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Yu A, Zhu M, Chen C, Li Y, Cui H, Liu S, Zhao Q. Implantable Flexible Sensors for Health Monitoring. Adv Healthc Mater 2024; 13:e2302460. [PMID: 37816513 DOI: 10.1002/adhm.202302460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/05/2023] [Indexed: 10/12/2023]
Abstract
Flexible sensors, as a significant component of flexible electronics, have attracted great interest the realms of human-computer interaction and health monitoring due to their high conformability, adjustable sensitivity, and excellent durability. In comparison to wearable sensor-based in vitro health monitoring, the use of implantable flexible sensors (IFSs) for in vivo health monitoring offers more accurate and reliable vital sign information due to their ability to adapt and directly integrate with human tissue. IFSs show tremendous promise in the field of health monitoring, with unique advantages such as robust signal reading capabilities, lightweight design, flexibility, and biocompatibility. Herein, a review of IFSs for vital signs monitoring is detailly provided, highlighting the essential conditions for in vivo applications. As the prerequisites of IFSs, the stretchability and wireless self-powered properties of the sensor are discussed, with a special attention paid to the sensing materials which can maintain prominent biosafety (i.e., biocompatibility, biodegradability, bioresorbability). Furthermore, the applications of IFSs monitoring various parts of the body are described in detail, with a summary in brain monitoring, eye monitoring, and blood monitoring. Finally, the challenges as well as opportunities in the development of next-generation IFSs are presented.
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Affiliation(s)
- Aoxi Yu
- College of Electronic and Optical Engineering, and College of Flexible Electronics (Future Technology), Nanjing University of Posts and Telecommunications, 9 Wenyuan, Nanjing, 210023, P. R. China
| | - Mingye Zhu
- State Key Laboratory of Organic Electronics and Information Displays, and Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210023, P. R. China
| | - Congkai Chen
- State Key Laboratory of Organic Electronics and Information Displays, and Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210023, P. R. China
| | - Yang Li
- College of Electronic and Optical Engineering, and College of Flexible Electronics (Future Technology), Nanjing University of Posts and Telecommunications, 9 Wenyuan, Nanjing, 210023, P. R. China
| | - Haixia Cui
- State Key Laboratory of Organic Electronics and Information Displays, and Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210023, P. R. China
| | - Shujuan Liu
- State Key Laboratory of Organic Electronics and Information Displays, and Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210023, P. R. China
| | - Qiang Zhao
- College of Electronic and Optical Engineering, and College of Flexible Electronics (Future Technology), Nanjing University of Posts and Telecommunications, 9 Wenyuan, Nanjing, 210023, P. R. China
- State Key Laboratory of Organic Electronics and Information Displays, and Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210023, P. R. China
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Canny E, Vansteensel MJ, van der Salm SMA, Müller-Putz GR, Berezutskaya J. Boosting brain-computer interfaces with functional electrical stimulation: potential applications in people with locked-in syndrome. J Neuroeng Rehabil 2023; 20:157. [PMID: 37980536 PMCID: PMC10656959 DOI: 10.1186/s12984-023-01272-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023] Open
Abstract
Individuals with a locked-in state live with severe whole-body paralysis that limits their ability to communicate with family and loved ones. Recent advances in brain-computer interface (BCI) technology have presented a potential alternative for these people to communicate by detecting neural activity associated with attempted hand or speech movements and translating the decoded intended movements to a control signal for a computer. A technique that could potentially enrich the communication capacity of BCIs is functional electrical stimulation (FES) of paralyzed limbs and face to restore body and facial movements of paralyzed individuals, allowing to add body language and facial expression to communication BCI utterances. Here, we review the current state of the art of existing BCI and FES work in people with paralysis of body and face and propose that a combined BCI-FES approach, which has already proved successful in several applications in stroke and spinal cord injury, can provide a novel promising mode of communication for locked-in individuals.
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Affiliation(s)
- Evan Canny
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariska J Vansteensel
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra M A van der Salm
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gernot R Müller-Putz
- Institute of Neural Engineering, Laboratory of Brain-Computer Interfaces, Graz University of Technology, Graz, Austria
| | - Julia Berezutskaya
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
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Reyes RD, Kobetic R, Nandor M, Makowski N, Audu M, Quinn R, Triolo R. Effect of Joint Friction Compensation on a "Muscle-First" Motor-Assisted Hybrid Neuroprosthesis. Front Neurorobot 2020; 14:588950. [PMID: 33362502 PMCID: PMC7759638 DOI: 10.3389/fnbot.2020.588950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022] Open
Abstract
This study assessed the metabolic energy consumption of walking with the external components of a “Muscle-First” Motor Assisted Hybrid Neuroprosthesis (MAHNP), which combines implanted neuromuscular stimulation with a motorized exoskeleton. The “Muscle-First” approach prioritizes generating motion with the wearer's own muscles via electrical stimulation with the actuators assisting on an as-needed basis. The motorized exoskeleton contributes passive resistance torques at both the hip and knee joints of 6Nm and constrains motions to the sagittal plane. For the muscle contractions elicited by neural stimulation to be most effective, the motorized joints need to move freely when not actively assisting the desired motion. This study isolated the effect of the passive resistance or “friction” added at the joints by the assistive motors and transmissions on the metabolic energy consumption of walking in the device. Oxygen consumption was measured on six able-bodied subjects performing 6 min walk tests at three different speeds (0.4, 0.8, and 1.2 m/s) under two different conditions: one with the motors producing no torque to compensate for friction, and the other having the motors injecting power to overcome passive friction based on a feedforward friction model. Average oxygen consumption in the uncompensated condition across all speeds, measured in Metabolic Equivalent of Task (METs), was statistically different than the friction compensated condition. There was an average decrease of 8.8% for METs and 1.9% for heart rate across all speeds. While oxygen consumption was reduced when the brace performed friction compensation, other factors may have a greater contribution to the metabolic energy consumption when using the device. Future studies will assess the effects of gravity compensation on the muscular effort required to lift the weight of the distal segments of the exoskeleton as well as the sagittal plane constraint on walking motions in individuals with spinal cord injuries (SCI).
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Affiliation(s)
- Ryan-David Reyes
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Rudolf Kobetic
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Mark Nandor
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Mechanical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Nathaniel Makowski
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Physical Medicine & Rehabilitation, MetroHealth Medical Center, Cleveland, OH, United States
| | - Musa Audu
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Roger Quinn
- Department of Mechanical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Ronald Triolo
- Advanced Platform Technology Center, Department of Veterans Affairs, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
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Makowski NS, Lombardo LM, Foglyano KM, Kobetic R, Pinault G, Selkirk SM, Triolo RJ. Walking after incomplete spinal cord injury with an implanted neuromuscular electrical stimulation system and a hinged knee replacement: a single-subject study. Spinal Cord Ser Cases 2020; 6:86. [PMID: 32934207 DOI: 10.1038/s41394-020-00336-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Single-subject repeated measures study. OBJECTIVES Neuromuscular electrical stimulation (NMES) can enhance walking for people with partial paralysis from incomplete spinal cord injury (iSCI). This single-subject study documents an individual's experience who both received an experimental implanted NMES system and underwent clinical bilateral hinged total knee arthroplasty (TKA). She walked in the community with knee pain prior to either intervention. Walking performance improved with an implanted NMES system. Knee pain and instability continued to worsen over time and eventually required TKA. This study evaluates the effects of these interventions. SETTING Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland OH, USA. METHODS The differential and combined effects of NMES and hinged knee replacement were assessed in terms of walking speed, toe clearance, knee angle, and participant perceptions with and without stimulation assistance both before and after TKA. RESULTS The combined approach both reduced pain and restored walking ability to levels achieved prior to developing significant knee pain that prevented walking without NMES. There was an interaction effect between NMES and TKA on walking speed. Toe clearance consistently improved with stimulation assistance and TKA prevented significant knee hyperextension. The greatest impact was on endurance. Knee replacement re-enabled long distance walking with the addition of stimulation again more than doubling her maximum walking distance from 214 to 513 m. CONCLUSIONS These data support further research of combined implantable interventions that may benefit people with iSCI. Furthermore, joint laxity and pain may not necessarily be contraindications to NMES if addressed with conventional clinical treatments.
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Affiliation(s)
- Nathaniel S Makowski
- MetroHealth Medical Center, Cleveland, OH, USA. .,Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA. .,Case Western Reserve University, Cleveland, OH, USA.
| | - Lisa M Lombardo
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Kevin M Foglyano
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Rudi Kobetic
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Gilles Pinault
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Stephen M Selkirk
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Ronald J Triolo
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
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Yildiz KA, Shin AY, Kaufman KR. Interfaces with the peripheral nervous system for the control of a neuroprosthetic limb: a review. J Neuroeng Rehabil 2020; 17:43. [PMID: 32151268 PMCID: PMC7063740 DOI: 10.1186/s12984-020-00667-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/17/2020] [Indexed: 12/22/2022] Open
Abstract
The field of prosthetics has been evolving and advancing over the past decade, as patients with missing extremities are expecting to control their prostheses in as normal a way as possible. Scientists have attempted to satisfy this expectation by designing a connection between the nervous system of the patient and the prosthetic limb, creating the field of neuroprosthetics. In this paper, we broadly review the techniques used to bridge the patient's peripheral nervous system to a prosthetic limb. First, we describe the electrical methods including myoelectric systems, surgical innovations and the role of nerve electrodes. We then describe non-electrical methods used alone or in combination with electrical methods. Design concerns from an engineering point of view are explored, and novel improvements to obtain a more stable interface are described. Finally, a critique of the methods with respect to their long-term impacts is provided. In this review, nerve electrodes are found to be one of the most promising interfaces in the future for intuitive user control. Clinical trials with larger patient populations, and for longer periods of time for certain interfaces, will help to evaluate the clinical application of nerve electrodes.
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Affiliation(s)
- Kadir A Yildiz
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kenton R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
- Motion Analysis Laboratory, W. Hall Wendel, Jr., Musculoskeletal Research, 200 First Street SW, Rochester, MN, 55905, USA.
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Zheng XS, Griffith AY, Chang E, Looker MJ, Fisher LE, Clapsaddle B, Cui XT. Evaluation of a conducting elastomeric composite material for intramuscular electrode application. Acta Biomater 2020; 103:81-91. [PMID: 31863910 DOI: 10.1016/j.actbio.2019.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 01/14/2023]
Abstract
Electrical stimulation of the muscle has been proven efficacious in preventing atrophy and/or reanimating paralyzed muscles. Intramuscular electrodes made from metals have significantly higher Young's Moduli than the muscle tissues, which has the potential to cause chronic inflammation and decrease device performance. Here, we present an intramuscular electrode made from an elastomeric conducting polymer composite consisting of PEDOT-PEG copolymer, silicone and carbon nanotubes (CNT) with fluorosilicone insulation. The electrode wire has a Young's modulus of 804 (±99) kPa, which better mimics the muscle tissue modulus than conventional stainless steel (SS) electrodes. Additionally, the non-metallic composition enables metal-artifact free CT and MR imaging. These soft wire (SW) electrodes present comparable electrical impedance to SS electrodes of similar geometric surface area, activate muscle at a lower threshold, and maintain stable electrical properties in vivo up to 4 weeks. Histologically, the SW electrodes elicited significantly less fibrotic encapsulation and less IBA-1 positive macrophage accumulation than the SS electrodes at one and three months. Further phenotyping the macrophages with the iNOS (pro-inflammatory) and ARG-1 (pro-healing) markers revealed significantly less presence of pro-inflammatory macrophage around SW implants at one month. By three months, there was a significant increase in pro-healing macrophages (ARG-1) around the SW implants but not around the SS implants. Furthermore, a larger number of AchR clusters closer to SW implants were found at both time points compared to SS implants. These results suggest that a softer implant encourages a more intimate and healthier electrode-tissue interface. STATEMENT OF SIGNIFICANCE: Intramuscular electrodes made from metals have significantly higher Young's Moduli than the muscle tissues, which has the potential to cause chronic inflammation and decrease device performance. Here, we present an intramuscular electrode made from an elastomeric conducting polymer composite consisting of PEDOT-PEG copolymer, silicone and carbon nanotubes with fluorosilicone insulation. This elastomeric composite results in an electrode wire with a Young's modulus mimicking that of the muscle tissue, which elicits significantly less foreign body response compared to stainless steel wires. The lack of metal in this composite also enables metal-artifact free MRI and CT imaging.
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Affiliation(s)
- X Sally Zheng
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Azante Y Griffith
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Emily Chang
- TDA Research Inc., Wheat Ridge, CO 80033, United States
| | | | - Lee E Fisher
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, United States; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, United States; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - X Tracy Cui
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, United States; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
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8
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Islam MA, Hamzaid NA, Ibitoye MO, Hasnan N, Wahab AKA, Davis GM. Mechanomyography responses characterize altered muscle function during electrical stimulation-evoked cycling in individuals with spinal cord injury. Clin Biomech (Bristol, Avon) 2018; 58:21-27. [PMID: 30005423 DOI: 10.1016/j.clinbiomech.2018.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 05/16/2018] [Accepted: 06/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Investigation of muscle fatigue during functional electrical stimulation (FES)-evoked exercise in individuals with spinal cord injury using dynamometry has limited capability to characterize the fatigue state of individual muscles. Mechanomyography has the potential to represent the state of muscle function at the muscle level. This study sought to investigate surface mechanomyographic responses evoked from quadriceps muscles during FES-cycling, and to quantify its changes between pre- and post-fatiguing conditions in individuals with spinal cord injury. METHODS Six individuals with chronic motor-complete spinal cord injury performed 30-min of sustained FES-leg cycling exercise on two days to induce muscle fatigue. Each participant performed maximum FES-evoked isometric knee extensions before and after the 30-min cycling to determine pre- and post- extension peak torque concomitant with mechanomyography changes. FINDINGS Similar to extension peak torque, normalized root mean squared (RMS) and mean power frequency (MPF) of the mechanomyography signal significantly differed in muscle activities between pre- and post-FES-cycling for each quadriceps muscle (extension peak torque up to 69%; RMS up to 80%, and MPF up to 19%). Mechanomyographic-RMS showed significant reduction during cycling with acceptable between-days consistency (intra-class correlation coefficients, ICC = 0.51-0.91). The normalized MPF showed a weak association with FES-cycling duration (ICC = 0.08-0.23). During FES-cycling, the mechanomyographic-RMS revealed greater fatigue rate for rectus femoris and greater fatigue resistance for vastus medialis in spinal cord injured individuals. INTERPRETATION Mechanomyographic-RMS may be a useful tool for examining real time muscle function of specific muscles during FES-evoked cycling in individuals with spinal cord injury.
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Affiliation(s)
- Md Anamul Islam
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Physical Therapy, College of Staten Island, City University of New York, New York 10314, USA
| | - Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Morufu Olusola Ibitoye
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Nazirah Hasnan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Ahmad Khairi Abdul Wahab
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Glen M Davis
- Clinical Exercise and Rehabilitation Unit, Discipline of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Sydney, 2006 NSW, Australia; Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
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10
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Sciancalepore M, Coslovich T, Lorenzon P, Ziraldo G, Taccola G. Extracellular stimulation with human “noisy” electromyographic patterns facilitates myotube activity. J Muscle Res Cell Motil 2015; 36:349-57. [DOI: 10.1007/s10974-015-9424-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/10/2015] [Indexed: 02/02/2023]
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Ho CH, Triolo RJ, Elias AL, Kilgore KL, DiMarco AF, Bogie K, Vette AH, Audu ML, Kobetic R, Chang SR, Chan KM, Dukelow S, Bourbeau DJ, Brose SW, Gustafson KJ, Kiss ZHT, Mushahwar VK. Functional electrical stimulation and spinal cord injury. Phys Med Rehabil Clin N Am 2015; 25:631-54, ix. [PMID: 25064792 DOI: 10.1016/j.pmr.2014.05.001] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Spinal cord injuries (SCI) can disrupt communications between the brain and the body, resulting in loss of control over otherwise intact neuromuscular systems. Functional electrical stimulation (FES) of the central and peripheral nervous system can use these intact neuromuscular systems to provide therapeutic exercise options to allow functional restoration and to manage medical complications following SCI. The use of FES for the restoration of muscular and organ functions may significantly decrease the morbidity and mortality following SCI. Many FES devices are commercially available and should be considered as part of the lifelong rehabilitation care plan for all eligible persons with SCI.
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Affiliation(s)
- Chester H Ho
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Foothills Medical Centre, Room 1195, 1403-29th Street NW, Calgary, Alberta T2N 2T9, Canada.
| | - Ronald J Triolo
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Orthopaedics, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Anastasia L Elias
- Chemical and Materials Engineering, W7-002 ECERF, University of Alberta, Edmonton, Alberta T6G 2V4, Canada
| | - Kevin L Kilgore
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Anthony F DiMarco
- MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Kath Bogie
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Orthopaedics, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Albert H Vette
- Department of Mechanical Engineering, University of Alberta, 4-9 Mechanical Engineering Building, Edmonton, Alberta T6G 2G8, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 - 111 Avenue, Edmonton, Alberta T5G 0B7, Canada
| | - Musa L Audu
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Rudi Kobetic
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Sarah R Chang
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - K Ming Chan
- Division of Physical Medicine and Rehabilitation, Centre for Neuroscience, University of Alberta, 5005 Katz Group Centre, 11361-87 Avenue, Edmonton, Alberta T6G 2E1, Canada
| | - Sean Dukelow
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Foothills Medical Centre, Room 1195, 1403-29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Dennis J Bourbeau
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Steven W Brose
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA; Ohio University Heritage College of Osteopathic Medicine, Grosvenor Hall, Athens, OH 45701, USA
| | - Kenneth J Gustafson
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Zelma H T Kiss
- Department of Clinical Neurosciences, Foothills Medical Centre, Room 1195, 1403-29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Vivian K Mushahwar
- Division of Physical Medicine and Rehabilitation, Centre for Neuroscience, University of Alberta, 5005 Katz Group Centre, 11361-87 Avenue, Edmonton, Alberta T6G 2E1, Canada
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To CS, Kobetic R, Bulea TC, Audu ML, Schnellenberger JR, Pinault G, Triolo RJ. Sensor-based hip control with hybrid neuroprosthesis for walking in paraplegia. ACTA ACUST UNITED AC 2014; 51:229-44. [DOI: 10.1682/jrrd.2012.10.0190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 09/17/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Curtis S. To
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | - Rudi Kobetic
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | | | | | | | - Gilles Pinault
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | - Ronald J. Triolo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
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Kurimoto S, Kato S, Nakano T, Yamamoto M, Takanobu N, Hirata H. Transplantation of embryonic motor neurons into peripheral nerve combined with functional electrical stimulation restores functional muscle activity in the rat sciatic nerve transection model. J Tissue Eng Regen Med 2013; 10:E477-E484. [DOI: 10.1002/term.1844] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 09/14/2013] [Accepted: 09/17/2013] [Indexed: 01/25/2023]
Affiliation(s)
- Shigeru Kurimoto
- Department of Hand Surgery; Nagoya University Graduate School of Medicine; Japan
| | - Shuichi Kato
- Department of Hand Surgery; Nagoya University Graduate School of Medicine; Japan
| | - Tomonori Nakano
- Department of Hand Surgery; Nagoya University Graduate School of Medicine; Japan
| | - Michiro Yamamoto
- Department of Hand Surgery; Nagoya University Graduate School of Medicine; Japan
| | - Nishizuka Takanobu
- Department of Hand Surgery; Nagoya University Graduate School of Medicine; Japan
| | - Hitoshi Hirata
- Department of Hand Surgery; Nagoya University Graduate School of Medicine; Japan
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Bulea TC, Kobetic R, Audu ML, Triolo RJ. Stance controlled knee flexion improves stimulation driven walking after spinal cord injury. J Neuroeng Rehabil 2013; 10:68. [PMID: 23826711 PMCID: PMC3708761 DOI: 10.1186/1743-0003-10-68] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 06/14/2013] [Indexed: 11/10/2022] Open
Abstract
Background Functional neuromuscular stimulation (FNS) restores walking function after paralysis from spinal cord injury via electrical activation of muscles in a coordinated fashion. Combining FNS with a controllable orthosis to create a hybrid neuroprosthesis (HNP) has the potential to extend walking distance and time by mechanically locking the knee joint during stance to allow knee extensor muscle to rest with stimulation turned off. Recent efforts have focused on creating advanced HNPs which couple joint motion (e.g., hip and knee or knee and ankle) to improve joint coordination during swing phase while maintaining a stiff-leg during stance phase. Methods The goal of this study was to investigate the effects of incorporating stance controlled knee flexion during loading response and pre-swing phases on restored gait. Knee control in the HNP was achieved by a specially designed variable impedance knee mechanism (VIKM). One subject with a T7 level spinal cord injury was enrolled and served as his own control in examining two techniques to restore level over-ground walking: FNS-only (which retained a stiff knee during stance) and VIKM-HNP (which allowed controlled knee motion during stance). The stimulation pattern driving the walking motion remained the same for both techniques; the only difference was that knee extensor stimulation was constant during stance with FNS-only and modulated together with the VIKM to control knee motion during stance with VIKM-HNP. Results Stance phase knee angle was more natural during VIKM-HNP gait while knee hyperextension persisted during stiff-legged FNS-only walking. During loading response phase, vertical ground reaction force was less impulsive and instantaneous gait speed was increased with VIKM-HNP, suggesting that knee flexion assisted in weight transfer to the leading limb. Enhanced knee flexion during pre-swing phase also aided flexion during swing, especially when response to stimulation was compromised. Conclusions These results show the potential advantages of incorporating stance controlled knee flexion into a hybrid neuroprosthesis for walking. The addition of such control to FNS driven walking could also enable non-level walking tasks such as uneven terrain, slope navigation and stair descent where controlled knee flexion during weight bearing is critical.
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Affiliation(s)
- Thomas C Bulea
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
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Bulea TC, Kobetic R, Audu M, Schnellenberger J, Triolo R. Finite state control of a variable impedance hybrid neuroprosthesis for locomotion after paralysis. IEEE Trans Neural Syst Rehabil Eng 2013; 21:141-51. [PMID: 23193320 PMCID: PMC3830532 DOI: 10.1109/tnsre.2012.2227124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We have previously reported on a novel variable impedance knee mechanism (VIKM). The VIKM was designed as a component of a hybrid neuroprosthesis to regulate knee flexion. The hybrid neuroprosthesis is a device that uses a controllable brace to support the body against collapse while stimulation provides power for movement. The hybrid neuroprosthesis requires a control system to coordinate the actions of the VIKM with the stimulation system; the development and evaluation of such a controller is presented. Brace mounted sensors and a baseline open loop stimulation pattern are utilized as control signals to activate the VIKM during stance phase while simultaneously modulating muscle stimulation in an on-off fashion. The objective is twofold: reduce the amount of stimulation necessary for walking while simultaneously restoring more biologically correct knee motion during stance using the VIKM. Custom designed hardware and software components were developed for controller implementation. The VIKM hybrid neuroprosthesis (VIKM-HNP) was evaluated during walking in one participant with thoracic level spinal cord injury. In comparison to walking with functional neuromuscular stimulation alone, the VIKM-HNP restored near normal stance phase knee flexion during loading response and pre-swing phases while decreasing knee extensor stimulation by up to 40%.
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Affiliation(s)
- Thomas C. Bulea
- Functional and Applied Biomechanics Section at the National Institutes of Health, Bethesda, MD, 20892 USA ()
| | - R. Kobetic
- Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106 USA ()
| | - M.L. Audu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106 USA ()
| | - J. Schnellenberger
- Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106 USA ()
| | - R.J. Triolo
- Department of Orthopaedics, Case Western Reserve University, Cleveland, OH 44106 USA, and also with the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106 USA ()
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Awad LN, Kesar TM, Reisman D, Binder-Macleod SA. Effects of repeated treadmill testing and electrical stimulation on post-stroke gait kinematics. Gait Posture 2013; 37:67-71. [PMID: 22796242 PMCID: PMC3488355 DOI: 10.1016/j.gaitpost.2012.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 05/25/2012] [Accepted: 06/07/2012] [Indexed: 02/02/2023]
Abstract
Improvements in task performance due to repeated testing have previously been documented in healthy and patient populations. The existence of a similar change in performance due to repeated testing has not been previously investigated at the level of gait kinematics in the post-stroke population. The presence of such changes may define the number of testing sessions necessary for measuring a stable baseline of pre-training gait performance, which is a necessary prerequisite for determining the effectiveness of gait interventions. Considering the emergence of treadmills as a popular tool for gait evaluation and retraining and the common addition of functional electrical stimulation (FES) to gait retraining protocols, the stability of gait kinematics during the repeated testing of post-stroke individuals on a treadmill, either with or without FES, needs to be determined. Nine individuals (age: 58.1±7.3 years), with hemi-paresis secondary to a stroke (onset: 7.3±6.0 years) participated in this study. An 8-camera motion analysis system was used to measure sagittal plane knee and ankle joint kinematics. Gait kinematics were compared across two (N=9) and five (N=5) testing sessions. No consistent changes in knee or ankle kinematics were observed during repeated testing. These findings indicate that clinicians and researchers may not need to spend valuable time and resources performing multiple testing and acclimatization sessions when assessing baseline gait kinematics in the post-stroke population for use in determining the effectiveness of gait interventions.
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Affiliation(s)
- Louis N. Awad
- Department of Physical Therapy, University of Delaware, Newark, DE 19716, USA,Graduate Program in Biomechanics and Movement Sciences, University of Delaware, Newark, DE 19716, USA
| | - Trisha M. Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA 30322, USA
| | - Darcy Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE 19716, USA,Graduate Program in Biomechanics and Movement Sciences, University of Delaware, Newark, DE 19716, USA
| | - Stuart A. Binder-Macleod
- Department of Physical Therapy, University of Delaware, Newark, DE 19716, USA,Graduate Program in Biomechanics and Movement Sciences, University of Delaware, Newark, DE 19716, USA
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Muscle Preactivation Control: Simulation of Ankle Joint Adjustments at Touchdown During Running on Uneven Ground. J Appl Biomech 2012; 28:718-25. [DOI: 10.1123/jab.28.6.718] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In locomotion, humans have to deal with irregularities in the ground. When they encounter uneven terrain with changes in vertical height, they adjust the geometry of their legs. Recent investigations have shown that the preactivation of the gastrocnemius muscle (GM) correlates with the ankle angle at touchdown, but it is as of yet unclear why these adjustments were achieved by the GM and not by the preactivation of the tibialis anterior (TA). To examine the differences between TA regulation and GM regulation regarding (1) ankle angle adjustment and (2) joint stiffness, we used a three-segment musculoskeletal model with two antagonistic muscles (GM, TA). During the GM regulation, the ankle angle was adjusted from 121° to 109° (dorsiflexion) by a 41% decrease in the GM activation. During the TA regulation, the activation of TA must be increased by about 52%. In addition, we found that the ankle stiffness was most sensitive to changes in activation of the GM and decreased by about 20% while adjusting the angle. In contrast, the ankle stiffness remains similar when using TA regulation. Thus, the GM regulation is more adequate for adjustment in the ankle joint, enabling sufficient regulation of angle and stiffness.
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Chao T, Askari S, De Leon R, Won D. A system to integrate electrical stimulation with robotically controlled treadmill training to rehabilitate stepping after spinal cord injury. IEEE Trans Neural Syst Rehabil Eng 2012; 20:730-7. [PMID: 22692941 DOI: 10.1109/tnsre.2012.2202292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A functional electrical stimulation (FES) system was engineered to integrate information from a robotically controlled position during stepping in order to time stimulation to continuous gait information in a rodent model of spinal cord injury (SCI). In contrast to conventional FES systems which have a fixed timing pattern relative to gait cycle onset (i.e., toe off/heel off or paw contact/heel strike), this system allows adaptation of stimulation to a robotically controlled position. Rationale for the system design is presented along with bench-test results verifying the timing of the stimulation with respect to hindlimb position. This robotically timed FES system will enable studies investigating the capability of this FES therapy to encourage rehabilitation by way of spinal plasticity.
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Affiliation(s)
- Tekang Chao
- Department of Electrical Engineering, California State University-Los Angeles, 90032, USA
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To CS, Kobetic R, Bulea TC, Audu ML, Schnellenberger JR, Pinault G, Triolo RJ. Stance control knee mechanism for lower-limb support in hybrid neuroprosthesis. ACTA ACUST UNITED AC 2012; 48:839-50. [PMID: 21938668 DOI: 10.1682/jrrd.2010.07.0135] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A hydraulic stance control knee mechanism (SCKM) was developed to fully support the knee against flexion during stance and allow uninhibited motion during swing for individuals with paraplegia using functional neuromuscular stimulation (FNS) for gait assistance. The SCKM was optimized for maximum locking torque for body-weight support and minimum resistance when allowing for free knee motion. Ipsilateral and contralateral position and force feedback were used to control the SCKM. Through bench and nondisabled testing, the SCKM was shown to be capable of supporting up to 70 N-m, require no more than 13% of the torque achievable with FNS to facilitate free motion, and responsively and repeatedly unlock under an applied flexion knee torque of up to 49 N-m. Preliminary tests of the SCKM with an individual with paraplegia demonstrated that it could support the body and maintain knee extension during stance without the stimulation of the knee extensor muscles. This was achieved without adversely affecting gait, and knee stability was comparable to gait assisted by knee extensor stimulation during stance.
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BION microstimulators: A case study in the engineering of an electronic implantable medical device. Med Eng Phys 2011; 33:7-16. [PMID: 21087890 DOI: 10.1016/j.medengphy.2010.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 08/14/2010] [Accepted: 08/18/2010] [Indexed: 11/20/2022]
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21
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Influence of electrical stimulation frequency on skeletal muscle force and fatigue. Ann Phys Rehabil Med 2010; 53:266-71, 271-7. [DOI: 10.1016/j.rehab.2010.03.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 01/27/2010] [Indexed: 11/22/2022]
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Gait training after stroke: a pilot study combining a gravity-balanced orthosis, functional electrical stimulation, and visual feedback. J Neurol Phys Ther 2009; 32:192-202. [PMID: 19265761 DOI: 10.1097/npt.0b013e31818e8fc2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
RATIONALE This case report describes the application of a novel gait retraining approach to an individual with poststroke hemiparesis. The rehabilitation protocol combined a specially designed leg orthosis (the gravity-balanced orthosis), treadmill walking, and functional electrical stimulation to the ankle muscles with the application of motor learning principles. CASE The participant was a 58-year-old man who had a stroke more than three years before the intervention. He underwent gait retraining over a period of five weeks for a total of 15 sessions during which the gravity compensation provided by the gravity-balanced orthosis and visual feedback about walking performance was gradually reduced. OUTCOMES At the end of five weeks, he decreased the time required to complete the Timed Up and Go test; his gait speed increased during overground walking; gait was more symmetrical; stride length, hip and knee joint excursions on the affected side increased. Except for gait symmetry, all other improvements were maintained one month post-intervention. CONCLUSIONS This case report describes possible advantages of judiciously combining different treatment techniques in improving the gait of chronic stroke survivors. Further studies are planned to evaluate the effectiveness of different components of this training in both the subacute and chronic stages of stroke recovery.
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Chou LW, Lee SC, Johnston TE, Binder-Macleod SA. The effectiveness of progressively increasing stimulation frequency and intensity to maintain paralyzed muscle force during repetitive activation in persons with spinal cord injury. Arch Phys Med Rehabil 2008; 89:856-64. [PMID: 18452732 DOI: 10.1016/j.apmr.2007.10.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 10/01/2007] [Accepted: 10/02/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the effectiveness of progressively increasing stimulation intensity, progressively increasing frequency, or progressively increasing both frequency and intensity on paralyzed quadriceps femoris muscle force maintenance during repetitive activation. DESIGN Factorial design with different stimulation protocols as independent variables. SETTING A muscle performance laboratory. PARTICIPANTS People (N=8) with spinal cord injury (SCI) (age, 14.63+/-1.77y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Number of contractions when the peak force was 90% or more of a subject's maximal twitch force. RESULTS The protocol involving progressively increasing stimulation intensity and then frequency generated more successful contractions (189.88+/-53.33) than progressively increasing the frequency followed by intensity (122.75+/-26.56 contractions). Regardless of the order, progressively increasing both intensity and frequency generated more successful contractions than progressively increasing intensity (97 contractions) or frequency (62 contractions) alone. CONCLUSIONS Our findings suggest that during repetitive electric activation, progressively increasing both stimulation frequency and intensity can produce more successful contractions than progressively increasing only frequency or intensity. These findings can help researchers and clinicians design more effective stimulation protocols for persons with SCI during functional electric stimulation applications.
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Affiliation(s)
- Li-Wei Chou
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
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Hu Y, Ming D, Wang YZ, Wong YW, Wan BK, Luk KDK, Leong JCY. Three-dimensional dynamical measurement of upper limb support during paraplegic walking. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2004:4944-7. [PMID: 17271422 DOI: 10.1109/iembs.2004.1404366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Functional electrical stimulation (FES) has been employed in paraplegic rehabilitation to resume their walking ability. However, there is less quantitative assessment method of FES walking efficiency and rehabilitation progress. This paper presents a new dynamical measurement of upper limb support force during paraplegic walking, which can be used to calculate the 3-D handle reaction vector (HRV). HRV may provide an assessment of FES-assisted efficiency. With a series of tests, the measurement accuracy, nonlinearity, and crosstalk of the designed system are testified. The force measurement error is found below 1.01%, while nonlinearity and crosstalk are less than 2.90%, and 3.19%, respectively. This means that the implemented walker system is reliable for the measurement of HRV during FES-assisted walking. A clinical trial is performed with a paraplegic subject. With the monitoring of FES-assisted walking, the downward component of HRV is found to decrease, implying the decreasing force generated from lower limb. The decrease slope in downward load curve can indirectly indicate the FES efficiency change during walking. The experiment and clinical trial results show that a 3-D dynamical measurement system is successfully accomplished to indirectly assess FES efficiency of lower limbs using quantitated forces applied by the upper limbs of paraplegic patients.
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Affiliation(s)
- Y Hu
- Department of Orthopaedics & Traumatology, Hong Kong University, China
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Kesar T, Binder-Macleod S. Effect of frequency and pulse duration on human muscle fatigue during repetitive electrical stimulation. Exp Physiol 2006; 91:967-76. [PMID: 16873456 DOI: 10.1113/expphysiol.2006.033886] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Different combinations of stimulation frequency and intensity can generate a targeted force during functional electrical stimulation (FES). This study compared isometric performance and muscle fatigue during repetitive stimulation with three different combinations of frequency and pulse duration that produced the same initial peak forces: protocol 1 used long pulse duration (fixed at 600 micros) and 11.5 +/- 1.2 Hz (low frequency); protocol 2 used 30 Hz (medium frequency) and medium pulse duration (150 +/- 21 micros); and protocol 3 used 60 Hz (high frequency) and short pulse duration (131 +/- 24 micros). Twenty and 60 Hz pre- and postfatigue testing trains were delivered at the pulse duration used by the fatiguing trains and at 600 micros pulse duration. The percentage decline in peak force between the first and last fatiguing train of each protocol was the measure of muscle performance. The declines in peak force of the 60 Hz testing trains were used to measure muscle fatigue. The 20 Hz:60 Hz peak force ratio was used as a measure of low-frequency fatigue. The results showed that protocol 1 produced the least decline in peak force in response to the fatiguing trains, as well as the least muscle fatigue and low-frequency fatigue when the pulse duration was maintained at the level used by the fatiguing trains. Interestingly, protocol 2 produced the least muscle fatigue, and there were no differences in the levels of low-frequency fatigue across protocols when a comparable motor unit population was tested using 600 micros pulse duration. The results suggest that if the frequency and intensity are kept constant during FES, using the lowest frequency and longest pulse duration may maximize performance.
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Affiliation(s)
- Trisha Kesar
- Department of Physical Therapy, 301 McKinly Laboratory, University of Delaware, Newark, DE 19716, USA
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Loeb GE, Richmond FJR, Baker LL. The BION devices: injectable interfaces with peripheral nerves and muscles. Neurosurg Focus 2006; 20:E2. [PMID: 16711659 DOI: 10.3171/foc.2006.20.5.3] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The purpose of this study was to describe a novel technology for implantable neuromuscular stimulation to treat complications of paralysis and disuse atrophy, including shoulder subluxation, hand contractures, drop foot, and osteoarthritis. The authors review the results so far of several pilot clinical studies of these muscle stimulation devices.
Methods
Miniature wireless stimulators received power and individually addressed command signals from an external radiofrequency transmission coil. One or more implants were injected through a 12-gauge hypodermic insertion tool into muscles or adjacent to motor nerves, where they provided the means to activate the muscles in any desired pattern of intensity and frequency. Randomized controlled studies in small numbers of patients are underway to identify efficacy, acceptability, best methods of practice, and any design changes that may be required to improve the technology.
Fifty patients have been enrolled in five studies; 35 patients have undergone implantation of a total of 79 BION1 devices. Comparisons with surface stimulation in patients who have suffered a stroke with shoulder subluxation and hand contractures show similar improvements in objective measures of efficacy but higher comfort levels for stimulation by implants.
Conclusions
Injected microstimulators represent a promising new class of technology for the rehabilitation of patients with upper motor neuropathies. As the technology evolves, practitioners may be able to use it to facilitate functional reanimation of paralyzed limbs.
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Affiliation(s)
- Gerald E Loeb
- Alfred Mann Institute for Biomedical Engineering and Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California 90089-1112, USA.
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Johnston TE, Betz RR, Smith BT, Benda BJ, Mulcahey MJ, Davis R, Houdayer TP, Pontari MA, Barriskill A, Creasey GH. Implantable FES system for upright mobility and bladder and bowel function for individuals with spinal cord injury. Spinal Cord 2006; 43:713-23. [PMID: 16010275 DOI: 10.1038/sj.sc.3101797] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Postintervention. OBJECTIVES To determine the effectiveness of the Praxis multifunctional implantable functional electrical stimulation (FES) system (Neopraxis Pty. Ltd, Lane Cove, NSW, Australia) to provide standing and stepping ability and bladder and bowel management for individuals with motor complete thoracic level spinal cord injuries (SCI). SETTING Pediatric orthopedic hospital specializing in SCI. SUBJECTS Three males, ages 17 and 21 years, with motor-complete thoracic level SCI and intact lower motor neurons to the muscles targeted for stimulation. METHODS Each subject was successfully implanted with the Praxis FES system. All three subjects received electrodes for upright mobility and the first two subjects received additional electrodes for stimulated bladder and bowel management. Following training, subjects were evaluated in their ability to use FES for nine mobility activities. Acute and chronic experiments of the effect of stimulation on bowel and bladder function were also performed. RESULTS All three subjects could independently stand up from the wheelchair and could walk at least 6 m using a swing through gait pattern. Two subjects were able to independently perform swing through gait for 6 min and one subject was able to independently ascend and descend stairs. Suppression of reflex bladder contractions by neuromodulation (subject 1) and stimulated contractions of the rectum (subject 2) were observed in acute experiments. When stimulation was applied over the course of several weeks, a positive effect on bowel function was measured. Stimulated bladder contractions were not achieved. CONCLUSION The feasibility of using the Praxis FES system for upright mobility and aiding aspects of bladder and bowel function was demonstrated with three subjects with thoracic level SCI.
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Affiliation(s)
- T E Johnston
- Shriners Hospitals for Children, 3551 North Broad St, Philadelphia, PA, USA
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Abstract
Paralyzed or paretic muscles can be made to contract by applying electrical currents to the intact peripheral motor nerves innervating them. When electrically elicited muscle contractions are coordinated in a manner that provides function, the technique is termed functional electrical stimulation (FES). In more than 40 years of FES research, principles for safe stimulation of neuromuscular tissue have been established, and methods for modulating the strength of electrically induced muscle contractions have been discovered. FES systems have been developed for restoring function in the upper extremity, lower extremity, bladder and bowel, and respiratory system. Some of these neuroprostheses have become commercialized products, and others are available in clinical research settings. Technological developments are expected to produce new systems that have no external components, are expandable to multiple applications, are upgradable to new advances, and are controlled by a combination of signals, including biopotential signals from nerve, muscle, and the brain.
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Affiliation(s)
- P Hunter Peckham
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA.
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Abstract
In the United States alone, there are more than 200,000 individuals living with a chronic spinal cord injury (SCI). Healthcare for these individuals creates a significant economic burden for the country, not to mention the physiological, psychological, and social suffering these people endure everyday. Regaining partial function can lead to greater independence, thereby improving quality of life. To ascertain what functions are most important to the SCI population, in regard to enhancing quality of life, a novel survey was performed in which subjects were asked to rank seven functions in order of importance to their quality of life. The survey was distributed via email, postal mail, the internet, interview, and word of mouth to the SCI community at large. A total of 681 responses were completed. Regaining arm and hand function was most important to quadriplegics, while regaining sexual function was the highest priority for paraplegics. Improving bladder and bowel function was of shared importance to both injury groups. A longitudinal analysis revealed only slight differences between individuals injured <3 years compared to those injured >3 years. The majority of participants indicated that exercise was important to functional recovery, yet more than half either did not have access to exercise or did not have access to a trained therapist to oversee that exercise. In order to improve the relevance of research in this area, the concerns of the SCI population must be better known and taken into account. This approach is consistent with and emphasized by the new NIH roadmap to discovery.
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Affiliation(s)
- Kim D Anderson
- Reeve-Irvine Research Center, Department of Anatomy and Neurobiology, University of California at Irvine, Irvine, California 92697-4292, USA.
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