Motor and Cognitive Modulation of a Single Session of Transcutaneous Auricular Vagus Nerve Stimulation in Post Stroke Patients: A Pilot Study

Objective: The aim of the present study is to explore whether a single session of transcutaneous Vagus Nerve Stimulation (tVNS) can enhance the ipsilesional, and contralesional upper limb motor functions as well as cognitive functions in stroke patients. The effects of the stimulation were evaluated through two different tasks: the box and blocks test (BB), indexing manual dexterity, and the Go/No-go task, a visuomotor paradigm used to assess both motor readiness and response inhibition. Tests were administered without tVNS, during tVNS and during sham tVNS. Results: The BB showed a statistical difference for both contralesional side (p = 0.05) between Basal-Real condition (p = 0.042) and ipsilesional side (p = 0.001) between Basal-Real (p = 0.008) and for Real-Sham (p = 0.005). Any statistical difference was found for the mean latencies in the three conditions of the Go/No-go test. Conclusion: A single session of tVNS seems to improve upper limb motor functions but not cognitive functions in post-stroke patients, despite a positive trend was detected.

A force-based human machine interface to drive a motorized upper limb exoskeleton. a pilot study

Muscular dystrophy is a strongly invalidating disease that causes the progressive loss of motor skills. The use of assistive devices, especially those in support of the upper limb, can increase the ability to perform daily-life activities and foster a partial recovery of the lost motor functionalities. However, for the use of these devices to be truly effective and accepted by patients, their activation must coincide with the user's intention to move. This work describes a new human-machine interface based on the integration of a six-axis force sensor to drive an upper limb motorized exoskeleton. This novel system can detect the patient's intention to move and produce displacements of the robotic device that are of magnitude and direction consistent with the user's wishes. The integration of the force-sensor interface in the BRIDGE/EMPATIA exoskeletal system was successful, and tests performed on both healthy and dystrophic subjects showed promising results, especially for the execution of planar movements.

Upper limb exosuit cable routing optimization

Exosuits are emerging as promising in assisting with activities of daily living. In the design phase of an exosuit, it is fundamental to maximize its portability. The goal of this work was to identify the best cable routing configuration for an upper limb cable-driven exosuit to assist elbow flexion. Simulations were run in OpenSim. Different cable configurations were evaluated. The goal was to minimize the overall tension of the cables to reduce the device's power consumption and torque requirements. The optimal configuration was evaluated in simulation for different percentages of assistance to study its effects in terms of muscle activation and joint reaction forces. We then tested three different configurations on a test bench to both evaluate the motor current and their effect on the pronation/supination of the elbow. Simulation results suggested that a double cable configuration might help to lower the motor torque and power consumption. This conclusion was supported by the experimental results, in which the motor current was reduced by 12.5% with respect to the single cable configuration. Simulation results also showed that the optimal configuration lowered muscle activation without greatly affecting joint reactions at the elbow, even though it might cause unwanted pronation/supination, as experimental results confirmed. However, since a double configuration results in greater complexity and reduced efficiency, single-cable solutions still represent a good option.

Hand grip support for rehabilitation and assistance: from patent to TRL5

In the last decades, the continuous increase in the number of the vast cohort of chronic patients that constantly need medical assistance and supervision, and the widespread lack of therapist has brought to an increased interest in the role of medical technologies in rehabilitative programs and assistive scenarios. Current clinical evidence in rehabilitation demonstrates that there is an important and increasing demand for innovative therapeutic solutions to recover the hand functions to prevent patients to need assistance in performing daily life activities. This works describes the pathway from patent to TRL5 of a device to support hand grip actions and interaction with daily life objects. E-KIRO is based on the use of electromagnets, which are able to attach/detach interactive objects equipped with a ferromagnetic plate. Five end-users used the device and scored it with excellent usability based on the System Usability Scale.

Upper-limb actuated exoskeleton for muscular dystrophy patients: preliminary results

Being able to perform a lost movement is an important experience towards increased independence and self-esteem, particularly for neuromuscular patients, who see their muscles weaken day after day. In this pilot study, preliminary results on the testing of a motorized upper-limb exoskeleton for muscular dystrophy patients are presented. The mechatronic system is a five Degrees of Freedom exoskeleton, which acts at shoulder, elbow, and wrist levels. It is designed to help severely impaired people to regain independence during daily-life activities. While wearing the exoskeleton, the user has the direct control of the system by actively piloting the position of end-effector by means of joystick or vocal control. The usability of the system and a quantitative assessment of arm functionality with and without the exoskeleton are evaluated on five muscular dystrophy patients. According to the objective functional benefit evaluation performed through the PUL scale, all participants strongly increased their range of motion and they were able to perform activities that were not possible without the exoskeleton, such as such as feeding, playing activities at the table, combing hair or using a keyboard. As for the evaluation of self-perceived functional benefit, four patients reflected the effective measured functional improvement. System usability has been evaluated to be good.

The combined action of a passive exoskeleton and an EMG-controlled neuroprosthesis for upper limb stroke rehabilitation: First results of the RETRAINER project

The combined use of Functional Electrical Stimulation (FES) and robotic technologies is advocated to improve rehabilitation outcomes after stroke. This work describes an arm rehabilitation system developed within the European project RETRAINER. The system consists of a passive 4-degrees-of-freedom exoskeleton equipped with springs to provide gravity compensation and electromagnetic brakes to hold target positions. FES is integrated in the system to provide additional support to the most impaired muscles. FES is triggered based on the volitional EMG signal of the same stimulated muscle; in order to encourage the active involvement of the patient the volitional EMG is also monitored throughout the task execution and based on it a happy or sad emoji is visualized at the end of each task. The control interface control of the system provides a GUI and multiple software tools to organize rehabilitation exercises and monitor rehabilitation progress. The functionality and the usability of the system was evaluated on four stroke patients. All patients were able to use the system and judged positively its wearability and the provided support. They were able to trigger the stimulation based on their residual muscle activity and provided different levels of active involvement in the exercise, in agreement with their level of impairment. A randomized controlled trial aimed at evaluating the effectiveness of the RETRAINER system to improve arm function after stroke is currently ongoing.

Neuro-mechanics of muscle coordination during recumbent pedaling in post-acute stroke patients

Motor impairment after stroke has been hypothesized to be related, among others, to impairments in the modular control of movement. In this study we analyzed muscle coordination and pedal forces during a recumbent pedaling exercise from a sample of post-acute stroke patients (n=5) and a population of age-matched healthy individuals (n=4). Healthy subjects and the less impaired patients showed a shared modular organization of pedaling based on 4 similar muscle synergies. The most impaired patient, characterized by a Motricity Index of 52/100, showed a reduced complexity (only 2 muscle synergies for the affected side). Differences between healthy subjects and post-stroke patients in the execution of the task were identified in terms of unbalance in mechanical work production, which well corresponded to the level of impairment. This pedaling unbalance could be traced back to different activation strategies of the 4 identified modules. Investigation on a more representative sample will provide a full characterization of the neuro-mechanics of pedaling after stroke, helping our understandings of the disruption of motor coordination at central level after stroke and of the most effective solutions for functional recovery.

Quantitative Evaluation of Performance during Robot-assisted Treatment

INTRODUCTION

This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation".

OBJECTIVES

The great potential of robots in extracting quantitative and meaningful data is not always exploited in clinical practice. The aim of the present work is to describe a simple parameter to assess the performance of subjects during upper limb robotic training exploiting data automatically recorded by the robot, with no additional effort for patients and clinicians.

METHODS

Fourteen children affected by cerebral palsy (CP) performed a training with Armeo®Spring. Each session was evaluated with P, a simple parameter that depends on the overall performance recorded, and median and interquartile values were computed to perform a group analysis.

RESULTS

Median (interquartile) values of P significantly increased from 0.27 (0.21) at T0 to 0.55 (0.27) at T1 . This improvement was functionally validated by a significant increase of the Melbourne Assessment of Unilateral Upper Limb Function.

CONCLUSIONS

The parameter described here was able to show variations in performance over time and enabled a quantitative evaluation of motion abilities in a way that is reliable with respect to a well-known clinical scale.

An ecological evaluation of the metabolic benefits due to robot-assisted gait training

Cerebral palsy (CP), one of the most common neurological disorders in childhood, features affected individual's motor skills and muscle actions. This results in elevated heart rate and rate of oxygen uptake during sub-maximal exercise, thus indicating a mean energy expenditure higher than healthy subjects. Rehabilitation, currently involving also robot-based devices, may have an impact also on these aspects. In this study, an ecological setting has been proposed to evaluate the energy expenditure of 4 children with CP before and after a robot-assisted gait training. Even if the small sample size makes it difficult to give general indications, results presented here are promising. Indeed, children showed an increasing trend of the energy expenditure per minute and a decreasing trend of the energy expenditure per step, in accordance to the control group. These data suggest a metabolic benefit of the treatment that may increase the locomotion efficiency of disabled children.

Biomimetic NMES controller for arm movements supported by a passive exoskeleton

The European Project MUltimodal Neuroprosthesis for Daily Upper limb Support (MUNDUS) aims at the development of an assistive platform for recovering direct interaction capability during daily life activities based on arm reaching and hand functions. Within this project the present study is focused on the design of a biomimetic controller able to modulate the neuromuscular electrical stimulation needed to perform reaching movements supported by a commercial passive exoskeleton for weight relief. Once defined the activities of daily life to be supported by the MUNDUS system, an experimental campaign on healthy subjects was carried out to identify the repeatable kinematics and muscular solution adopted during the target movements. The kinematics resulted to be highly stereotyped, a root mean squared error lower than 5° was found between all the trajectories obtained by healthy subjects in the same movement. A principal component analysis was performed on the EMG signals: less than 5 components explained more than the 85% of the signal variance. This result suggested that the muscular strategy adopted by healthy subjects was stereotyped and can be replicated by a biomimetic NMES controller. The controller was based on a time-delay artificial neural network which mapped the dynamic and non-linear relationship between kinematics and EMG activations to determine the stimulation timing. The stimulation levels reproduced the same scaling factors found between muscles in the stereotyped strategy. The controller was tested on 2 healthy subjects and though it was a feedforward controller, it showed good accuracy in reaching the desired target positions. The integration of a feedback controller is foreseen to ensure the complete accomplishment of the task and to compensate for unpredictable conditions such as muscular fatigue.

A novel environmental chamber for neuronal network multisite recordings

Environmental stability is a critical issue for neuronal networks in vitro. Hence, the ability to control the physical and chemical environment of cell cultures during electrophysiological measurements is an important requirement in the experimental design. In this work, we describe the development and the experimental verification of a closed chamber for multisite electrophysiology and optical monitoring. The chamber provides stable temperature, pH and humidity and guarantees cell viability comparable to standard incubators. Besides, it integrates the electronics for long-term neuronal activity recording. The system is portable and adaptable for multiple network housings, which allows performing parallel experiments in the same environment. Our results show that this device can be a solution for long-term electrophysiology, for dual network experiments and for coupled optical and electrical measurements.

Cycling induced by functional electrical stimulation in children affected by cerebral palsy: case report

BACKGROUND

Recently, the efficacy of functional electrical stimulation (FES) cycling have been demonstrated on the improvement of strength and motor control in adults with stroke. FES-cycling, providing a repetitive goal-oriented task, could facilitate cortical reorganization and utilization of residual cortico-spinal pathways. These benefits could be more enhanced in children because of the greater plasticity and flexibility of their central nervous system.

AIM

The aim of the present case report study was to explore the feasibility of FES-cycling in children with cerebral palsy (CP) and to provide a set of instrumental measures able to evaluate the effects of this novel treatment on cycling and walking ability.

DESIGN

Interventional study.

SETTING AND POPULATION

Two ambulant outpatient children with diplegic CP were recruited by the "E. Medea" Scientific Institute.

METHODS

Patients followed a FES-cycling treatment for 30 minutes a day, 3 days a week for 7 weeks. Pre and post treatment tests were performed, namely clinical measures and electromyographic, kinematic and oxygen expenditure analysis during gait and cycling.

RESULTS

The treatment was safe, feasible and well accepted by the 2 children. After treatment both patients achieved a more symmetrical muscular strategy during voluntary cycling and gait and a significant reduction of muscle co-contractions during cycling. These improvements were corroborated by a decrease in oxygen expenditure during the post test for one of the two children, the less impaired, implying a better exploiting of bi-articular muscles.

CONCLUSION AND CLINICAL REHABILITATION IMPACT

FES-cycling is feasible and safe and it may be an alternative rehabilitation method for diplegic CP patients. The set of instrumental measurements proposed seems to be a valuable tool for functional assessment to identify subclinical anomalies and improvements on cycling and gait in CP patients.

Functional evaluation and rehabilitation engineering

Life is complex and all about movement, which allows us to interact with the environment and communicate with each other. The human nervous system is capable of performing a simultaneous and integrated control of 100-150 mechanical degrees of freedom of movement in the body via tensions generated by about 700 muscles. In its widest context, movement is carried out by a sensory motor system comprising multiple sensors (visual,auditory, and proprioceptive),multiple actuators (muscles acting on the skeletal system),and an intermediary processor that can be summarized as a multiple-input–multiple-output nonlinear dynamic time-varying control system. This grand control system is capable of responding with remarkable accuracy,speed, appropriateness,versatility, and adaptability to a wide spectrum of continuous and discrete stimuli and conditions and is certainly orders of magnitude more complex and sophisticated than the most advanced robotic systems currently available. In the last decades,a great deal of research has been carried out in the fields of functional evaluation of human performance and rehabilitation engineering. These fields combine knowledge, concepts, and methods from across many disciplines (e.g., biomechanics,neuroscience, and physiology), with the aim of developing apparatuses and methods fort he measurement and analysis of complex sensory motor performance and the ultimate goal of enhancing the execution of different tasks in both healthy people and persons with reduced capabilities from different causes (injury, disease, amputation,and neural degeneration).

A new cross-correlation algorithm for the analysis of "in vitro" neuronal network activity aimed at pharmacological studies

Modern drug discovery for Central Nervous System pathologies has recently focused its attention to in vitro neuronal networks as models for the study of neuronal activities. Micro Electrode Arrays (MEAs), a widely recognized tool for pharmacological investigations, enable the simultaneous study of the spiking activity of discrete regions of a neuronal culture, providing an insight into the dynamics of networks. Taking advantage of MEAs features and making the most of the cross-correlation analysis to assess internal parameters of a neuronal system, we provide an efficient method for the evaluation of comprehensive neuronal network activity. We developed an intra network burst correlation algorithm, we evaluated its sensitivity and we explored its potential use in pharmacological studies. Our results demonstrate the high sensitivity of this algorithm and the efficacy of this methodology in pharmacological dose-response studies, with the advantage of analyzing the effect of drugs on the comprehensive correlative properties of integrated neuronal networks.

Development and validation of a spike detection and classification algorithm aimed at implementation on hardware devices

Neurons cultured in vitro on MicroElectrode Array (MEA) devices connect to each other, forming a network. To study electrophysiological activity and long term plasticity effects, long period recording and spike sorter methods are needed. Therefore, on-line and real time analysis, optimization of memory use and data transmission rate improvement become necessary. We developed an algorithm for amplitude-threshold spikes detection, whose performances were verified with (a) statistical analysis on both simulated and real signal and (b) Big O Notation. Moreover, we developed a PCA-hierarchical classifier, evaluated on simulated and real signal. Finally we proposed a spike detection hardware design on FPGA, whose feasibility was verified in terms of CLBs number, memory occupation and temporal requirements; once realized, it will be able to execute on-line detection and real time waveform analysis, reducing data storage problems.

Cycling induced by functional electrical stimulation improves the muscular strength and the motor control of individuals with post-acute stroke. Europa Medicophysica-SIMFER 2007 Award Winner

AIM

The aim of this study was to investigate the effectiveness of cycling induced by functional electrical stimulation (FES) in patients with postacute stroke.

METHODS

Twenty postacute inpatients were recruited and were randomly shared in a control group (56+/-9.2 years old, 50.8+/-24.5 days post-stroke) performing the standard rehabilitation (SR) and a FES group (51+/-12 years old, 56.1+/-22.8 days post-stroke) performing FES cycling in addition to SR. Both the groups performed 3 hours of rehabilitation per day for 4 weeks. The FES cycling was applied daily for 35 minutes and quadriceps, hamstring, gluteus maximus and tibialis anterior of both the legs were stimulated. The two groups were compared by the following outcome measurements before and after treatment: maximum isometric voluntary contraction (MVC) of quadriceps, walking and sit-to-stand ability, motricity index, upright motor control test and trunk control test.

RESULTS

After the treatment, the U-Mann-Whitney test demonstrated that the FES group produced a significantly higher increase of the muscular force produced by both the quadriceps during MVC with respect to the control group (P<0.05). Seventy percent of FES patients learned how to perform the sit to stand movement with three different rising speeds while no control patients develop the ability to perform the task properly.

CONCLUSION

Rehabilitation including FES cycling was more effective in promoting muscle strength and motor recovery of the lower extremity than therapist-assisted SR alone. Tests on an enlarged number of patients are necessary for generalization before proposing FES cycling in the clinical rehabilitation of post-acute stroke patients.

How does microgravity affect the muscular and kinematic synergies in a complex movement?

The planning and the execution of voluntary movement relies on sensorimotor transformations in which representations of the external environment are integrated into motor programs. We studied executions of Whole Body Pointing movements, in normal and in transient microgravity (parabolic flights) conditions. Three processes could lead to adaptation to the new environmental condition: a radical change of terrestrial synergies, their partial modification or preservation. By applying a multivariate analysis on kinematic and electromyographic (EMG) data and by comparing the 1g and 0g conditions, our findings hint the hypothesis the descending information from vestibular system may be directed to change the synergies' modulation. An analogous analysis was performed on the kinematics: the invariance of intersegmental coordination among the segments' elevation angles suggests that these kinematic waveforms are used as reference signals to determine the appropriate muscle synergies in a subordinate and flexible manner in order to adapt to the novel mechanical constraints.

Evaluation of theories of complex movement planning in different levels of gravity

Due to high redundancy of degrees of freedom in the human body, we can perform any movement, from the simplest to the most complex, in many different ways. Several studies are still trying to identify the motor strategies that master this redundancy and generate the movements whose characteristics are highly stereotyped. The aim of this work is to build a simulator that is able to evaluate different motor planning hypotheses. The most interesting applications of this tool occur in studies of the motor strategy in microgravity conditions. The comparison between simulated movements and kinematics data recorded both on Earth, and during a 5-month mission on board the Mir station shows that for a complex whole-body movement (such as trunk bending) a single planning criterion cannot explain all movement aspects. However, the simulator allows an understanding of the motor planning adaptation of astronauts. In space, the lack of equilibrium constraint (which on Earth brings about the center of mass control) leads to a new motor strategy that minimizes dynamic interactions with the floor.

Model of head-neck joint fast movements in the frontal plane

The objective of this work is to develop a model representing the physiological systems driving fast head movements in frontal plane. All the contributions occurring mechanically in the head movement are considered: damping, stiffness, physiological limit of range of motion, gravitational field, and muscular torques due to voluntary activation as well as to stretch reflex depending on fusal afferences. Model parameters are partly derived from the literature, when possible, whereas undetermined block parameters are determined by optimising the model output, fitting to real kinematics data acquired by a motion capture system in specific experimental set-ups. The optimisation for parameter identification is performed by genetic algorithms. Results show that the model represents very well fast head movements in the whole range of inclination in the frontal plane. Such a model could be proposed as a tool for transforming kinematics data on head movements in 'neural equivalent data', especially for assessing head control disease and properly planning the rehabilitation process. In addition, the use of genetic algorithms seems to fit well the problem of parameter identification, allowing for the use of a very simple experimental set-up and granting model robustness.

ELITE-S2: the multifactorial movement analysis facility for the International Space Station

Experimental observations of adaptation processes of the motor control system to altered gravity conditions can provide useful elements to the investigations on the mechanisms underlying motor control of human subject. The microgravity environment obtained on orbital flights represents a unique experimental condition for the monitoring of motor adaptation. The research in motor control exploits the changes caused by microgravity on the overall sensorimotor process, due to the impairment of the sensory systems whose function depends upon the presence of the gravity vector. Motor control in microgravity has been investigated during parabolic flights and short-term space missions, in particular for analysis of movement-posture co-ordination when equilibrium is no longer a constraint. Analysis of long-term adaptation would also be very interesting, calling for long-term body motion observations during the process of complete motor adaptation to the weightlessness environment. ELITE-S2 is an innovative facility for quantitative human movement analysis in weightless conditions onboard the International Space Station (ISS). ELITE-S2 is being developed by the Italian Space Agency, ASI is to be delivering the flight models to NASA to be included in an expressed rack in US Lab Module in February 2004. First mission is currently planned for summer 2004 (increment 10 ULF 2 ISS).

Euromir 95 T4 experiment 'Human Posture in microgravity': global results and future perspectives

After 7 years of studies on Euromir 95 T4 experiment 'Human Posture in microgravity' dataset, some important remarks can be proposed for best exploiting future experimental campaigns as well as for neurophysiological investigations on-ground. The main focus of such experiments was to monitor the process of learning and adapting to the new environment in performing complex voluntary movements. Euromir 95 was the first quantitative investigation with high technology instrumentation (ELITE-S) involving two subjects starting from 15 days after the launch until 5 months of mission. Results confirm the excellent capability of mutation of motor planning by the central nervous system (CNS) in order to best exploit environmental constraints and advantages. Under this view, the results offer a unique cue for improving the design of rehabilitation processes in motor pathologies.

Optimisation of shape kernel and threshold in image-processing motion analysers

The aim of the work is to optimise the image processing of a motion analyser. This is to improve accuracy, which is crucial for neurophysiological and rehabilitation applications. A new motion analyser, ELITE-S2, for installation on the International Space Station is described, with the focus on image processing. Important improvements are expected in the hardware of ELITE-S2 compared with ELITE and previous versions (ELITE-S and Kinelite). The core algorithm for marker recognition was based on the current ELITE version, using the cross-correlation technique. This technique was based on the matching of the expected marker shape, the so-called kernel, with image features. Optimisation of the kernel parameters was achieved using a genetic algorithm, taking into account noise rejection and accuracy. Optimisation was achieved by performing tests on six highly precise grids (with marker diameters ranging from 1.5 to 4 mm), representing all allowed marker image sizes, and on a noise image. The results of comparing the optimised kernels and the current ELITE version showed a great improvement in marker recognition accuracy, while noise rejection characteristics were preserved. An average increase in marker co-ordinate accuracy of +22% was achieved, corresponding to a mean accuracy of 0.11 pixel in comparison with 0.14 pixel, measured over all grids. An improvement of +37%, corresponding to an improvement from 0.22 pixel to 0.14 pixel, was observed over the grid with the biggest markers.

Motor coordination in weightless conditions revealed by long-term microgravity adaptation

The functional approach to studying human motor systems attempts to give a better understanding of the processes behind planning movements and their coordinated performance by relying on weightlessness as a particularly enlightening experimental condition. Indeed, quantitative monitoring of sensorimotor adaptation of subjects exposed to weightlessness outlines the functional role of gravity in motor and postural organization. The recent accessibility of the MIR Space Station has allowed for the first time experimental quantitative kinematic analysis of long-term sensorimotor and postural adaptation to the weightless environment though opto-electronic techniques. In the frame of the EUROMIR'95 Mission, two protocols of voluntary posture perturbation (erect posture, EP; forward trunk bending, FTB) were carried out during four months of microgravity exposure. Results show that postural strategies for quasistatic body orientation in weightlessness are based on the alignment of geometrical body axes (head and trunk) along external references. A proper whole body positioning appears to be recovered only after months of microgravity exposure. By contrast, typically, terrestrial strategies of co-ordination between movement and posture are promptly restored and used when performing motor activities in the weightless environment. This result is explained under the assumption that there may be different sensorimotor integration processes for static and dynamic postural function and that the organisation of coordinated movement might rely stably on egocentric references and kinematics synergies for motor control.

Static and dynamic postural control in long-term microgravity: evidence of a dual adaptation

The adaptation of dynamic movement-posture coordination during forward trunk bending was investigated in long-term weightlessness. Three-dimensional movement analysis was carried out in two astronauts during a 4-mo microgravity exposure. The principal component analysis was applied to joint-angle kinematics for the assessment of angular synergies. The anteroposterior center of mass (CM) displacement accompanying trunk flexion was also quantified. The results reveal that subjects kept typically terrestrial strategies of movement-posture coordination. The temporary disruption of joint-angular synergies observed at subjects' first in-flight session was promptly recovered when repetitive sessions in flight were analyzed. The CM anteroposterior shift was consistently <3-4 cm, suggesting that subjects could dynamically control the CM position throughout the whole flight. This is in contrast to the observed profound microgravity-induced disruption of the quasi-static body orientation and initial CM positioning. Although this study was based on only two subjects, evidence is provided that static and dynamic postural control might be under two separate mechanisms, adapting with their specific time course to the constraints of microgravity.

Perspectives on MEMS in bioengineering: a novel capacitive position microsensor

We describe a novel capacitive position sensor using micromachining to achieve high sensitivity and large range of motion. These sensors require a new theoretical framework to describe and optimize their performance. Employing a complete description of the electrical fields, the sensor should deviate from the standard geometries used for capacitive sensors. By this optimization, the sensor gains a twofold increase in sensitivity. Results on a PC board 10x model imply that the micromachined sensor should achieve a sensitivity of less than 10 nm over 500-micron range of travel. Some bioengineering applications are addressed, including positioning of micromirrors for laser surgery and dose control for implantable drug delivery systems.