceived less demanding than EMGb, even though patient motivation was higher for EMGb. Robot was perceived to be effective, easy to use, reliable and safe: acceptability was rated as very high by all patients. Conclusions Specific effects can be related to biofeedback content: when muscular-based information is used, a more direct effect on lower limb spasticity and muscle activity is evidenced. In a similar manner, when biofeedback treatment is based on joint torque data, a higher patient compliance effect in terms of force exerted is achieved. Subjects who underwent EMGb seemed to be more motivated than those treated with Rb.
Collapse
Affiliation(s)
- Federica Tamburella
- Spinal Rehabilitation Laboratory - Neurological and Spinal Cord Injury Rehabilitation Department A, Santa Lucia Foundation IRCCS, Via Ardeatina 306 -, 00179, Rome, Italy. .,Laboratory of Robotics Applied to Neurological Rehabilitation- NeuroRobot - Neurological and Spinal Cord Injury Rehabilitation Department A, Santa Lucia Foundation IRCCS, Via Ardeatina 306 -, 00179, Rome, Italy.
| | - Juan C Moreno
- Spanish National Research Council, Cajal Institute, Neural Rehabilitation Group, Av. Doctor Arce, 37, 28002, Madrid, Spain
| | | | - Iolanda Pisotta
- Laboratory of Robotics Applied to Neurological Rehabilitation- NeuroRobot - Neurological and Spinal Cord Injury Rehabilitation Department A, Santa Lucia Foundation IRCCS, Via Ardeatina 306 -, 00179, Rome, Italy
| | - Marco Iosa
- Laboratory for the Study of Mind and Action in Rehabilitation Technologies - Smart Lab, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179, Rome, Italy
| | - Febo Cincotti
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy.,Neuroelectrical Imaging and BCI Lab, IRCCS S. Lucia Foundation, Via Ardeatina 306 -, 00179, Rome, Italy
| | - Donatella Mattia
- Neuroelectrical Imaging and BCI Lab, IRCCS S. Lucia Foundation, Via Ardeatina 306 -, 00179, Rome, Italy
| | - José L Pons
- Spanish National Research Council, Cajal Institute, Neural Rehabilitation Group, Av. Doctor Arce, 37, 28002, Madrid, Spain.,Legs & Walking AbilityLab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine. Department of Biomedical Engineering & Department of Mechanical Engineering, McCormick School of Engineering. Northwestern University, Chicago, IL, USA
| | - Marco Molinari
- Spinal Rehabilitation Laboratory - Neurological and Spinal Cord Injury Rehabilitation Department A, Santa Lucia Foundation IRCCS, Via Ardeatina 306 -, 00179, Rome, Italy.,Laboratory of Robotics Applied to Neurological Rehabilitation- NeuroRobot - Neurological and Spinal Cord Injury Rehabilitation Department A, Santa Lucia Foundation IRCCS, Via Ardeatina 306 -, 00179, Rome, Italy
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Loeuillet C, Touquet B, Oury B, Eddaikra N, Pons JL, Guichou JF, Labesse G, Sereno D. Synthesis of aminophenylhydroxamate and aminobenzylhydroxamate derivatives and in vitro screening for antiparasitic and histone deacetylase inhibitory activity. Int J Parasitol Drugs Drug Resist 2018; 8:59-66. [PMID: 29414107 PMCID: PMC6114082 DOI: 10.1016/j.ijpddr.2018.01.002] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 12/21/2022]
Abstract
A series of aminophenylhydroxamates and aminobenzylhydroxamates were synthesized and screened for their antiparasitic activity against Leishmania, Trypanosoma, and Toxoplasma. Their anti-histone deacetylase (HDAC) potency was determined. Moderate to no antileishmanial or antitrypanosomal activity was found (IC50 > 10 μM) that contrast with the highly efficient anti-Toxoplasma activity (IC50 < 1.0 μM) of these compounds. The antiparasitic activity of the synthetized compounds correlates well with their HDAC inhibitory activity. The best-performing compound (named 363) express a high anti-HDAC6 inhibitory activity (IC50 of 0.045 ± 0.015 μM) a moderate cytotoxicity and a high anti-Toxoplasma activity in the range of known anti-Toxoplasma compounds (IC50 of 0.35-2.25 μM). The calculated selectivity index (10-300 using different human cell lines) of the compound 363 makes it a lead compound for the future development of anti-Toxoplasma molecules.
Collapse
Affiliation(s)
- C Loeuillet
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France; IRD, Univ Montpellier, MiVegec, Montpellier, France
| | - B Touquet
- Institute for Advanced Biosciences (IAB), Team Host-Pathogen Interactions & Immunity to Infection, INSERM U 1209, CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France
| | - B Oury
- IRD, Univ Montpellier, InterTryp, Montpellier, France; IRD, Univ Montpellier, MiVegec, Montpellier, France
| | - N Eddaikra
- Laboratoire d'Eco-épidemiologie Parasitaire et Génétique des Populations, Institut Pasteur d'Alger, Route du Petit Staoueli, Dely Brahim, Alger, Algeria; Laboratoire de Biochimie Analytique et Biotechnologies, Université Mouloud Mammeri de Tizi Ouzou, Algeria
| | - J L Pons
- Centre de Biochimie Structurale (CBS), INSERM, CNRS, Université de Montpellier, France
| | - J F Guichou
- Centre de Biochimie Structurale (CBS), INSERM, CNRS, Université de Montpellier, France
| | - G Labesse
- Centre de Biochimie Structurale (CBS), INSERM, CNRS, Université de Montpellier, France
| | - D Sereno
- IRD, Univ Montpellier, InterTryp, Montpellier, France; IRD, Univ Montpellier, MiVegec, Montpellier, France.
| |
Collapse
|
18
|
Resquín F, Gonzalez-Vargas J, Ibáñez J, Brunetti F, Dimbwadyo I, Carrasco L, Alves S, Gonzalez-Alted C, Gomez-Blanco A, Pons JL. Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study. J Neuroeng Rehabil 2017; 14:104. [PMID: 29025427 PMCID: PMC5639749 DOI: 10.1186/s12984-017-0312-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 03/09/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022] Open
Abstract
Background Brain injury survivors often present upper-limb motor impairment affecting the execution of functional activities such as reaching. A currently active research line seeking to maximize upper-limb motor recovery after a brain injury, deals with the combined use of functional electrical stimulation (FES) and mechanical supporting devices, in what has been previously termed hybrid robotic systems. This study evaluates from the technical and clinical perspectives the usability of an integrated hybrid robotic system for the rehabilitation of upper-limb reaching movements after a brain lesion affecting the motor function. Methods The presented system is comprised of four main components. The hybrid assistance is given by a passive exoskeleton to support the arm weight against gravity and a functional electrical stimulation device to assist the execution of the reaching task. The feedback error learning (FEL) controller was implemented to adjust the intensity of the electrical stimuli delivered on target muscles according to the performance of the users. This control strategy is based on a proportional-integral-derivative feedback controller and an artificial neural network as the feedforward controller. Two experiments were carried out in this evaluation. First, the technical viability and the performance of the implemented FEL controller was evaluated in healthy subjects (N = 12). Second, a small cohort of patients with a brain injury (N = 4) participated in two experimental session to evaluate the system performance. Also, the overall satisfaction and emotional response of the users after they used the system was assessed. Results In the experiment with healthy subjects, a significant reduction of the tracking error was found during the execution of reaching movements. In the experiment with patients, a decreasing trend of the error trajectory was found together with an increasing trend in the task performance as the movement was repeated. Brain injury patients expressed a great acceptance in using the system as a rehabilitation tool. Conclusions The study demonstrates the technical feasibility of using the hybrid robotic system for reaching rehabilitation. Patients’ reports on the received intervention reveal a great satisfaction and acceptance of the hybrid robotic system. Trial registration Retrospective trial registration in ISRCTN Register with study ID ISRCTN12843006.
Collapse
Affiliation(s)
- F Resquín
- Neural Rehabilitation Group, Cajal Institute of the Spanish National Research Council (CSIC), Avda. Doctor Arce, 37, 28002, Madrid, Spain.
| | - J Gonzalez-Vargas
- Neural Rehabilitation Group, Cajal Institute of the Spanish National Research Council (CSIC), Avda. Doctor Arce, 37, 28002, Madrid, Spain
| | - J Ibáñez
- Neural Rehabilitation Group, Cajal Institute of the Spanish National Research Council (CSIC), Avda. Doctor Arce, 37, 28002, Madrid, Spain.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - F Brunetti
- Catholic University of Asunción, Asunción, Paraguay
| | - I Dimbwadyo
- Occupational Therapy Department. Occupational Thinks Research Group. Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Madrid, Spain
| | - L Carrasco
- Occupational Thinks Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - S Alves
- Centro de Referencia Estatal de Atención al Daño Cerebral (CEADAC), Madrid, Spain
| | - C Gonzalez-Alted
- Centro de Referencia Estatal de Atención al Daño Cerebral (CEADAC), Madrid, Spain
| | - A Gomez-Blanco
- Centro de Referencia Estatal de Atención al Daño Cerebral (CEADAC), Madrid, Spain
| | - J L Pons
- Neural Rehabilitation Group, Cajal Institute of the Spanish National Research Council (CSIC), Avda. Doctor Arce, 37, 28002, Madrid, Spain.,Tecnológico de Monterrey, Monterrey, México
| |
Collapse
|
19
|
Barroso FO, Torricelli D, Molina-Rueda F, Alguacil-Diego IM, Cano-de-la-Cuerda R, Santos C, Moreno JC, Miangolarra-Page JC, Pons JL. Combining muscle synergies and biomechanical analysis to assess gait in stroke patients. J Biomech 2017; 63:98-103. [PMID: 28882330 DOI: 10.1016/j.jbiomech.2017.08.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 08/01/2017] [Accepted: 08/05/2017] [Indexed: 12/17/2022]
Abstract
The understanding of biomechanical deficits and impaired neural control of gait after stroke is crucial to prescribe effective customized treatments aimed at improving walking function. Instrumented gait analysis has been increasingly integrated into the clinical practice to enhance precision and inter-rater reliability for the assessment of pathological gait. On the other hand, the analysis of muscle synergies has gained relevance as a novel tool to describe the neural control of walking. Since muscle synergies and gait analysis capture different but equally important aspects of walking, we hypothesized that their combination can improve the current clinical tools for the assessment of walking performance. To test this hypothesis, we performed a complete bilateral, lower limb biomechanical and muscle synergies analysis on nine poststroke hemiparetic patients during overground walking. Using stepwise multiple regression, we identified a number of kinematic, kinetic, spatiotemporal and synergy-related features from the paretic and non-paretic side that, combined together, allow to predict impaired walking function better than the Fugl-Meyer Assessment score. These variables were time of peak knee flexion, VAFtotal values, duration of stance phase, peak of paretic propulsion and range of hip flexion. Since these five variables describe important biomechanical and neural control features underlying walking deficits poststroke, they may be feasible to drive customized rehabilitation therapies aimed to improve walking function. This paper demonstrates the feasibility of combining biomechanical and neural-related measures to assess locomotion performance in neurologically injured individuals.
Collapse
Affiliation(s)
- Filipe O Barroso
- Department of Physiology, Feinberg School of Medicine - Northwestern University, Chicago, IL, United States; Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain; Centre ALGORITMI, University of Minho, Azurém, Guimarães, Portugal
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain.
| | - Francisco Molina-Rueda
- Movement Analysis, Biomechanics, Ergonomic and Motor Control Laboratory (LAMBECOM), Faculty of Health Sciences at the Rey Juan Carlos University, Madrid, Spain
| | - Isabel M Alguacil-Diego
- Movement Analysis, Biomechanics, Ergonomic and Motor Control Laboratory (LAMBECOM), Faculty of Health Sciences at the Rey Juan Carlos University, Madrid, Spain
| | - Roberto Cano-de-la-Cuerda
- Movement Analysis, Biomechanics, Ergonomic and Motor Control Laboratory (LAMBECOM), Faculty of Health Sciences at the Rey Juan Carlos University, Madrid, Spain
| | - Cristina Santos
- Centre ALGORITMI, University of Minho, Azurém, Guimarães, Portugal
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Juan C Miangolarra-Page
- Movement Analysis, Biomechanics, Ergonomic and Motor Control Laboratory (LAMBECOM), Faculty of Health Sciences at the Rey Juan Carlos University, Madrid, Spain
| | - José L Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| |
Collapse
|
20
|
Alvarez MT, Torricelli D, Del-Ama AJ, Pinto D, Gonzalez-Vargas J, Moreno JC, Gil-Agudo A, Pons JL. Simultaneous estimation of human and exoskeleton motion: A simplified protocol. IEEE Int Conf Rehabil Robot 2017; 2017:1431-1436. [PMID: 28814021 DOI: 10.1109/icorr.2017.8009449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Adequate benchmarking procedures in the area of wearable robots is gaining importance in order to compare different devices on a quantitative basis, improve them and support the standardization and regulation procedures. Performance assessment usually focuses on the execution of locomotion tasks, and is mostly based on kinematic-related measures. Typical drawbacks of marker-based motion capture systems, gold standard for measure of human limb motion, become challenging when measuring limb kinematics, due to the concomitant presence of the robot. This work answers the question of how to reliably assess the subject's body motion by placing markers over the exoskeleton. Focusing on the ankle joint, the proposed methodology showed that it is possible to reconstruct the trajectory of the subject's joint by placing markers on the exoskeleton, although foot flexibility during walking can impact the reconstruction accuracy. More experiments are needed to confirm this hypothesis, and more subjects and walking conditions are needed to better characterize the errors of the proposed methodology, although our results are promising, indicating small errors.
Collapse
|
21
|
Casco S, Fuster I, Galeano R, Moreno JC, Pons JL, Brunetti F. Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation. IEEE Int Conf Rehabil Robot 2017; 2017:1660-1665. [PMID: 28814058 DOI: 10.1109/icorr.2017.8009486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hybrid rehabilitation robotics combine neuro-prosthetic devices (close-loop functional electrical stimulation systems) and traditional robotic structures and actuators to explore better therapies and promote a more efficient motor function recovery or compensation. Although hybrid robotics and ankle neuroprostheses (NPs) have been widely developed over the last years, there are just few studies on the use of NPs to electrically control both ankle flexion and extension to promote ankle recovery and improved gait patterns in paretic limbs. The aim of this work is to develop an ankle NP specifically designed to work in the field of hybrid robotics. This article presents early steps towards this goal and makes a brief review about motor NPs and Functional Electrical Stimulation (FES) principles and most common devices used to aid the ankle functioning during the gait cycle. It also shows a current sources analysis done in this framework, in order to choose the best one for this intended application.
Collapse
|
22
|
Tamburella F, Moreno JC, Iosa M, Pisotta I, Cincotti F, Mattia D, Pons JL, Molinari M. Boosting the traditional physiotherapist approach for stroke spasticity using a sensorized ankle foot orthosis: a pilot study. Top Stroke Rehabil 2017; 24:447-456. [PMID: 28460597 DOI: 10.1080/10749357.2017.1318340] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Spasticity is a motor disorder that is commonly treated manually by a physical therapist (PhT) stretching the muscles. Recent data on learning have demonstrated the importance of human-to-human interaction in improving rehabilitation: cooperative motor behavior engages specific areas of the motor system compared with execution of a task alone. OBJECTIVES We hypothesize that PhT-guided therapy that involves active collaboration with the patient (Pt) through shared biomechanical visual biofeedback (vBFB) positively impacts learning and performance by the Pt during ankle spasticity treatment. A sensorized ankle foot orthosis (AFO) was developed to provide online quantitative data of joint range of motion (ROM), angular velocity, and electromyographic activity to the PhT and Pt during the treatment of ankle spasticity. METHODS Randomized controlled clinical trial. Ten subacute stroke inpatients, randomized into experimental (EXP) and control (CTRL) groups, underwent six weeks of daily treatment. The EXP group was treated with an active AFO, and the CTRL group was given an inactive AFO. Spasticity, ankle ROM, ankle active and passive joint speed, and coactivation index (CI) were assessed at enrollment and after 15-30 sessions. RESULTS Spasticity and CI (p < 0.005) decreased significantly after training only in the EXP group, in association with a significant rise in active joint speed and active ROM (p < 0.05). Improvements in spasticity (p < 0.05), active joint speed (p < 0.001), and CI (p < 0.001) after treatment differed between the EXP and CTRL groups. CONCLUSIONS PhT-Pt sharing of exercise information, provided by joint sensorization and vBFB, improved the efficacy of the conventional approach for treating ankle spasticity in subacute stroke Pts.
Collapse
Affiliation(s)
- Federica Tamburella
- a SPInal REhabilitation Lab and Laboratory (SPIRE Lab.), Neurorehabilitation1 - Spinal Center , IRCCS S. Lucia Foundation , Rome , Italy.,b Laboratory of Robotics Applied to Neurological Rehabilitation, (NeuroRobot Lab.), Neurorehabilitation1 - Spinal Center , IRCCS S. Lucia Foundation , Rome , Italy
| | - Juan C Moreno
- c Spanish National Research Council, Cajal Institute, Neural Rehabilitation Group , Madrid , Spain
| | - Marco Iosa
- d Clinical Laboratory of Experimental Neurorehabilitation , IRCCS S. Lucia Foundation , Rome , Italy
| | - Iolanda Pisotta
- b Laboratory of Robotics Applied to Neurological Rehabilitation, (NeuroRobot Lab.), Neurorehabilitation1 - Spinal Center , IRCCS S. Lucia Foundation , Rome , Italy
| | - Febo Cincotti
- e Department of Computer, Control and Management Engineering , Sapienza University of Rome , Rome , Italy.,f Neuroelectrical Imaging and BCI Lab , IRCCS S. Lucia Foundation , Rome , Italy
| | - Donatella Mattia
- f Neuroelectrical Imaging and BCI Lab , IRCCS S. Lucia Foundation , Rome , Italy
| | - José L Pons
- c Spanish National Research Council, Cajal Institute, Neural Rehabilitation Group , Madrid , Spain
| | - Marco Molinari
- b Laboratory of Robotics Applied to Neurological Rehabilitation, (NeuroRobot Lab.), Neurorehabilitation1 - Spinal Center , IRCCS S. Lucia Foundation , Rome , Italy
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Pérez-Nombela S, Barroso F, Torricelli D, de Los Reyes-Guzmán A, Del-Ama AJ, Gómez-Soriano J, Pons JL, Gil-Agudo Á. Modular control of gait after incomplete spinal cord injury: differences between sides. Spinal Cord 2016; 55:79-86. [PMID: 27349606 DOI: 10.1038/sc.2016.99] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/21/2016] [Accepted: 05/24/2016] [Indexed: 01/11/2023]
Abstract
STUDY DESIGN This is an analytical descriptive study. OBJECTIVES The main goal of this study was to compare the modular organization of bilateral lower limb control in incomplete spinal cord injury (iSCI) patients during overground walking, using muscle synergies analysis. The secondary goal was to determine whether the similarity between the patients and control group correlate with clinical indicators of walking performance. SETTING This study was conducted in National Hospital for Spinal Cord Injury (Toledo, Spain). METHODS Eight iSCI patients and eight healthy subjects completed 10 walking trials at matched speed. For each trial, three-dimensional motion analysis and surface electromyography (sEMG) analysis of seven leg muscles from both limbs were performed. Muscle synergies were extracted from sEMG signals using a non-negative matrix factorization algorithm. The optimal number of synergies has been defined as the minimum number needed to obtain variability accounted for (VAF) ⩾90%. RESULTS When compared with healthy references, iSCI patients showed fewer muscle synergies in the most affected side and, in both sides, significant differences in the composition of synergy 2. The degree of similarity of these variables with the healthy reference, together with the composition of synergy 3 of the most affected side, presented significant correlations (P<0.05) with walking performance. CONCLUSION The analysis of muscle synergies shows potential to detect differences between the two sides in patients with iSCI. Specifically, the VAF may constitute a new neurophysiological metric to assess and monitor patients' condition throughout the gait recovery process.
Collapse
Affiliation(s)
- S Pérez-Nombela
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
| | - F Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain.,Centre ALGORITMI, University of Minho, Azurém, Guimarães, Portugal
| | - D Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - A de Los Reyes-Guzmán
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
| | - A J Del-Ama
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
| | - J Gómez-Soriano
- Sensoriomotor Function Group, National Hospital for Spinal Cord Injury, Toledo, Spain.,Toledo Physiotherapy Research Group (GIFTO). Nursing and Physical Therapy School, Castilla-La Mancha, Toledo, Spain
| | - J L Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Á Gil-Agudo
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Barroso FO, Torricelli D, Bravo-Esteban E, Taylor J, Gómez-Soriano J, Santos C, Moreno JC, Pons JL. Muscle Synergies in Cycling after Incomplete Spinal Cord Injury: Correlation with Clinical Measures of Motor Function and Spasticity. Front Hum Neurosci 2016; 9:706. [PMID: 26793088 PMCID: PMC4707299 DOI: 10.3389/fnhum.2015.00706] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 08/25/2015] [Accepted: 12/15/2015] [Indexed: 11/24/2022] Open
Abstract
Background: After incomplete spinal cord injury (iSCI), patients suffer important sensorimotor impairments, such as abnormal locomotion patterns and spasticity. Complementary to current clinical diagnostic procedures, the analysis of muscle synergies has emerged as a promising tool to study muscle coordination, which plays a major role in the control of multi-limb functional movements. Objective: Based on recent findings suggesting that walking and cycling share similar synergistic control, the analysis of muscle synergies during cycling might be explored as an early descriptor of gait-related impaired control. This idea was split into the following two hypotheses: (a) iSCI patients present a synergistic control of muscles during cycling; (b) muscle synergies outcomes extracted during cycling correlate with clinical measurements of gait performance and/or spasticity. Methods: Electromyographic (EMG) activity of 13 unilateral lower limb muscles was recorded in a group of 10 healthy individuals and 10 iSCI subjects during cycling at four different cadences. A non-negative matrix factorization (NNMF) algorithm was applied to identify synergistic components (i.e., activation coefficients and muscle synergy vectors). Reconstruction goodness scores (VAF and r2) were used to evaluate the ability of a given number of synergies to reconstruct the EMG signals. A set of metrics based on the similarity between pathologic and healthy synergies were correlated with clinical scales of gait performance and spasticity. Results: iSCI patients preserved a synergistic control of muscles during cycling. The similarity with the healthy reference was consistent with the degree of the impairment, i.e., less impaired patients showed higher similarities with the healthy reference. There was a strong correlation between reconstruction goodness scores at 42 rpm and motor performance scales (TUG, 10-m test and WISCI II). On the other hand, the similarity between the healthy and affected synergies presented correlation with some spasticity symptoms measured by Penn, Modified Ashworth and SCATS scales. Conclusion: Overall, the results of this study support the hypothesis that the analysis of muscle synergies during cycling can provide detailed quantitative assessment of functional motor impairments and symptoms of spasticity caused by abnormal spatiotemporal muscle co-activation following iSCI.
Collapse
Affiliation(s)
- Filipe O Barroso
- Electronics Department, University of MinhoGuimarães, Portugal; Neural Rehabilitation Group, Cajal Institute, Spanish National Research CouncilMadrid, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council Madrid, Spain
| | - Elisabeth Bravo-Esteban
- Sensorimotor Function Group - Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla la Mancha (SESCAM)Toledo, Spain; iPhysio Research Group, San Jorge UniversityZaragoza, Spain
| | - Julian Taylor
- Sensorimotor Function Group - Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla la Mancha (SESCAM)Toledo, Spain; National Spinal Injuries Centre, Stoke Mandeville Spinal Research, Buckinghamshire Health Trust, National Health Service (NHS)Aylesbury, UK; Harris Manchester College, University of OxfordOxford, UK
| | - Julio Gómez-Soriano
- Sensorimotor Function Group - Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla la Mancha (SESCAM)Toledo, Spain; Toledo Physiotherapy Research Group (GIFTO), Nursing and Physical Therapy School, Castilla la Mancha UniversityToledo, Spain
| | - Cristina Santos
- Electronics Department, University of Minho Guimarães, Portugal
| | - Juan C Moreno
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council Madrid, Spain
| | - José L Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council Madrid, Spain
| |
Collapse
|
27
|
Hortal E, Planelles D, Resquin F, Climent JM, Azorín JM, Pons JL. Using a brain-machine interface to control a hybrid upper limb exoskeleton during rehabilitation of patients with neurological conditions. J Neuroeng Rehabil 2015; 12:92. [PMID: 26476869 PMCID: PMC4609472 DOI: 10.1186/s12984-015-0082-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 03/31/2015] [Accepted: 10/08/2015] [Indexed: 11/30/2022] Open
Abstract
Background As a consequence of the increase of cerebro-vascular accidents, the number of people suffering from motor disabilities is raising. Exoskeletons, Functional Electrical Stimulation (FES) devices and Brain-Machine Interfaces (BMIs) could be combined for rehabilitation purposes in order to improve therapy outcomes. Methods In this work, a system based on a hybrid upper limb exoskeleton is used for neurological rehabilitation. Reaching movements are supported by the passive exoskeleton ArmeoSpring and FES. The movement execution is triggered by an EEG-based BMI. The BMI uses two different methods to interact with the exoskeleton from the user’s brain activity. The first method relies on motor imagery tasks classification, whilst the second one is based on movement intention detection. Results Three healthy users and five patients with neurological conditions participated in the experiments to verify the usability of the system. Using the BMI based on motor imagery, healthy volunteers obtained an average accuracy of 82.9 ± 14.5 %, and patients obtained an accuracy of 65.3 ± 9.0 %, with a low False Positives rate (FP) (19.2 ± 10.4 % and 15.0 ± 8.4 %, respectively). On the other hand, by using the BMI based on detecting the arm movement intention, the average accuracy was 76.7 ± 13.2 % for healthy users and 71.6 ± 15.8 % for patients, with 28.7 ± 19.9 % and 21.2 ± 13.3 % of FP rate (healthy users and patients, respectively). Conclusions The accuracy of the results shows that the combined use of a hybrid upper limb exoskeleton and a BMI could be used for rehabilitation therapies. The advantage of this system is that the user is an active part of the rehabilitation procedure. The next step will be to verify what are the clinical benefits for the patients using this new rehabilitation procedure.
Collapse
Affiliation(s)
- Enrique Hortal
- Brain-Machine Interface Systems Lab, Miguel Hernández University of Elche, Av. de la Universidad, S/N, Elche, 03202, Spain.
| | - Daniel Planelles
- Brain-Machine Interface Systems Lab, Miguel Hernández University of Elche, Av. de la Universidad, S/N, Elche, 03202, Spain.
| | - Francisco Resquin
- Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain.
| | - José M Climent
- Department of Physical Medicine and Rehabilitation, Hospital General Universitario de Alicante, Alicante, Spain.
| | - José M Azorín
- Brain-Machine Interface Systems Lab, Miguel Hernández University of Elche, Av. de la Universidad, S/N, Elche, 03202, Spain.
| | - José L Pons
- Rehabilitation Group, Cajal Institute, Spanish National Research Council, Madrid, Spain.
| |
Collapse
|
28
|
Ibáñez J, Serrano JI, del Castillo MD, Minguez J, Pons JL. Predictive classification of self-paced upper-limb analytical movements with EEG. Med Biol Eng Comput 2015; 53:1201-10. [PMID: 25980505 DOI: 10.1007/s11517-015-1311-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/04/2015] [Indexed: 12/01/2022]
Abstract
The extent to which the electroencephalographic activity allows the characterization of movements with the upper limb is an open question. This paper describes the design and validation of a classifier of upper-limb analytical movements based on electroencephalographic activity extracted from intervals preceding self-initiated movement tasks. Features selected for the classification are subject specific and associated with the movement tasks. Further tests are performed to reject the hypothesis that other information different from the task-related cortical activity is being used by the classifiers. Six healthy subjects were measured performing self-initiated upper-limb analytical movements. A Bayesian classifier was used to classify among seven different kinds of movements. Features considered covered the alpha and beta bands. A genetic algorithm was used to optimally select a subset of features for the classification. An average accuracy of 62.9 ± 7.5% was reached, which was above the baseline level observed with the proposed methodology (30.2 ± 4.3%). The study shows how the electroencephalography carries information about the type of analytical movement performed with the upper limb and how it can be decoded before the movement begins. In neurorehabilitation environments, this information could be used for monitoring and assisting purposes.
Collapse
Affiliation(s)
- Jaime Ibáñez
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council - CSIC, Av. Doctor Arce, 37, 28002, Madrid, Spain.
| | - J I Serrano
- Neural and Cognitive Engineering Group, Centro de Automática y Robótica, Spanish National Research Council - CSIC, Arganda del Rey, Spain
| | - M D del Castillo
- Neural and Cognitive Engineering Group, Centro de Automática y Robótica, Spanish National Research Council - CSIC, Arganda del Rey, Spain
| | - J Minguez
- Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
- BitBrain Technologies, Zaragoza, Spain
| | - J L Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council - CSIC, Av. Doctor Arce, 37, 28002, Madrid, Spain
| |
Collapse
|
29
|
Kadri B, Cuny P, Linossier R, Sangare N, Pons JL, Descoutures JM. PP-031 The use of guidelines in the cytotoxic drugs preparation unit: what is the real workload for pharmacy technicians? Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.311] [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] [Indexed: 11/03/2022] Open
|
30
|
Skalafouris C, Pons JL, Plassart F, Descoutures JM. DD-005 Developing a management strategy for medication units free of secondary packaging in a hospital pharmacy. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
31
|
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.
Collapse
|
32
|
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.
Collapse
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;
| |
Collapse
|
33
|
Ibáñez J, Serrano JI, del Castillo MD, Monge-Pereira E, Molina-Rueda F, Alguacil-Diego I, Pons JL. Detection of the onset of upper-limb movements based on the combined analysis of changes in the sensorimotor rhythms and slow cortical potentials. J Neural Eng 2014; 11:056009. [PMID: 25082789 DOI: 10.1088/1741-2560/11/5/056009] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Characterizing the intention to move by means of electroencephalographic activity can be used in rehabilitation protocols with patients' cortical activity taking an active role during the intervention. In such applications, the reliability of the intention estimation is critical both in terms of specificity 'number of misclassifications' and temporal accuracy. Here, a detector of the onset of voluntary upper-limb reaching movements based on the cortical rhythms and the slow cortical potentials is proposed. The improvement in detections due to the combination of these two cortical patterns is also studied. APPROACH Upper-limb movements and cortical activity were recorded in healthy subjects and stroke patients performing self-paced reaching movements. A logistic regression combined the output of two classifiers: (i) a naïve Bayes classifier trained to detect the event-related desynchronization preceding the movement onset and (ii) a matched filter detecting the bereitschaftspotential. The proposed detector was compared with the detectors by using each one of these cortical patterns separately. In addition, differences between the patients and healthy subjects were analysed. MAIN RESULTS On average, 74.5 ± 13.8% and 82.2 ± 10.4% of the movements were detected with 1.32 ± 0.87 and 1.50 ± 1.09 false detections generated per minute in the healthy subjects and the patients, respectively. A significantly better performance was achieved by the combined detector (as compared to the detectors of the two cortical patterns separately) in terms of true detections (p = 0.099) and false positives (p = 0.0083). SIGNIFICANCE A rationale is provided for combining information from cortical rhythms and slow cortical potentials to detect the onsets of voluntary upper-limb movements. It is demonstrated that the two cortical processes supply complementary information that can be summed up to boost the performance of the detector. Successful results have been also obtained with stroke patients, which supports the use of the proposed system in brain-computer interface applications with this group of patients.
Collapse
Affiliation(s)
- J Ibáñez
- Bioengineering Group, Spanish Research Council (CSIC), Arganda del Rey, Madrid E-28500, Spain
| | | | | | | | | | | | | |
Collapse
|
34
|
Barroso FO, Torricelli D, Moreno JC, Taylor J, Gomez-Soriano J, Bravo-Esteban E, Piazza S, Santos C, Pons JL. Shared muscle synergies in human walking and cycling. J Neurophysiol 2014; 112:1984-98. [PMID: 25057144 DOI: 10.1152/jn.00220.2014] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [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: 02/01/2023] Open
Abstract
The motor system may rely on a modular organization (muscle synergies activated in time) to execute different tasks. We investigated the common control features of walking and cycling in healthy humans from the perspective of muscle synergies. Three hypotheses were tested: 1) muscle synergies extracted from walking trials are similar to those extracted during cycling; 2) muscle synergies extracted from one of these motor tasks can be used to mathematically reconstruct the electromyographic (EMG) patterns of the other task; 3) muscle synergies of cycling can result from merging synergies of walking. A secondary objective was to identify the speed (and cadence) at which higher similarities emerged. EMG activity from eight muscles of the dominant leg was recorded in eight healthy subjects during walking and cycling at four matched cadences. A factorization technique [nonnegative matrix factorization (NNMF)] was applied to extract individual muscle synergy vectors and the respective activation coefficients behind the global muscular activity of each condition. Results corroborated hypotheses 2 and 3, showing that 1) four synergies from walking and cycling can successfully explain most of the EMG variability of cycling and walking, respectively, and 2) two of four synergies from walking appear to merge together to reconstruct one individual synergy of cycling, with best reconstruction values found for higher speeds. Direct comparison of the muscle synergy vectors of walking and the muscle synergy vectors of cycling (hypothesis 1) produced moderated values of similarity. This study provides supporting evidence for the hypothesis that cycling and walking share common neuromuscular mechanisms.
Collapse
Affiliation(s)
- Filipe O Barroso
- Electronics Department, University of Minho, Azurém, Guimarães, Portugal; Bioengineering Group, Spanish National Research Council (CSIC), Arganda del Rey, Madrid, Spain;
| | - Diego Torricelli
- Bioengineering Group, Spanish National Research Council (CSIC), Arganda del Rey, Madrid, Spain
| | - Juan C Moreno
- Bioengineering Group, Spanish National Research Council (CSIC), Arganda del Rey, Madrid, Spain
| | - Julian Taylor
- Sensorimotor Function Group-National Paraplegia Hospital SESCAM, Toledo, Spain; and
| | - Julio Gomez-Soriano
- Sensorimotor Function Group-National Paraplegia Hospital SESCAM, Toledo, Spain; and Nursing and Physical Therapy School, Castilla la Mancha University, Toledo, Spain
| | - Elisabeth Bravo-Esteban
- Bioengineering Group, Spanish National Research Council (CSIC), Arganda del Rey, Madrid, Spain; Sensorimotor Function Group-National Paraplegia Hospital SESCAM, Toledo, Spain; and
| | - Stefano Piazza
- Bioengineering Group, Spanish National Research Council (CSIC), Arganda del Rey, Madrid, Spain
| | - Cristina Santos
- Electronics Department, University of Minho, Azurém, Guimarães, Portugal
| | - José L Pons
- Bioengineering Group, Spanish National Research Council (CSIC), Arganda del Rey, Madrid, Spain
| |
Collapse
|
35
|
Del-Ama AJ, Gil-Agudo A, Pons JL, Moreno JC. Hybrid gait training with an overground robot for people with incomplete spinal cord injury: a pilot study. Front Hum Neurosci 2014; 8:298. [PMID: 24860478 PMCID: PMC4026740 DOI: 10.3389/fnhum.2014.00298] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 12/15/2013] [Accepted: 04/23/2014] [Indexed: 11/24/2022] Open
Abstract
Locomotor training has proved to provide beneficial effect in terms of mobility in incomplete paraplegic patients. Neuroprosthetic technology can contribute to increase the efficacy of a training paradigm in the promotion of a locomotor pattern. Robotic exoskeletons can be used to manage the unavoidable loss of performance of artificially driven muscles. Hybrid exoskeletons blend complementary robotic and neuro-prosthetic technologies. The aim of this pilot study was to determine the effects of hybrid gait training in three case studies with persons with incomplete spinal cord injury (iSCI) in terms of locomotion performance during assisted gait, patient-robot adaptations, impact on ambulation and assessment of lower limb muscle strength and spasticity. Participants with iSCI received interventions with a hybrid bilateral exoskeleton for 4 days. Assessment of gait function revealed that patients improved the 6 min and 10 m walking tests after the intervention, and further improvements were observed 1 week after the intervention. Muscle examination revealed improvements in knee and hip sagittal muscle balance scores and decreased score in ankle extensor balance. It is concluded that improvements in biomechanical function of the knee joint after the tested overground hybrid gait trainer are coherent with improvements in gait performance.
Collapse
Affiliation(s)
- Antonio J Del-Ama
- Biomechanics and Technical Aids Unit, National Hospital for Spinal Cord Injury Toledo, Spain
| | - Angel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Spinal Cord Injury Toledo, Spain
| | - José L Pons
- Bioengineering Group, Spanish National Research Council Madrid, Spain
| | - Juan C Moreno
- Bioengineering Group, Spanish National Research Council Madrid, Spain
| |
Collapse
|
36
|
del-Ama AJ, Gil-Agudo A, Pons JL, Moreno JC. Hybrid FES-robot cooperative control of ambulatory gait rehabilitation exoskeleton. J Neuroeng Rehabil 2014; 11:27. [PMID: 24594302 PMCID: PMC3995973 DOI: 10.1186/1743-0003-11-27] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [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: 03/04/2013] [Accepted: 02/12/2014] [Indexed: 12/14/2022] Open
Abstract
Robotic and functional electrical stimulation (FES) approaches are used for rehabilitation of walking impairment of spinal cord injured individuals. Although devices are commercially available, there are still issues that remain to be solved. Control of hybrid exoskeletons aims at blending robotic exoskeletons and electrical stimulation to overcome the drawbacks of each approach while preserving their advantages. Hybrid actuation and control have a considerable potential for walking rehabilitation but there is a need of novel control strategies of hybrid systems that adequately manage the balance between FES and robotic controllers. Combination of FES and robotic control is a challenging issue, due to the non-linear behavior of muscle under stimulation and the lack of developments in the field of hybrid control. In this article, a cooperative control strategy of a hybrid exoskeleton is presented. This strategy is designed to overcome the main disadvantages of muscular stimulation: electromechanical delay and change in muscle performance over time, and to balance muscular and robotic actuation during walking. Experimental results in healthy subjects show the ability of the hybrid FES-robot cooperative control to balance power contribution between exoskeleton and muscle stimulation. The robotic exoskeleton decreases assistance while adequate knee kinematics are guaranteed. A new technique to monitor muscle performance is employed, which allows to estimate muscle fatigue and implement muscle fatigue management strategies. Kinesis is therefore the first ambulatory hybrid exoskeleton that can effectively balance robotic and FES actuation during walking. This represents a new opportunity to implement new rehabilitation interventions to induce locomotor activity in patients with paraplegia. Acronym list: 10mWT: ten meters walking test; 6MWT: six minutes walking test; FSM: finite-state machine; t-FSM: time-domain FSM; c-FSM: cycle-domain FSM; FES: functional electrical stimulation; HKAFO: hip-knee-ankle-foot orthosis; ILC: iterative error-based learning control; MFE: muscle fatigue estimator; NILC: Normalized stimulation output from ILC controller; PID: Proportional-Integral-derivative Control; PW: Stimulation pulse width; QUEST: Quebec User Evaluation of Satisfaction with assistive Technology; SCI: Spinal cord injury; TTI: torque-time integral; VAS: Visual Analog Scale.
Collapse
Affiliation(s)
- Antonio J del-Ama
- Biomechanics and Technical Aids Unit, National Hospital for Spinal Cord Injury, SESCAM, Toledo, Spain.
| | | | | | | |
Collapse
|
37
|
Bravo-Esteban E, Taylor J, Aleixandre M, Simon-Martínez C, Torricelli D, Pons JL, Gómez-Soriano J. Tibialis Anterior muscle coherence during controlled voluntary activation in patients with spinal cord injury: diagnostic potential for muscle strength, gait and spasticity. J Neuroeng Rehabil 2014; 11:23. [PMID: 24594207 PMCID: PMC3973993 DOI: 10.1186/1743-0003-11-23] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 02/15/2013] [Accepted: 02/12/2014] [Indexed: 12/11/2022] Open
Abstract
Background Coherence estimation has been used as an indirect measure of voluntary neurocontrol of residual motor activity following spinal cord injury (SCI). Here intramuscular Tibialis Anterior (TA) coherence estimation was performed within specific frequency bands for the 10-60 Hz bandwidth during controlled ankle dorsiflexion in subjects with incomplete SCI with and without spasticity. Methods In the first cohort study 15 non-injured and 14 motor incomplete SCI subjects were recruited to evaluate TA coherence during controlled movement. Specifically 15-30 Hz EMG was recorded during dorsiflexion with: i) isometric activation at 50, 75 and 100% of maximal voluntary torque (MVT), ii) isokinetic activation at 60 and 120°/s and iii) isotonic dorsiflexion at 50% MVT. Following identification of the motor tasks necessary for measurement of optimal TA coherence a second cohort was analyzed within the 10-16 Hz, 15-30 Hz, 24-40 Hz and 40-60 Hz bandwidths from 22 incomplete SCI subjects, with and without spasticity. Results Intramuscular 40-60 Hz, but not 15-30 Hz TA, coherence calculated in SCI subjects during isometric activation at 100% of MVT was lower than the control group. In contrast only isometric activation at 100% of MVT 15-30 Hz TA coherence was higher in subjects with less severe SCI (AIS D vs. AIS C), and correlated functionally with dorsiflexion MVT. Higher TA coherence was observed for the SCI group during 120°/s isokinetic movement. In addition 15-30 Hz TA coherence calculated during isometric activation at 100% MVT or 120°/s isokinetic movement correlated moderately with walking function and time from SCI, respectively. Spasticity symptoms correlated negatively with coherence during isometric activation at 100% of MVT in all tested frequency bands, except for 15-30 Hz. Specifically, 10-16 Hz coherence correlated inversely with passive resistive torque to ankle dorsiflexion, while clinical measures of muscle hypertonia and spasm severity correlated inversely with 40-60 Hz. Conclusion Analysis of intramuscular 15-30 Hz TA coherence during isometric activation at 100% of MVT is related to muscle strength and gait function following incomplete SCI. In contrast several spasticity symptoms correlated negatively with 10-16 Hz and 40-60 Hz TA coherence during isometric activation at 100% MVT. Validation of the diagnostic potential of TA coherence estimation as a reliable and comprehensive measure of muscle strength, gait and spasticity should facilitate SCI neurorehabilation.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Julio Gómez-Soriano
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, Toledo, Spain.
| |
Collapse
|
38
|
Cotteret C, Linossier-rocher R, Joly L, Pons JL, Descoutures JM. CP-044 Audit of the patient treatment process in an oncology outpatient clinic: from welcome to the administration of chemotherapy. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.43] [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] [Indexed: 11/03/2022] Open
|
39
|
Ibanez J, Serrano JI, del Castillo MD, Monge E, Molina F, Rivas FM, Alguacil I, Miangolarra JC, Pons JL. Upper-limb muscular electrical stimulation driven by EEG-based detections of the intentions to move: a proposed intervention for patients with stroke. Annu Int Conf IEEE Eng Med Biol Soc 2014; 2014:1646-1649. [PMID: 25570289 DOI: 10.1109/embc.2014.6943921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study proposes an intervention for stroke patients in which electrical stimulation of muscles in the affected arm is supplied when movement intention is detected from the electroencephalographic signal. The detection relies on the combined analysis of two movement related cortical patterns: the event-related desynchronization and the bereitschaftspotential. Results with two healthy subjects and three chronic stroke patients show that reliable EEG-based estimations of the movement onsets can be generated (on average, 66.9 ± 26.4 % of the movements are detected with 0.42 ± 0.17 false activations per minute) which in turn give rise to electrical stimuli providing sensory feedback tightly associated to the movement planning (average detection latency of the onsets of the movements was 54.4 ± 287.9 ms).
Collapse
|
40
|
Morone G, Iosa M, Tamburella F, Muzzioli L, Pisotta I, Moreno JC, Pons JL, Paolucci S, Cincotti F, Molinari M. An EMG Pattern Comparison of Exoskeleton vs. End-Effector Robotic Device for Assisted Walking Training. Biosystems & Biorobotics 2014. [DOI: 10.1007/978-3-319-08072-7_82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
|
41
|
Piazza S, Torricelli D, Brunetti F, del-Ama AJ, Gil-Agudo A, Pons JL. A novel FES control paradigm based on muscle synergies for postural rehabilitation therapy with hybrid exoskeletons. Conf Proc IEEE Eng Med Biol Soc 2013; 2012:1868-71. [PMID: 23366277 DOI: 10.1109/embc.2012.6346316] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hybrid exoskeletons combine robotic orthoses and motor neuroprosthetic devices to compensate for motor disabilities and assist rehabilitation. The basic idea is to take benefits from the strength of each technology, primarily the power of robotic actuators and the clinical advantages of using patient's muscles, while compensating for the respective weaknesses: weight and autonomy for the former, fatigue and stability for the latter. While a wide repertory of solutions have been proposed in literature for the control of robotic orthoses and simple motor neuroprosthesis, the same problem on a complex hybrid architecture, involving a wide number of muscles distributed on multiple articulations, still waits for a practical solution. In this article we present a general algorithm for the control of the neuroprosthesis in the execution of functional coordinated movements. The method extracts muscle synergies as a mean to diagnose residual neuromotor capabilities, and adapts the rehabilitation exercise to patient requirements in a dynamic way. Fatigue effects and unexpected perturbations are compensated by monitoring functional state variables estimated from sensors in the robot. The proposed concept is applied to a case-study scenario, in which a postural balance rehabilitation therapy is presented.
Collapse
Affiliation(s)
- S Piazza
- Bioengineering Group, Spanish Research Council, Spain.
| | | | | | | | | | | |
Collapse
|
42
|
Collantes I, Asin G, Moreno JC, Pons JL. Analysis of biomechanical data to determine the degree of users participation during robotic-assisted gait rehabilitation. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2012:4855-8. [PMID: 23367015 DOI: 10.1109/embc.2012.6347081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Recent studies have shown evidence indicating that effective robotic rehabilitation is only possible when the user actively participates during training. Providing a complete effective biofeedback to the patient representing his compliance to the therapy and his performance is thought that his active participation will be enhanced significantly, thus, improving his rehabilitation. We have performed a study with the driven gait orthosis (DGO) Lokomat (Hocoma AG, Volketswil, Switzerland). The objective of the present study is the analysis of the effect of different types of participation (attention to the functional task) from subjects receiving robotic assisted gait training on the kinematic and kinetic patterns. The obtained results provide useful evidence of specific biomechanical features that can be used to design more useful, robust, focused and intuitive biomechanical biofeedback during robotic assisted gait rehabilitation in stroke survivors.
Collapse
Affiliation(s)
- I Collantes
- Bioengineering Group, Consejo Superior de Investigaciones Cientficas, Carretera de Campo Real km 0.200 Arganda del Rey, 28500 Madrid, Spain.
| | | | | | | |
Collapse
|
43
|
Moreno JC, Barroso F, Farina D, Gizzi L, Santos C, Molinari M, Pons JL. Effects of robotic guidance on the coordination of locomotion. J Neuroeng Rehabil 2013; 10:79. [PMID: 23870328 PMCID: PMC3724716 DOI: 10.1186/1743-0003-10-79] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [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: 08/20/2012] [Accepted: 06/14/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Functional integration of motor activity patterns enables the production of coordinated movements, such as walking. The activation of muscles by weightened summation of activation signals has been demonstrated to represent the spatiotemporal components that determine motor behavior during walking. Exoskeleton robotic devices are now often used in the rehabilitation practice to assist physical therapy of individuals with neurological disorders. These devices are used to promote motor recovery by providing guidance force to the patients. The guidance should in principle lead to a muscle coordination similar to physiological human walking. However, the influence of robotic devices on locomotor patterns needs still to be characterized. The aim of this study was to analyze the effect of force guidance and gait speed on the modular organization of walking in a group of eight healthy subjects. METHOD A group of healthy subjects walked on a treadmill with and without robotic aiding at speeds of 1.5, 2.0 and 2.5 Km/h. The guidance force was varied between 20%, 40%, 70% and 100% level of assistance. EMG recordings were obtained from seven leg muscles of the dominant leg and kinematic and kinetic features of the knee and hip joints were extracted. RESULTS Four motor modules were sufficient to represent the variety of behavioral goals demanded during robotic guidance, with similar relationships between muscle patterns and biomechanical parameters across subjects, confirming that the low-dimensional and impulsive control of human walking is maintained using robotic force guidance. The conditions of guidance force and speed that maintained correct and incorrect (not natural) modular control were identified. CONCLUSION In neurologically intact subjects robotic-guided walking at various force guidance and speed levels does not alter the basic locomotor control and timing. This allows the design of robotic-aided rehabilitation strategies aimed at the modulation of motor modules, which are altered in stroke.
Collapse
Affiliation(s)
- Juan C Moreno
- Bioengineering Group, Spanish National Research Council, CSIC, Carretera Campo Real, Madrid, Spain.
| | | | | | | | | | | | | |
Collapse
|
44
|
Gil-Agudo A, Pérez-Nombela S, Pérez-Rizo E, del Ama-Espinosa A, Crespo-Ruiz B, Pons JL. Comparative biomechanical analysis of gait in patients with central cord and Brown-Séquard syndrome. Disabil Rehabil 2013; 35:1869-76. [DOI: 10.3109/09638288.2013.766268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
45
|
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.
Collapse
|
46
|
Barroso F, Torricelli D, Moreno JC, Taylor J, Gómez-Soriano J, Esteban EB, Santos C, Pons JL. Similarity of muscle synergies in human walking and cycling: preliminary results. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:6933-6936. [PMID: 24111339 DOI: 10.1109/embc.2013.6611152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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
Recent investigations on how the Motor System coordinates different tasks in humans have indicated that a low-dimensional structure of muscle synergies is sufficient to explain specific spatiotemporal components underlying such behaviors. In this work, we tested the hypothesis that pedaling and walking share common modular features by using the muscle synergies paradigm. Seven healthy subjects walked on a treadmill at their maximum speed and also cycled in an ergometer, set at the same walking cadence. EMG activity was recorded from 10 muscles of the most dominant leg. A Non-Negative Matrix Factorization algorithm was applied to extract synergies. Four synergies were sufficient to explain 90% of the EMG variability during walking and cycling. There were statistically significant correlations (higher than 71%) across similar synergies for each task (walking and pedaling). These preliminary results support the hypothesis of modular control across different human motor tasks and may indicate that some synergies are shared amongst different rhythmic movements.
Collapse
|
47
|
Abstract
In this article the principles of human locomotion are revisited and reviewed. This has been done in the framework of two European projects, where the elicitation of these mechanisms inform, on the one hand, the design of artificial bipedal walkers (H2R), and on the other hand the design of lower limb exoskeletons (BETTER) for rehabilitation of gait in post-stroke patients. Passive dynamics emerging from the morphology of the human musculoskeletal system, reflexes as stabilization mechanisms, modular control of movement as well as supra-spinal control of gait are reviewed to get insight on how these mechanisms can be used to explain human locomotion.
Collapse
|
48
|
Abstract
BACKGROUND It is hypothesized that locomotion is achieved by means of rhythm generating networks (central pattern generators) and muscle activation generating networks. This modular organization can be partly identified from the analysis of the muscular activity by means of factorization algorithms. The activity of rhythm generating networks is described by activation signals whilst the muscle intervention generating network is represented by motor modules (muscle synergies). In this study, we extend the analysis of modular organization of walking to the case of robot-aided locomotion, at varying speed and body weight support level. METHODS Non Negative Matrix Factorization was applied on surface electromyographic signals of 8 lower limb muscles of healthy subjects walking in gait robotic trainer at different walking velocities (1 to 3 km/h) and levels of body weight support (0 to 30%). RESULTS The muscular activity of volunteers could be described by low dimensionality (4 modules), as for overground walking. Moreover, the activation signals during robot-aided walking were bursts of activation timed at specific phases of the gait cycle, underlying an impulsive controller, as also observed in overground walking. This modular organization was consistent across the investigated speeds, body weight support level, and subjects. CONCLUSIONS These results indicate that walking in a Lokomat robotic trainer is achieved by similar motor modules and activation signals as overground walking and thus supports the use of robotic training for re-establishing natural walking patterns.
Collapse
Affiliation(s)
- Leonardo Gizzi
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | | | | | | | | | | |
Collapse
|
49
|
del-Ama AJ, Koutsou AD, Moreno JC, de-los-Reyes A, Gil-Agudo A, Pons JL. Review of hybrid exoskeletons to restore gait following spinal cord injury. ACTA ACUST UNITED AC 2012; 49:497-514. [PMID: 22773254 DOI: 10.1682/jrrd.2011.03.0043] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Different approaches are available to compensate gait in persons with spinal cord injury, including passive orthoses, functional electrical stimulation (FES), and robotic exoskeletons. However, several drawbacks arise from each specific approach. Orthotic gait is energy-demanding for the user and functionally ineffective. FES uses the muscles as natural actuators to generate gait, providing not only functional but also psychological benefits to the users. However, disadvantages are also related to the early appearance of muscle fatigue and the control of joint trajectories. Robotic exoskeletons that provide joint moment compensation or substitution to the body during walking have been developed in recent years. Significant advances have been achieved, but the technology itself is not mature yet because of many limitations related to both physical and cognitive interaction as well as portability and energy-management issues. Meanwhile, the combination of FES technology and exoskeletons has emerged as a promising approach to both gait compensation and rehabilitation, bringing together technologies, methods, and rehabilitation principles that can overcome the drawbacks of each individual approach. This article presents an overview of hybrid lower-limb exoskeletons, related technologies, and advances in actuation and control systems. Also, we highlight the functional assessment of individuals with spinal cord injury.
Collapse
Affiliation(s)
- Antonio J del-Ama
- Biomechanics and Technical Aids Unit, National Hospital for Spinal Cord Injury, SESCAM, Toledo, Spain.
| | | | | | | | | | | |
Collapse
|
50
|
Brunetti F, Garay Á, Moreno JC, Pons JL. Enhancing functional electrical stimulation for emerging rehabilitation robotics in the framework of HYPER project. IEEE Int Conf Rehabil Robot 2012; 2011:5975370. [PMID: 22275574 DOI: 10.1109/icorr.2011.5975370] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper presents the development of a novel functional electrical stimulation (FES) system. New approaches in emerging rehabilitation robotics propose the use of residual muscular activity or limbs movements during the rehabilitation process of neuromotor. More ambitious projects propose the use of FES systems to restore or compensate motor capabilities by controlling existing muscles or subject limbs. These emerging approaches require more sophisticated FES devices in terms of channels, signals controls and portability. In the framework of HYPER project, such devices are being developed to support the main objective of the project: the development of neurorobots and neuroprosthetics to restore functional motor capabilities in patients who suffered cerebrovascular accidents or spinal cord injury. The presented portable FES system includes novel elec-trostimulator circuits and improved channel switching capacities to enable emerging approaches in rehabilitation robotics.
Collapse
|