1
|
Marquez-Chin M, Saadatnia Z, Sun YC, Naguib HE, Popovic MR. A dry polymer nanocomposite transcutaneous electrode for functional electrical stimulation. Biomed Eng Online 2024; 23:10. [PMID: 38279147 PMCID: PMC10811815 DOI: 10.1186/s12938-024-01200-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Functional electrical stimulation (FES) can be used in rehabilitation to aid or improve function in people with paralysis. In clinical settings, it is common practice to use transcutaneous electrodes to apply the electrical stimulation, since they are non-invasive, and can be easily applied and repositioned as necessary. However, the current electrode options available for transcutaneous FES are limited and can have practical disadvantages, such as the need for a wet interface with the skin for better comfort and performance. Hence, we were motivated to develop a dry stimulation electrode which could perform equivalently or better than existing commercially available options. METHODS We manufactured a thin-film dry polymer nanocomposite electrode, characterized it, and tested its performance for stimulation purposes with thirteen healthy individuals. We compared its functionality in terms of stimulation-induced muscle torque and comfort level against two other types of transcutaneous electrodes: self-adhesive hydrogel and carbon rubber. Each electrode type was also tested using three different stimulators and different intensity levels of stimulation. RESULTS We found the proposed dry polymer nanocomposite electrode to be functional for stimulation, as there was no statistically significant difference between its performance to the other standard electrodes. Namely, the proposed dry electrode had comparable muscle torque generated and comfort level as the self-adhesive hydrogel and carbon rubber electrodes. From all combinations of electrode type and stimulators tested, the dry polymer nanocomposite electrode with the MyndSearch stimulator had the most comfortable average rating. CONCLUSIONS The dry polymer nanocomposite electrode is a durable and flexible alternative to existing self-adhesive hydrogel and carbon rubber electrodes, which can be used without the addition of a wet interfacing agent (i.e., water or gel) to perform as well as the current electrodes used for stimulation purposes.
Collapse
Affiliation(s)
- Melissa Marquez-Chin
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
| | - Zia Saadatnia
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
- Department of Mechanical and Manufacturing Engineering, Ontario Tech University, Oshawa, ON, Canada
| | - Yu-Chen Sun
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Hani E Naguib
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Milos R Popovic
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Tajali S, Iwasa SN, Sin V, Atputharaj S, Desai (Kapadia) N, Musselman KE, Popovic MR, Masani K. The Orthotic Effects of Different Functional Electrical Stimulation Protocols on Walking Performance in Individuals with Incomplete Spinal Cord Injury: A Case Series. Top Spinal Cord Inj Rehabil 2023; 29:142-152. [PMID: 38174132 PMCID: PMC10759841 DOI: 10.46292/sci23-00021s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Functional electrical stimulation (FES) of paralyzed muscles can facilitate walking after spinal cord injury (SCI). Objectives To test the orthotic effects of different FES walking protocols on lower joint kinematics and walking speed. Methods Three adults with incomplete SCI participated in this study. Their lower extremity motor scores and 10-meter walk test results were as follows: subject A: 50, 1.05 m/s, subject B: 44, 0.29 m/s, and subject C: 32, 0.27 m/s. Participants completed four conditions of over-ground walking including no FES and three bilateral FES-walking protocols as follows: multi-muscle stimulation (stimulation of quadriceps and gastrocnemius in the stance phase, and hamstring and tibialis anterior in the swing phase), drop foot (tibialis anterior stimulation), and flexor withdrawal (common peroneal nerve stimulation). The FES system obtained gait phase information from foot switches located under the individuals' heels. Three-dimensional kinematic analysis was undertaken to measure minimum toe clearance (MTC); ankle, knee, and hip range of motion (ROM); stride length; and stride speed. Results Compared to no-FES walking, MTC increased during drop foot (all subjects), flexor withdrawal (subjects A and B), and multi-muscle stimulation (subjects B and C) protocols. A significant decrease in ankle ROM was seen with drop foot (all subjects), flexor withdrawal (subjects A), and multi-muscle stimulation (subjects A and C) protocols. Hip ROM increased with drop foot (subjects B and C), flexor withdrawal (subject B), and multi-muscle stimulation (subject C) protocols. Conclusion Three FES walking protocols induced positive kinematic changes as indicated by increased MTC, decreased ankle ROM, and increased hip ROM during walking in subjects with incomplete SCI.
Collapse
Affiliation(s)
- Shirin Tajali
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - Stephanie N. Iwasa
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
- CRANIA, University Health Network, and University of Toronto, Toronto, ON, Canada
| | - Vivian Sin
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - Sharmini Atputharaj
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - Naaz Desai (Kapadia)
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
- CRANIA, University Health Network, and University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Kristin E. Musselman
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
- CRANIA, University Health Network, and University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Milos R. Popovic
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
- CRANIA, University Health Network, and University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Kei Masani
- The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
- CRANIA, University Health Network, and University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Borda L, Gozzi N, Preatoni G, Valle G, Raspopovic S. Automated calibration of somatosensory stimulation using reinforcement learning. J Neuroeng Rehabil 2023; 20:131. [PMID: 37752607 PMCID: PMC10523674 DOI: 10.1186/s12984-023-01246-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The identification of the electrical stimulation parameters for neuromodulation is a subject-specific and time-consuming procedure that presently mostly relies on the expertise of the user (e.g., clinician, experimenter, bioengineer). Since the parameters of stimulation change over time (due to displacement of electrodes, skin status, etc.), patients undergo recurrent, long calibration sessions, along with visits to the clinics, which are inefficient and expensive. To address this issue, we developed an automatized calibration system based on reinforcement learning (RL) allowing for accurate and efficient identification of the peripheral nerve stimulation parameters for somatosensory neuroprostheses. METHODS We developed an RL algorithm to automatically select neurostimulation parameters for restoring sensory feedback with transcutaneous electrical nerve stimulation (TENS). First, the algorithm was trained offline on a dataset comprising 49 subjects. Then, the neurostimulation was then integrated with a graphical user interface (GUI) to create an intuitive AI-based mapping platform enabling the user to autonomously perform the sensation characterization procedure. We assessed the algorithm against the performance of both experienced and naïve and of a brute force algorithm (BFA), on 15 nerves from five subjects. Then, we validated the AI-based platform on six neuropathic nerves affected by distal sensory loss. RESULTS Our automatized approach demonstrated the ability to find the optimal values of neurostimulation achieving reliable and comfortable elicited sensations. When compared to alternatives, RL outperformed the naïve and BFA, significantly decreasing the time for mapping and the number of delivered stimulation trains, while improving the overall quality. Furthermore, the RL algorithm showed performance comparable to trained experimenters. Finally, we exploited it successfully for eliciting sensory feedback in neuropathic patients. CONCLUSIONS Our findings demonstrated that the AI-based platform based on a RL algorithm can automatically and efficiently calibrate parameters for somatosensory nerve stimulation. This holds promise to avoid experts' employment in similar scenarios, thanks to the merging between AI and neurotech. Our RL algorithm has the potential to be used in other neuromodulation fields requiring a mapping process of the stimulation parameters. TRIAL REGISTRATION ClinicalTrial.gov (Identifier: NCT04217005).
Collapse
Affiliation(s)
- Luigi Borda
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland
| | - Noemi Gozzi
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland
| | - Greta Preatoni
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland
| | - Giacomo Valle
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland.
| |
Collapse
|
4
|
Gupta A, Vardalakis N, Wagner FB. Neuroprosthetics: from sensorimotor to cognitive disorders. Commun Biol 2023; 6:14. [PMID: 36609559 PMCID: PMC9823108 DOI: 10.1038/s42003-022-04390-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Neuroprosthetics is a multidisciplinary field at the interface between neurosciences and biomedical engineering, which aims at replacing or modulating parts of the nervous system that get disrupted in neurological disorders or after injury. Although neuroprostheses have steadily evolved over the past 60 years in the field of sensory and motor disorders, their application to higher-order cognitive functions is still at a relatively preliminary stage. Nevertheless, a recent series of proof-of-concept studies suggest that electrical neuromodulation strategies might also be useful in alleviating some cognitive and memory deficits, in particular in the context of dementia. Here, we review the evolution of neuroprosthetics from sensorimotor to cognitive disorders, highlighting important common principles such as the need for neuroprosthetic systems that enable multisite bidirectional interactions with the nervous system.
Collapse
Affiliation(s)
- Ankur Gupta
- grid.462010.1Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000 Bordeaux, France
| | | | - Fabien B. Wagner
- grid.462010.1Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000 Bordeaux, France
| |
Collapse
|
5
|
Ni L, Yao Z, Zhao Y, Zhang T, Wang J, Li S, Chen Z. Electrical stimulation therapy for peripheral nerve injury. Front Neurol 2023; 14:1081458. [PMID: 36908597 PMCID: PMC9998520 DOI: 10.3389/fneur.2023.1081458] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
Peripheral nerve injury is common and frequently occurs in extremity trauma patients. The motor and sensory impairment caused by the injury will affect patients' daily life and social work. Surgical therapeutic approaches don't assure functional recovery, which may lead to neuronal atrophy and hinder accelerated regeneration. Rehabilitation is a necessary stage for patients to recover better. A meaningful role in non-pharmacological intervention is played by rehabilitation, through individualized electrical stimulation therapy. Clinical studies have shown that electrical stimulation enhances axon growth during nerve repair and accelerates sensorimotor recovery. According to different effects and parameters, electrical stimulation can be divided into neuromuscular, transcutaneous, and functional electrical stimulation. The therapeutic mechanism of electrical stimulation may be to reduce muscle atrophy and promote muscle reinnervation by increasing the expression of structural protective proteins and neurotrophic factors. Meanwhile, it can modulate sensory feedback and reduce neuralgia by inhibiting the descending pathway. However, there are not many summary clinical application parameters of electrical stimulation, and the long-term effectiveness and safety also need to be further explored. This article aims to explore application methodologies for effective electrical stimulation in the rehabilitation of peripheral nerve injury, with simultaneous consideration for fundamental principles of electrical stimulation and the latest technology. The highlight of this paper is to identify the most appropriate stimulation parameters (frequency, intensity, duration) to achieve efficacious electrical stimulation in the rehabilitation of peripheral nerve injury.
Collapse
Affiliation(s)
- Lingmei Ni
- Infection Prevention and Control Department, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhao Yao
- The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yifan Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tianfang Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Wang
- The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Siyue Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zuobing Chen
- The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.,Department of Rehabilitation Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
6
|
Readioff R, Siddiqui ZK, Stewart C, Fulbrook L, O’Connor RJ, Chadwick EK. Use and evaluation of assistive technologies for upper limb function in tetraplegia. J Spinal Cord Med 2022; 45:809-820. [PMID: 33606599 PMCID: PMC9662059 DOI: 10.1080/10790268.2021.1878342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT More than half of all spinal cord injuries (SCI) occur at the cervical level leading to loss of upper limb function, restricted activity and reduced independence. Several technologies have been developed to assist with upper limb functions in the SCI population. OBJECTIVE There is no clear clinical consensus on the effectiveness of the current assistive technologies for the cervical SCI population, hence this study reviews the literature in the years between 1999 and 2019. METHODS A systematic review was performed on the state-of-the-art assistive technology that supports and improves the function of impaired upper limbs in cervical SCI populations. Combinations of terms, covering assistive technology, SCI, and upper limb, were used in the search, which resulted in a total of 1770 articles. Data extractions were performed on the selected studies which involved summarizing details on the assistive technologies, characteristics of study participants, outcome measures, and improved upper limb functions when using the device. RESULTS A total of 24 articles were found and grouped into five categories, including neuroprostheses (invasive and non-invasive), orthotic devices, hybrid systems, robots, and arm supports. Only a few selected studies comprehensively reported characteristics of the participants. There was a wide range of outcome measures and all studies reported improvements in upper limb function with the devices. CONCLUSIONS This study highlighted that assistive technologies can improve functions of the upper limbs in SCI patients. It was challenging to draw generalizable conclusions because of factors, such as heterogeneity of recruited participants, a wide range of outcome measures, and the different technologies employed.
Collapse
Affiliation(s)
- Rosti Readioff
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK,Correspondence to: Rosti Readioff, Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, LeedsLS2 9JT, UK. ; @Dr_Rosti
| | - Zaha Kamran Siddiqui
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Caroline Stewart
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK,The Orthotic Research and Locomotor Assessment Unit (ORLAU), the Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, UK
| | - Louisa Fulbrook
- The Orthotic Research and Locomotor Assessment Unit (ORLAU), the Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, UK
| | - Rory J. O’Connor
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | |
Collapse
|
7
|
Remsik AB, van Kan PLE, Gloe S, Gjini K, Williams L, Nair V, Caldera K, Williams JC, Prabhakaran V. BCI-FES With Multimodal Feedback for Motor Recovery Poststroke. Front Hum Neurosci 2022; 16:725715. [PMID: 35874158 PMCID: PMC9296822 DOI: 10.3389/fnhum.2022.725715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 05/26/2022] [Indexed: 01/31/2023] Open
Abstract
An increasing number of research teams are investigating the efficacy of brain-computer interface (BCI)-mediated interventions for promoting motor recovery following stroke. A growing body of evidence suggests that of the various BCI designs, most effective are those that deliver functional electrical stimulation (FES) of upper extremity (UE) muscles contingent on movement intent. More specifically, BCI-FES interventions utilize algorithms that isolate motor signals-user-generated intent-to-move neural activity recorded from cerebral cortical motor areas-to drive electrical stimulation of individual muscles or muscle synergies. BCI-FES interventions aim to recover sensorimotor function of an impaired extremity by facilitating and/or inducing long-term motor learning-related neuroplastic changes in appropriate control circuitry. We developed a non-invasive, electroencephalogram (EEG)-based BCI-FES system that delivers closed-loop neural activity-triggered electrical stimulation of targeted distal muscles while providing the user with multimodal sensory feedback. This BCI-FES system consists of three components: (1) EEG acquisition and signal processing to extract real-time volitional and task-dependent neural command signals from cerebral cortical motor areas, (2) FES of muscles of the impaired hand contingent on the motor cortical neural command signals, and (3) multimodal sensory feedback associated with performance of the behavioral task, including visual information, linked activation of somatosensory afferents through intact sensorimotor circuits, and electro-tactile stimulation of the tongue. In this report, we describe device parameters and intervention protocols of our BCI-FES system which, combined with standard physical rehabilitation approaches, has proven efficacious in treating UE motor impairment in stroke survivors, regardless of level of impairment and chronicity.
Collapse
Affiliation(s)
- Alexander B. Remsik
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- School of Medicine and Public Health, Institute for Clinical and Translational Research, University of Wisconsin–Madison, Madison, WI, United States
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Peter L. E. van Kan
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, United States
- Neuroscience Training Program, University of Wisconsin–Madison, Madison, WI, United States
| | - Shawna Gloe
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Klevest Gjini
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurology, University of Wisconsin–Madison, Madison, WI, United States
| | - Leroy Williams
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Educational Psychology, University of Wisconsin–Madison, Madison, WI, United States
| | - Veena Nair
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Kristin Caldera
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
| | - Justin C. Williams
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Neuroscience Training Program, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
- Medical Scientist Training Program, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
- Department of Psychology, University of Wisconsin–Madison, Madison, WI, United States
| |
Collapse
|
8
|
Milosevic M, Nakanishi T, Sasaki A, Yamaguchi A, Nomura T, Popovic MR, Nakazawa K. Cortical Re-organization After Traumatic Brain Injury Elicited Using Functional Electrical Stimulation Therapy: A Case Report. Front Neurosci 2021; 15:693861. [PMID: 34489624 PMCID: PMC8417438 DOI: 10.3389/fnins.2021.693861] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/26/2021] [Indexed: 01/17/2023] Open
Abstract
Functional electrical stimulation therapy (FEST) can improve motor function after neurological injuries. However, little is known about cortical changes after FEST and weather it can improve motor function after traumatic brain injury (TBI). Our study examined cortical changes and motor improvements in one male participant with chronic TBI suffering from mild motor impairment affecting the right upper-limb during 3-months of FEST and during 3-months follow-up. In total, 36 sessions of FEST were applied to enable upper-limb grasping and reaching movements. Short-term assessments carried out using transcranial magnetic stimulation (TMS) showed reduced cortical silent period (CSP), indicating cortical and/or subcortical inhibition after each intervention. At the same time, no changes in motor evoked potentials (MEPs) were observed. Long-term assessments showed increased MEP corticospinal excitability after 12-weeks of FEST, which seemed to remain during both follow-ups, while no changes in CSP were observed. Similarly, long-term assessments using TMS mapping showed larger hand MEP area in the primary motor cortex (M1) after 12-weeks of FEST as well as during both follow-ups. Corroborating TMS results, functional magnetic resonance imaging (fMRI) data showed M1 activations increased during hand grip and finger pinch tasks after 12-weeks of FEST, while gradual reduction of activity compared to after the intervention was seen during follow-ups. Widespread changes were seen not only in the M1, but also sensory, parietal rostroventral, supplementary motor, and premotor areas in both contralateral and ipsilateral hemispheres, especially during the finger pinch task. Drawing test performance showed improvements after the intervention and during follow-ups. Our findings suggest that task-specific and repetitive FEST can effectively increase cortical activations by integrating voluntary motor commands and sensorimotor network through functional electrical stimulation (FES). Overall, our results demonstrated cortical re-organization in an individual with chronic TBI after FEST.
Collapse
Affiliation(s)
- Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Osaka, Japan
| | - Tomoya Nakanishi
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Atsushi Sasaki
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Akiko Yamaguchi
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Osaka, Japan
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,CRANIA, University Health Network, Toronto, ON, Canada
| | - Kimitaka Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
| |
Collapse
|
9
|
Shokur S, Mazzoni A, Schiavone G, Weber DJ, Micera S. A modular strategy for next-generation upper-limb sensory-motor neuroprostheses. MED 2021; 2:912-937. [DOI: 10.1016/j.medj.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023]
|
10
|
Shin H, Hawari MA, Hu X. Activation of Superficial and Deep Finger Flexors Through Transcutaneous Nerve Stimulation. IEEE J Biomed Health Inform 2021; 25:2575-2582. [PMID: 33259310 DOI: 10.1109/jbhi.2020.3041669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Functional electrical stimulation (FES) is a common technique to elicit muscle contraction and help improve muscle strength. Traditional FES over the muscle belly typically only activates superficial muscle regions. In the case of hand FES, this prevents the activation of the deeper flexor muscles which control the distal finger joints. Here, we evaluated whether an alternative transcutaneous nerve-bundle stimulation approach can activate both superficial and deep extrinsic finger flexors using a high-density stimulation grid. METHODS Transverse ultrasound of the forearm muscles was used to obtain cross-sectional images of the underlying finger flexors during stimulated finger flexions and kinematically-matched voluntary motions. Finger kinematics were recorded, and an image registration method was used to capture the large deformation of the muscle regions during each flexion. This deformation was used as a surrogate measure of the contraction of muscle tissue, and the regions of expanding tissue can identify activated muscles. RESULTS The nerve-bundle stimulation elicited contractions in the superficial and deep finger flexors. Both separate and concurrent activation of these two muscles were observed. Joint kinematics of the fingers also matched the expected regions of muscle contractions. CONCLUSIONS Our results showed that the nerve-bundle stimulation technique can activate the deep extrinsic finger flexors, which are typically not accessible via traditional surface FES. SIGNIFICANCE Our nerve-bundle stimulation method enables us to produce the full range of motion of different joints necessary for various functional grasps, which could benefit future neuroprosthetic applications.
Collapse
|
11
|
Gill M, Linde M, Fautsch K, Hale R, Lopez C, Veith D, Calvert J, Beck L, Garlanger K, Edgerton R, Sayenko D, Lavrov I, Thoreson A, Grahn P, Zhao K. Epidural Electrical Stimulation of the Lumbosacral Spinal Cord Improves Trunk Stability During Seated Reaching in Two Humans With Severe Thoracic Spinal Cord Injury. Front Syst Neurosci 2020; 14:79. [PMID: 33328910 PMCID: PMC7710539 DOI: 10.3389/fnsys.2020.569337] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Quality of life measurements indicate that independent performance of activities of daily living, such as reaching to manipulate objects, is a high priority of individuals living with motor impairments due to spinal cord injury (SCI). In a small number of research participants with SCI, electrical stimulation applied to the dorsal epidural surface of the spinal cord, termed epidural spinal electrical stimulation (ES), has been shown to improve motor functions, such as standing and stepping. However, the impact of ES on seated reaching performance, as well as the approach to identifying stimulation parameters that improve reaching ability, have yet to be described. Objective: Herein, we characterize the effects of ES on seated reaching performance in two participants with chronic, complete loss of motor and sensory functions below thoracic-level SCI. Additionally, we report the effects of delivering stimulation to discrete cathode/anode locations on a 16-contact electrode array spanning the lumbosacral spinal segments on reach distance while participants were seated on a mat and/or in their wheelchair. Methods: Two males with mid-thoracic SCI due to trauma, each of which occurred more than 3 years prior to study participation, were enrolled in a clinical trial at Mayo Clinic, Rochester, MN, USA. Reaching performance was assessed, with and without ES, at several time points throughout the study using the modified functional reach test (mFRT). Altogether, participant 1 performed 1,164 reach tests over 26-time points. Participant 2 performed 480 reach tests over 17-time points. Results: Median reach distances during ES were higher for both participants compared to without ES. Forward reach distances were greater than lateral reach distances in all environments, mat or wheelchair, for both participants. Stimulation delivered in the caudal region of the array resulted in improved forward reach distance compared to stimulation in the rostral region. For both participants, when stimulation was turned off, no significant changes in reach distance were observed throughout the study. Conclusion: ES enhanced seated reaching-performance of individuals with chronic SCI. Additionally, electrode configurations delivering stimulation in caudal regions of the lumbosacral spinal segments may improve reaching ability compared to rostral regions.
Collapse
Affiliation(s)
- Megan Gill
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Margaux Linde
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Kalli Fautsch
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Rena Hale
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Daniel Veith
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Jonathan Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Lisa Beck
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Kristin Garlanger
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Reggie Edgerton
- Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA, United States.,The Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Ultimo, NSW, Australia
| | - Dimitry Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Hospital, Houston, TX, United States
| | - Igor Lavrov
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Andrew Thoreson
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Peter Grahn
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States.,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kristin Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
12
|
Milosevic M, Marquez-Chin C, Masani K, Hirata M, Nomura T, Popovic MR, Nakazawa K. Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation. Biomed Eng Online 2020; 19:81. [PMID: 33148270 PMCID: PMC7641791 DOI: 10.1186/s12938-020-00824-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022] Open
Abstract
Delivering short trains of electric pulses to the muscles and nerves can elicit action potentials resulting in muscle contractions. When the stimulations are sequenced to generate functional movements, such as grasping or walking, the application is referred to as functional electrical stimulation (FES). Implications of the motor and sensory recruitment of muscles using FES go beyond simple contraction of muscles. Evidence suggests that FES can induce short- and long-term neurophysiological changes in the central nervous system by varying the stimulation parameters and delivery methods. By taking advantage of this, FES has been used to restore voluntary movement in individuals with neurological injuries with a technique called FES therapy (FEST). However, long-lasting cortical re-organization (neuroplasticity) depends on the ability to synchronize the descending (voluntary) commands and the successful execution of the intended task using a FES. Brain-computer interface (BCI) technologies offer a way to synchronize cortical commands and movements generated by FES, which can be advantageous for inducing neuroplasticity. Therefore, the aim of this review paper is to discuss the neurophysiological mechanisms of electrical stimulation of muscles and nerves and how BCI-controlled FES can be used in rehabilitation to improve motor function.
Collapse
Affiliation(s)
- Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama-cho, Toyonaka, Osaka, 560-8531, Japan.
| | - Cesar Marquez-Chin
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Kei Masani
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, 1-3 Machikaneyama-cho, Toyonaka, Osaka, 560-8531, Japan
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada
- CRANIA, University Health Network & University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Kimitaka Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, 3-8-1 Komaba, Meguro, Tokyo, 153-8902, Japan
| |
Collapse
|
13
|
Anderson KD, Wilson JR, Korupolu R, Pierce J, Bowen JM, O'Reilly D, Kapadia N, Popovic MR, Thabane L, Musselman KE. Multicentre, single-blind randomised controlled trial comparing MyndMove neuromodulation therapy with conventional therapy in traumatic spinal cord injury: a protocol study. BMJ Open 2020; 10:e039650. [PMID: 32988951 PMCID: PMC7523215 DOI: 10.1136/bmjopen-2020-039650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION This protocol is describing a multicentre, single-blind randomised controlled trial. The objective is to compare the efficacy of MyndMove therapy versus conventional therapy (CT) in improving upper extremity function in individuals with C4-C7 traumatic, incomplete spinal cord injury (SCI). It is being conducted in two US and two Canadian SCI rehabilitation centres. METHODS AND ANALYSIS Sixty people aged 18 years or older with a C4-C7 incomplete (AIS B-D) SCI between 4 months and 8 years postinjury are randomised to receive 40 sessions of MyndMove neuromodulation therapy or CT within a 14-week period of time. Therapy sessions are 1 hour in duration with a dose of 3-5 sessions per week. Assessments occur prior to randomisation, after 20 sessions, after 40 sessions and 10 weeks after the last session. The primary outcome measure is the efficacy of MyndMove therapy versus CT in improving upper extremity function as measured by Spinal Cord Independence Measure III: Self-Care subscore after 40 sessions. Secondary outcomes include: (1) improvements in the SCIM mobility subscore; (2) upper limb functions measured by Graded Redefined Assessment of Strength, Sensibility and Prehension and (3) Toronto Rehab Institute Hand Function Test; (4) To assess safety as measured by serious and non-serious adverse events recorded for participants in both groups of the study population over the duration of the study; (5) to compare the change in quality of life as measured by the Spinal Cord Injury-Quality of Life; and (6) to evaluate the impact on healthcare resource utilisation. ETHICS AND DISSEMINATION All ethical approvals were obtained prior to enrolling any participants. Dissemination of the results of the study will be made at peer-reviewed academic meetings and through peer-reviewed medical journals TRIAL REGISTRATION NUMBER: NCT03439319.
Collapse
Affiliation(s)
- Kim D Anderson
- Department of Physical Medicine and Rehabilitation, MetroHealth System, Cleveland, Ohio, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
| | - James R Wilson
- Department of Physical Medicine and Rehabilitation, MetroHealth System, Cleveland, Ohio, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
| | - Radha Korupolu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas, USA
- The Institute for Rehabilitation and Research (TIRR), Houston, Texas, USA
| | - Jacqueline Pierce
- Centre for Neurology Studies, Health Tech Connex, Surrey, British Columbia, Canada
| | - James M Bowen
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Daria O'Reilly
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- TELUS Health, Toronto, Ontario, Canada
| | - Naaz Kapadia
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Milos R Popovic
- The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Biostatistics Unit, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Kristin E Musselman
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Kapadia N, Moineau B, Popovic MR. Functional Electrical Stimulation Therapy for Retraining Reaching and Grasping After Spinal Cord Injury and Stroke. Front Neurosci 2020; 14:718. [PMID: 32742254 PMCID: PMC7364342 DOI: 10.3389/fnins.2020.00718] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 12/31/2022] Open
Abstract
Neurological conditions like hemiplegia following stroke or tetraplegia following spinal cord injury, result in a massive compromise in motor function. Each of the two conditions can leave individuals dependent on caregivers for the rest of their lives. Once medically stable, rehabilitation is the main stay of treatment. This article will address rehabilitation of upper extremity function. It is long known that moving the affected limb is crucial to recovery following any kind of injury. Overtime, it has also been established that just moving the affected extremities does not suffice, and that the movements have to involve patient’s participation, be as close to physiologic movements as possible, and should ideally stimulate the entire neuromuscular circuitry involved in producing the desired movement. For over four decades now, functional electrical stimulation (FES) is being used to either replace or retrain function. The FES therapy discussed in this article has been used to retrain upper extremity function for over 15 years. Published data of pilot studies and randomized control trials show that FES therapy produces significant changes in arm and hand function. There are specific principles of the FES therapy as applied in our studies: (i) stimulation is applied using surface stimulation electrodes, (ii) there is minimum to virtually no pain during application, (iii) each session lasts no more than 45–60 min, (iv) the technology is quite robust and can make up for specificity to a certain extent, and (v) fine motor function like two finger precision grip can be trained (i.e., thumb and index finger tip to tip pinch). The FES therapy protocols can be successfully applied to individuals with paralysis resulting from stroke or spinal cord injury.
Collapse
Affiliation(s)
- Naaz Kapadia
- Rehabilitation Engineering Laboratory, The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Bastien Moineau
- Rehabilitation Engineering Laboratory, The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Myant Inc., Toronto, ON, Canada
| | - Milos R Popovic
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
15
|
Kibleur P, Tata SR, Greiner N, Conti S, Barra B, Zhuang K, Kaeser M, Ijspeert A, Capogrosso M. Spatiotemporal Maps of Proprioceptive Inputs to the Cervical Spinal Cord During Three-Dimensional Reaching and Grasping. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1668-1677. [DOI: 10.1109/tnsre.2020.2986491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
16
|
Khan MA, Das R, Iversen HK, Puthusserypady S. Review on motor imagery based BCI systems for upper limb post-stroke neurorehabilitation: From designing to application. Comput Biol Med 2020; 123:103843. [PMID: 32768038 DOI: 10.1016/j.compbiomed.2020.103843] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022]
Abstract
Strokes are a growing cause of mortality and many stroke survivors suffer from motor impairment as well as other types of disabilities in their daily life activities. To treat these sequelae, motor imagery (MI) based brain-computer interface (BCI) systems have shown potential to serve as an effective neurorehabilitation tool for post-stroke rehabilitation therapy. In this review, different MI-BCI based strategies, including "Functional Electric Stimulation, Robotics Assistance and Hybrid Virtual Reality based Models," have been comprehensively reported for upper-limb neurorehabilitation. Each of these approaches have been presented to illustrate the in-depth advantages and challenges of the respective BCI systems. Additionally, the current state-of-the-art and main concerns regarding BCI based post-stroke neurorehabilitation devices have also been discussed. Finally, recommendations for future developments have been proposed while discussing the BCI neurorehabilitation systems.
Collapse
Affiliation(s)
- Muhammad Ahmed Khan
- Department of Health Technology, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark.
| | - Rig Das
- Department of Health Technology, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark
| | - Helle K Iversen
- Department of Neurology, University of Copenhagen, Rigshospitalet, 2600, Glostrup, Denmark
| | | |
Collapse
|
17
|
A review for the peripheral nerve interface designer. J Neurosci Methods 2019; 332:108523. [PMID: 31743684 DOI: 10.1016/j.jneumeth.2019.108523] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022]
Abstract
Informational density and relative accessibility of the peripheral nervous system make it an attractive site for therapeutic intervention. Electrode-based electrophysiological interfaces with peripheral nerves have been under development since the 1960s and, for several applications, have seen widespread clinical implementation. However, many applications require a combination of neural target resolution and stability which has thus far eluded existing peripheral nerve interfaces (PNIs). With the goal of aiding PNI designers in development of devices that meet the demands of next-generation applications, this review seeks to collect and present practical considerations and best practices which emerge from the literature, including both lessons learned during early PNI development and recent ideas. Fundamental and practical principles guiding PNI design are reviewed, followed by an updated and critical account of existing PNI designs and strategies. Finally, a brief survey of in vitro and in vivo PNI characterization methods is presented.
Collapse
|
18
|
Configuration of electrical spinal cord stimulation through real-time processing of gait kinematics. Nat Protoc 2019; 13:2031-2061. [PMID: 30190556 DOI: 10.1038/s41596-018-0030-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Epidural electrical stimulation (EES) of the spinal cord and real-time processing of gait kinematics are powerful methods for the study of locomotion and the improvement of motor control after injury or in neurological disorders. Here, we describe equipment and surgical procedures that can be used to acquire chronic electromyographic (EMG) recordings from leg muscles and to implant targeted spinal cord stimulation systems that remain stable up to several months after implantation in rats and nonhuman primates. We also detail how to exploit these implants to configure electrical spinal cord stimulation policies that allow control over the degree of extension and flexion of each leg during locomotion. This protocol uses real-time processing of gait kinematics and locomotor performance, and can be configured within a few days. Once configured, stimulation bursts are delivered over specific spinal cord locations with precise timing that reproduces the natural spatiotemporal activation of motoneurons during locomotion. These protocols can also be easily adapted for the safe implantation of systems in the vicinity of the spinal cord and to conduct experiments involving real-time movement feedback and closed-loop controllers.
Collapse
|
19
|
Bullard AJ, Nason SR, Irwin ZT, Nu CS, Smith B, Campean A, Peckham PH, Kilgore KL, Willsey MS, Patil PG, Chestek CA. Design and testing of a 96-channel neural interface module for the Networked Neuroprosthesis system. Bioelectron Med 2019; 5:3. [PMID: 32232094 PMCID: PMC7098219 DOI: 10.1186/s42234-019-0019-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/25/2019] [Indexed: 11/20/2022] Open
Abstract
Background The loss of motor functions resulting from spinal cord injury can have devastating implications on the quality of one’s life. Functional electrical stimulation has been used to help restore mobility, however, current functional electrical stimulation (FES) systems require residual movements to control stimulation patterns, which may be unintuitive and not useful for individuals with higher level cervical injuries. Brain machine interfaces (BMI) offer a promising approach for controlling such systems; however, they currently still require transcutaneous leads connecting indwelling electrodes to external recording devices. While several wireless BMI systems have been designed, high signal bandwidth requirements limit clinical translation. Case Western Reserve University has developed an implantable, modular FES system, the Networked Neuroprosthesis (NNP), to perform combinations of myoelectric recording and neural stimulation for controlling motor functions. However, currently the existing module capabilities are not sufficient for intracortical recordings. Methods Here we designed and tested a 1 × 4 cm, 96-channel neural recording module prototype to fit within the specifications to mate with the NNP. The neural recording module extracts power between 0.3–1 kHz, instead of transmitting the raw, high bandwidth neural data to decrease power requirements. Results The module consumed 33.6 mW while sampling 96 channels at approximately 2 kSps. We also investigated the relationship between average spiking band power and neural spike rate, which produced a maximum correlation of R = 0.8656 (Monkey N) and R = 0.8023 (Monkey W). Conclusion Our experimental results show that we can record and transmit 96 channels at 2ksps within the power restrictions of the NNP system and successfully communicate over the NNP network. We believe this device can be used as an extension to the NNP to produce a clinically viable, fully implantable, intracortically-controlled FES system and advance the field of bioelectronic medicine.
Collapse
Affiliation(s)
- Autumn J Bullard
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
| | - Samuel R Nason
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
| | - Zachary T Irwin
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
| | - Chrono S Nu
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
| | - Brian Smith
- 2Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA
| | - Alex Campean
- 2Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA
| | - P Hunter Peckham
- 2Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA.,3Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH USA
| | - Kevin L Kilgore
- 2Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA.,3Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH USA.,4Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH USA
| | - Matthew S Willsey
- 5Department of Neurosurgery, University of Michigan, Ann Arbor, MI USA
| | - Parag G Patil
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA.,5Department of Neurosurgery, University of Michigan, Ann Arbor, MI USA.,6Department of Neurology, University of Michigan, Ann Arbor, MI USA.,7Department of Anesthesiology, University of Michigan, Ann Arbor, MI USA
| | - Cynthia A Chestek
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA.,8Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI USA
| |
Collapse
|
20
|
A Tangible Solution for Hand Motion Tracking in Clinical Applications. SENSORS 2019; 19:s19010208. [PMID: 30626130 PMCID: PMC6339214 DOI: 10.3390/s19010208] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/22/2018] [Accepted: 12/23/2018] [Indexed: 11/16/2022]
Abstract
Objective real-time assessment of hand motion is crucial in many clinical applications including technically-assisted physical rehabilitation of the upper extremity. We propose an inertial-sensor-based hand motion tracking system and a set of dual-quaternion-based methods for estimation of finger segment orientations and fingertip positions. The proposed system addresses the specific requirements of clinical applications in two ways: (1) In contrast to glove-based approaches, the proposed solution maintains the sense of touch. (2) In contrast to previous work, the proposed methods avoid the use of complex calibration procedures, which means that they are suitable for patients with severe motor impairment of the hand. To overcome the limited significance of validation in lab environments with homogeneous magnetic fields, we validate the proposed system using functional hand motions in the presence of severe magnetic disturbances as they appear in realistic clinical settings. We show that standard sensor fusion methods that rely on magnetometer readings may perform well in perfect laboratory environments but can lead to more than 15 cm root-mean-square error for the fingertip distances in realistic environments, while our advanced method yields root-mean-square errors below 2 cm for all performed motions.
Collapse
|
21
|
Salchow-Hömmen C, Jankowski N, Valtin M, Schönijahn L, Böttcher S, Dähne F, Schauer T. User-centered practicability analysis of two identification strategies in electrode arrays for FES induced hand motion in early stroke rehabilitation. J Neuroeng Rehabil 2018; 15:123. [PMID: 30594257 PMCID: PMC6310929 DOI: 10.1186/s12984-018-0460-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Surface electrode arrays have become popular in the application of functional electrical stimulation (FES) on the forearm. Arrays consist of multiple, small elements, which can be activated separately or in groups, forming virtual electrodes (VEs). As technology progress yields rising numbers of possible elements, an effective search strategy for suitable VEs in electrode arrays is of increasing importance. Current methods can be time-consuming, lack user integration, and miss an evaluation regarding clinical acceptance and practicability. METHODS Two array identification procedures with different levels of user integration-a semi-automatic and a fully automatic approach-are evaluated. The semi-automatic method allows health professionals to continuously modify VEs via a touchscreen while the stimulation intensities are automatically controlled to maintain sufficient wrist extension. The automatic approach evaluates stimulation responses of various VEs for different intensities using a cost function and joint-angles recordings. Both procedures are compared in a clinical setup with five sub-acute stroke patients with moderate hand disabilities. The task was to find suitable VEs in two arrays with 59 elements in total to generate hand opening and closing for a grasp-and-release task. Practicability and acceptance by patients and health professionals were investigated using questionnaires and interviews. RESULTS Both identification methods yield suitable VEs for hand opening and closing in patients who could tolerate the stimulation. However, the resulting VEs differed for both approaches. The average time for a complete search was 25% faster for the semi-automatic approach (semi-automatic: 7.3min, automatic: 10.5min). User acceptance was high for both methods, while no clear preference could be identified. CONCLUSIONS The semi-automatic approach should be preferred as the search strategy in arrays on the forearm. The observed faster search duration will further reduce when applying the system repeatedly on a patient as only small position adjustments for VEs are required. However, the setup time will significantly increase for generation of various grasp types and adaptation to different arm postures. We recommend different levels of user integration in FES systems such that the search strategy can be chosen based on the users' preferences and application scenario.
Collapse
Affiliation(s)
| | - Natalie Jankowski
- Institut für Rehabilitationswissenschaften, Humboldt Universität zu Berlin, Unter den Linden 6, Berlin, 10099 Germany
| | - Markus Valtin
- Control Systems Group, Technische Universität Berlin, Einsteinufer 17, Berlin, 10587 Germany
| | - Laura Schönijahn
- Institut für Rehabilitationswissenschaften, Humboldt Universität zu Berlin, Unter den Linden 6, Berlin, 10099 Germany
| | - Sebastian Böttcher
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Warener Str. 7, Berlin, 12683 Germany
| | - Frank Dähne
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Warener Str. 7, Berlin, 12683 Germany
| | - Thomas Schauer
- Control Systems Group, Technische Universität Berlin, Einsteinufer 17, Berlin, 10587 Germany
| |
Collapse
|
22
|
Shin H, Zheng Y, Hu X. Variation of Finger Activation Patterns Post-stroke Through Non-invasive Nerve Stimulation. Front Neurol 2018; 9:1101. [PMID: 30619058 PMCID: PMC6301189 DOI: 10.3389/fneur.2018.01101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/03/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose: A transcutaneous proximal nerve stimulation technique utilizing an electrode grid along the nerve bundles has previously shown flexible activation of multiple fingers. This case study aimed to further demonstrate the ability of this novel stimulation technique to induce various finger grasp patterns in a stroke survivor. Methods: An individual with chronic hemiplegia and severe hand impairment was recruited. Electrical stimulation was delivered to different pairs of an electrode grid along the ulnar and median nerves to selectively activate different finger flexor muscles, with an automated electrode switching method. The resultant individual isometric flexion forces and forearm flexor high-density electromyography (HDEMG) were acquired to evaluate the finger activation patterns. A medium and low level of overall activation were chosen to gauge the available finger patterns for both the contralateral and paretic hands. All the flexion forces were then clustered to categorize the different types of grasp patterns. Results: Both the contralateral and paretic sides demonstrated various force clusters including single and multi-finger activation patterns. The contralateral hand showed finger activation patterns mainly centered on median nerve activation of the index, middle, and ring fingers. The paretic hand exhibited fewer total activation patterns, but still showed activation of all four fingers in some combination. Conclusion: Our results show that electrical stimulation at multiple positions along the proximal nerve bundles can elicit a select variety of finger activation patterns even in a stroke survivor with minimal hand function. This system could be further implemented for better rehabilitative training to help induce functional grasp patterns or to help regain muscle mass.
Collapse
Affiliation(s)
- Henry Shin
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, United States
| | - Yang Zheng
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, United States
| | - Xiaogang Hu
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, United States
| |
Collapse
|
23
|
Barra B, Roux C, Kaeser M, Schiavone G, Lacour SP, Bloch J, Courtine G, Rouiller EM, Schmidlin E, Capogrosso M. Selective Recruitment of Arm Motoneurons in Nonhuman Primates Using Epidural Electrical Stimulation of the Cervical Spinal Cord. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:1424-1427. [PMID: 30440659 DOI: 10.1109/embc.2018.8512554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recovery of reaching and grasping ability is the priority for people with cervical spinal cord injury (SCI). Epidural electrical stimulation (EES) has shown promising results in improving motor control after SCI in various animal models and in humans. Notably, the application of stimulation bursts with spatiotemporal sequences that reproduce the natural activation of motoneurons restored skilled leg movements in rodent and nonhuman primate models of SCI. Here, we studied whether this conceptual framework could be transferred to the design of cervical EES protocols for the recovery of reaching and grasping in nonhuman primates. We recorded muscle activity during a reaching and grasping task in a macaque monkey and found that this task involves a stereotypical spatiotemporal map of motoneuron activation. We then characterized the specificity of a spinal implant for the delivery of EES to cervical spinal segments in the same animal. Finally, we combined these results to design a simple stimulation protocol that may reproduce natural motoneuron activation and thus facilitate upper limb movements after injury.
Collapse
|
24
|
Brill N, Naufel SN, Polasek K, Ethier C, Cheesborough J, Agnew S, Miller LE, Tyler DJ. Evaluation of high-density, multi-contact nerve cuffs for activation of grasp muscles in monkeys. J Neural Eng 2018; 15:036003. [PMID: 28825407 PMCID: PMC5910281 DOI: 10.1088/1741-2552/aa8735] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this work was to evaluate whether nerve cuffs can selectively activate hand muscles for functional electrical stimulation (FES). FES typically involves identifying and implanting electrodes in many individual muscles, but nerve cuffs only require implantation at a single site around the nerve. This method is surgically more attractive. Nerve cuffs may also more effectively stimulate intrinsic hand muscles, which are difficult to implant and stimulate without spillover to adjacent muscles. APPROACH To evaluate its ability to selectively activate muscles, we implanted and tested the flat interface nerve electrode (FINE), which is designed to selectively stimulate peripheral nerves that innervate multiple muscles (Tyler and Durand 2002 IEEE Trans. Neural Syst. Rehabil. Eng. 10 294-303). We implanted FINEs on the nerves and bipolar intramuscular wires for recording compound muscle action potentials (CMAPs) from up to 20 muscles in each arm of six monkeys. We then collected recruitment curves while the animals were anesthetized. MAIN RESULT A single FINE implanted on an upper extremity nerve in the monkey can selectively activate muscles or small groups of muscles to produce multiple, independent hand functions. SIGNIFICANCE FINE cuffs can serve as a viable supplement to intramuscular electrodes in FES systems, where they can better activate intrinsic and extrinsic muscles with lower currents and less extensive surgery.
Collapse
Affiliation(s)
| | - SN Naufel
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA
| | - K Polasek
- Department of Engineering, Hope College, 27 Graves Pl. Holland MI, 49423
| | - C Ethier
- Centre de recherche de l’Institut universitaire en santé mentale de Québec, Department of Psychiatry and Neuroscience, Université Laval, Quebec City, QC, Canada
| | - J Cheesborough
- Clinical Instructor, Surgery, Plastic & Reconstructive Surgery, Stanford University
| | - S Agnew
- Assistant Professor, Division of Plastic Surgery and Department of Orthopaedic Surgery, Loyola University Medical Center
| | - LE Miller
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Avenue, Chicago, IL 60611, USA
- Sensory Motor Performance Program (SMPP), Shirley Ryan Ability Lab, 355 Erie Street, Suite 1406, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - DJ Tyler
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, USA
| |
Collapse
|
25
|
Electrode placement on the forearm for selective stimulation of finger extension/flexion. PLoS One 2018; 13:e0190936. [PMID: 29324829 PMCID: PMC5764314 DOI: 10.1371/journal.pone.0190936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/22/2017] [Indexed: 12/17/2022] Open
Abstract
It is still challenging to achieve a complex grasp or fine finger control by using surface functional electrical stimulation (FES), which usually requires a precise electrode configuration under laboratory or clinical settings. The goals of this study are as follows: 1) to study the possibility of selectively activating individual fingers; 2) to investigate whether the current activation threshold and selective range of individual fingers are affected by two factors: changes in the electrode position and forearm rotation (pronation, neutral and supination); and 3) to explore a theoretical model for guidance of the electrode placement used for selective activation of individual fingers. A coordinate system with more than 400 grid points was established over the forearm skin surface. A searching procedure was used to traverse all grid points to identify the stimulation points for finger extension/flexion by applying monophasic stimulation pulses. Some of the stimulation points for finger extension and flexion were selected and tested in their respective two different forearm postures according to the number and the type of the activated fingers and the strength of finger action response to the electrical stimulation at the stimulation point. The activation thresholds and current ranges of the selectively activated finger at each stimulation point were determined by visual analysis. The stimulation points were divided into three groups (“Low”, “Medium” and “High”) according to the thresholds of the 1st activated fingers. The angles produced by the selectively activated finger within selective current ranges were measured and analyzed. Selective stimulation of extension/flexion is possible for most fingers. Small changes in electrode position and forearm rotation have no significant effect on the threshold amplitude and the current range for the selective activation of most fingers (p > 0.05). The current range is the largest (more than 2 mA) for selective activation of the thumb, followed by those for the index, ring, middle and little fingers. The stimulation points in the “Low” group for all five fingers lead to noticeable finger angles at low current intensity, especially for the index, middle, and ring fingers. The slopes of the finger angle variation in the “Low” group for digits 2~4 are inversely proportional to the current intensity, whereas the slopes of the finger angle variation in other groups and in all groups for the thumb and little finger are proportional to the current intensity. It is possible to selectively activate the extension/flexion of most fingers by stimulating the forearm muscles. The physiological characteristics of each finger should be considered when placing the negative electrode for selective stimulation of individual fingers. The electrode placement used for the selective activation of individual fingers should not be confined to the location with the lowest activation threshold.
Collapse
|
26
|
Allen M, Zhong Q, Kirsch N, Dani A, Clark WW, Sharma N. A Nonlinear Dynamics-Based Estimator for Functional Electrical Stimulation: Preliminary Results From Lower-Leg Extension Experiments. IEEE Trans Neural Syst Rehabil Eng 2017; 25:2365-2374. [PMID: 28885155 DOI: 10.1109/tnsre.2017.2748420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Miniature inertial measurement units (IMUs) are wearable sensors that measure limb segment or joint angles during dynamic movements. However, IMUs are generally prone to drift, external magnetic interference, and measurement noise. This paper presents a new class of nonlinear state estimation technique called state-dependent coefficient (SDC) estimation to accurately predict joint angles from IMU measurements. The SDC estimation method uses limb dynamics, instead of limb kinematics, to estimate the limb state. Importantly, the nonlinear limb dynamic model is formulated into state-dependent matrices that facilitate the estimator design without performing a Jacobian linearization. The estimation method is experimentally demonstrated to predict knee joint angle measurements during functional electrical stimulation of the quadriceps muscle. The nonlinear knee musculoskeletal model was identified through a series of experiments. The SDC estimator was then compared with an extended kalman filter (EKF), which uses a Jacobian linearization and a rotation matrix method, which uses a kinematic model instead of the dynamic model. Each estimator's performance was evaluated against the true value of the joint angle, which was measured through a rotary encoder. The experimental results showed that the SDC estimator, the rotation matrix method, and EKF had root mean square errors of 2.70°, 2.86°, and 4.42°, respectively. Our preliminary experimental results show the new estimator's advantage over the EKF method but a slight advantage over the rotation matrix method. However, the information from the dynamic model allows the SDC method to use only one IMU to measure the knee angle compared with the rotation matrix method that uses two IMUs to estimate the angle.
Collapse
|
27
|
Effects of orthotic therapeutic electrical stimulation in the treatment of patients with paresis associated with acute cervical spinal cord injury: a randomized control trial. Spinal Cord 2017; 55:1066-1070. [DOI: 10.1038/sc.2017.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/22/2017] [Accepted: 05/22/2017] [Indexed: 11/08/2022]
|
28
|
Müller-Putz GR, Plank P, Stadlbauer B, Statthaler K, Uroko JB. 15 Years of Evolution of Non-Invasive EEG-Based Methods for Restoring Hand & Arm Function with Motor Neuroprosthetics in Individuals with High Spinal Cord Injury: A Review of Graz BCI Research. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/jbise.2017.106024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
29
|
Ethier C, Miller LE. Brain-controlled muscle stimulation for the restoration of motor function. Neurobiol Dis 2015; 83:180-90. [PMID: 25447224 PMCID: PMC4412757 DOI: 10.1016/j.nbd.2014.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 12/21/2022] Open
Abstract
Loss of the ability to move, as a consequence of spinal cord injury or neuromuscular disorder, has devastating consequences for the paralyzed individual, and great economic consequences for society. Functional electrical stimulation (FES) offers one means to restore some mobility to these individuals, improving not only their autonomy, but potentially their general health and well-being as well. FES uses electrical stimulation to cause the paralyzed muscles to contract. Existing clinical systems require the stimulation to be preprogrammed, with the patient typically using residual voluntary movement of another body part to trigger and control the patterned stimulation. The rapid development of neural interfacing in the past decade offers the promise of dramatically improved control for these patients, potentially allowing continuous control of FES through signals recorded from motor cortex, as the patient attempts to control the paralyzed body part. While application of these 'brain-machine interfaces' (BMIs) has undergone dramatic development for control of computer cursors and even robotic limbs, their use as an interface for FES has been much more limited. In this review, we consider both FES and BMI technologies and discuss the prospect for combining the two to provide important new options for paralyzed individuals.
Collapse
Affiliation(s)
- Christian Ethier
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611, USA
| | - Lee E Miller
- Department of Physiology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave., Chicago, IL 60611, USA; Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road Evanston, IL 60208, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 345 E. Superior Ave., Chicago, IL 60611, USA.
| |
Collapse
|
30
|
Venugopalan L, Taylor PN, Cobb JE, Swain ID. Upper limb functional electrical stimulation devices and their man-machine interfaces. J Med Eng Technol 2015; 39:471-9. [PMID: 26508077 DOI: 10.3109/03091902.2015.1102344] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Functional Electrical Stimulation (FES) is a technique that uses electricity to activate the nerves of a muscle that is paralysed due to hemiplegia, multiple sclerosis, Parkinson's disease or spinal cord injury (SCI). FES has been widely used to restore upper limb functions in people with hemiplegia and C5-C7 tetraplegia and has improved their ability to perform their activities of daily living (ADL). At the time of writing, a detailed literature review of the existing upper limb FES devices and their man-machine interfaces (MMI) showed that only the NESS H200 was commercially available. However, the rigid arm splint doesn't fit everyone and prevents the use of a tenodesis grip. Hence, a robust and versatile upper limb FES device that can be used by a wider group of people is required.
Collapse
Affiliation(s)
- L Venugopalan
- a The National Clinical FES Centre, Salisbury District Hospital , Salisbury , Wiltshire , UK and.,b The Faculty of Science and Technology, Bournemouth University , Poole , Dorset , UK
| | - P N Taylor
- a The National Clinical FES Centre, Salisbury District Hospital , Salisbury , Wiltshire , UK and
| | - J E Cobb
- b The Faculty of Science and Technology, Bournemouth University , Poole , Dorset , UK
| | - I D Swain
- a The National Clinical FES Centre, Salisbury District Hospital , Salisbury , Wiltshire , UK and.,b The Faculty of Science and Technology, Bournemouth University , Poole , Dorset , UK
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Gregersen H, Lybæk M, Lauge Johannesen I, Leicht P, Nissen UV, Biering-Sørensen F. Satisfaction with upper extremity surgery in individuals with tetraplegia. J Spinal Cord Med 2015; 38:161-9. [PMID: 25243666 PMCID: PMC4397197 DOI: 10.1179/2045772314y.0000000259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To supplement the scant information available regarding the satisfaction of patients with tetraplegia following upper extremity reconstructive surgery for such individuals with spinal cord injury (SCI). STUDY DESIGN Retrospective study with questionnaire follow-up. SETTING The Danish Spinal Cord Injury Centers. MATERIAL AND METHODS In the initial review period, 119 upper extremity surgeries were performed on patients with tetraplegia (n = 49). Seven died and the remaining 42 were invited to complete a follow-up questionnaire with a five-level scale ranging from strongly agree to strongly disagree regarding satisfaction. Forty patients completed the questionnaire. RESULTS Median time from first surgery was 13 years (2-36). Sixty-five percent of the sample had a C5-C6 SCI, with 64% experiencing complete injury. Initially, 76% of the sample expressed general satisfaction with life, but only 28% of the sample reported that hand appearance improved after surgery. Interestingly, those having surgery from 1991 to 2008 reported significantly greater satisfaction (P < 0.001) and were significantly more satisfied with activities of daily living (ADL) (P < 0.001) than those having surgery between the years 1973 and 1990. In particular, gain of independence was obtained with pinch/specific hand surgery compared to triceps activation. Accordingly, the pinch/specific hand surgery group was significantly more satisfied than the triceps group on the ADL (P = 0.027), and the independence questions (P < 0.001). CONCLUSION Overall satisfaction with upper extremity surgery is high. It can have a positive impact on life in general, ability to perform ADL, as well as supplying an increased level of independence.
Collapse
Affiliation(s)
- Hanne Gregersen
- Clinic for Spinal Cord Injuries, Copenhagen University Hospital, Glostrup Hospital, Hornbæk, Denmark,Correspondence to: Hanne Gregersen, Clinic for Spinal Cord Injuries, Glostrup Hospital, Havnevej 25, Hornbæk DK-3100, Denmark.
| | - Mille Lybæk
- West Danish Center for Spinal Cord Injuries, Viborg Hospital, Denmark
| | | | - Pernille Leicht
- Orthopaedic Department, Hand Surgery Section, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ulla Vig Nissen
- Clinic for Spinal Cord Injuries, Copenhagen University Hospital, Glostrup Hospital, Hornbæk, Denmark
| | | |
Collapse
|
33
|
Aoyagi Y, Tsubahara A. Therapeutic Orthosis and Electrical Stimulation for Upper Extremity Hemiplegia After Stroke: A Review of Effectiveness Based on Evidence. Top Stroke Rehabil 2015; 11:9-15. [PMID: 15480949 DOI: 10.1310/6q5q-69pu-nlq9-avmr] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Upper extremity hemiplegia after stroke is common and disabling. Apart from conventional physical and occupational therapy, a number of additional approaches that use devices such as orthoses, prostheses, electrical stimulation, and robots have been introduced. The purpose of this review was to assess the clinical efficacy of such devices used for the affected upper extremities of acute, subacute, and chronic stroke patients. Assessments of their effectiveness and recommendations were based on the weight of published scientific evidence. The amount of evidence with respect to hand splints and shoulder slings is limited. Further study with a well-designed randomized controlled trial (RCT) is required to investigate accurately their short- and long-term efficacy. A number of studies suggested that the use of electrical stimulation for reducing shoulder subluxation or improving the function of wrist and finger extensors is effective during or shortly after the daily treatment period. The robotic approach to hemiplegic upper extremities appears to be a novel therapeutic strategy that may help improve hand and arm function. However, the longer term effectiveness after discontinuation as well as the motor recovery mechanism of electrical stimulation or robotic devices remains unclear. More research is needed to determine the evidence-based effectiveness of electrical stimulation or other devices for stroke survivors.
Collapse
Affiliation(s)
- Yoichiro Aoyagi
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | | |
Collapse
|
34
|
Mallory GW, Grahn PJ, Hachmann JT, Lujan JL, Lee KH. Optical stimulation for restoration of motor function after spinal cord injury. Mayo Clin Proc 2015; 90:300-7. [PMID: 25659246 PMCID: PMC4339262 DOI: 10.1016/j.mayocp.2014.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 12/31/2022]
Abstract
Spinal cord injury can be defined as a loss of communication between the brain and the body due to disrupted pathways within the spinal cord. Although many promising molecular strategies have emerged to reduce secondary injury and promote axonal regrowth, there is still no effective cure, and recovery of function remains limited. Functional electrical stimulation (FES) represents a strategy developed to restore motor function without the need for regenerating severed spinal pathways. Despite its technological success, however, FES has not been widely integrated into the lives of spinal cord injury survivors. In this review, we briefly discuss the limitations of existing FES technologies. Additionally, we discuss how optogenetics, a rapidly evolving technique used primarily to investigate select neuronal populations within the brain, may eventually be used to replace FES as a form of therapy for functional restoration after spinal cord injury.
Collapse
Affiliation(s)
- Grant W Mallory
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Peter J Grahn
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Jan T Hachmann
- School of Medicine, Heidelberg University, Neuenheimer Feld, Bergheim, Germany
| | - J Luis Lujan
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.
| |
Collapse
|
35
|
Rupp R. Challenges in clinical applications of brain computer interfaces in individuals with spinal cord injury. FRONTIERS IN NEUROENGINEERING 2014; 7:38. [PMID: 25309420 PMCID: PMC4174119 DOI: 10.3389/fneng.2014.00038] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/08/2014] [Indexed: 01/15/2023]
Abstract
Brain computer interfaces (BCIs) are devices that measure brain activities and translate them into control signals used for a variety of applications. Among them are systems for communication, environmental control, neuroprostheses, exoskeletons, or restorative therapies. Over the last years the technology of BCIs has reached a level of matureness allowing them to be used not only in research experiments supervised by scientists, but also in clinical routine with patients with neurological impairments supervised by clinical personnel or caregivers. However, clinicians and patients face many challenges in the application of BCIs. This particularly applies to high spinal cord injured patients, in whom artificial ventilation, autonomic dysfunctions, neuropathic pain, or the inability to achieve a sufficient level of control during a short-term training may limit the successful use of a BCI. Additionally, spasmolytic medication and the acute stress reaction with associated episodes of depression may have a negative influence on the modulation of brain waves and therefore the ability to concentrate over an extended period of time. Although BCIs seem to be a promising assistive technology for individuals with high spinal cord injury systematic investigations are highly needed to obtain realistic estimates of the percentage of users that for any reason may not be able to operate a BCI in a clinical setting.
Collapse
Affiliation(s)
- Rüdiger Rupp
- Experimental Neurorehabilitation, Spinal Cord Injury Center, Heidelberg University Hospital Heidelberg, Germany
| |
Collapse
|
36
|
Hugosdóttir R, Jónasson SÞ, Sigþórsson H, Helgason Þ. Feasibility Study of a Novel Electrode Concept for a Neuroprosthesis for Augmentation of Impaired Finger Functions. Eur J Transl Myol 2014; 24:4671. [PMID: 26913139 PMCID: PMC4756741 DOI: 10.4081/ejtm.2014.4671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The project “Finger Rehabilitation” aims to design a neuroprosthesis with integrated electronics. The neuroprosthesis should enable spinal cord injured people, with injury at cervical vertebrae level, to increase finger mobility and activity with the use of functional electrical stimulation. The equipment is based on several integrated factors. The user has to be independent from any external help and has to be able to put it on, control the electrical stimulation and remove it by himself. The neuroprosthesis has to be both flexible and stable for the electrodes to remain firmly on the skin. In this part of the project, new electrodes which do not get stuck on the skin are described. The electrodes are small and have low impedance. A sleeve, made from glass fibres, is also described. The electrode matrices are integrated in the sleeve. The neuroprosthesis fits a patient with spinal cord injury at C5-C6. In this work, a novel electrode concept integrated in a glass fibre sleeve is tested on its ability for use in an “independent user” neuroprosthesis for finger movement rehabilitation.
Collapse
Affiliation(s)
| | | | | | - Þórður Helgason
- (1) Reykjavík University, Reykjavík; (2) Science and Developement Department, Landspitali - University Hospital, Reykjavík, Iceland
| |
Collapse
|
37
|
Klauer C, Schauer T, Reichenfelser W, Karner J, Zwicker S, Gandolla M, Ambrosini E, Ferrante S, Hack M, Jedlitschka A, Duschau-Wicke A, Gföhler M, Pedrocchi A. Feedback control of arm movements using Neuro-Muscular Electrical Stimulation (NMES) combined with a lockable, passive exoskeleton for gravity compensation. Front Neurosci 2014; 8:262. [PMID: 25228853 PMCID: PMC4151235 DOI: 10.3389/fnins.2014.00262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 08/04/2014] [Indexed: 11/25/2022] Open
Abstract
Within the European project MUNDUS, an assistive framework was developed for the support of arm and hand functions during daily life activities in severely impaired people. This contribution aims at designing a feedback control system for Neuro-Muscular Electrical Stimulation (NMES) to enable reaching functions in people with no residual voluntary control of the arm and shoulder due to high level spinal cord injury. NMES is applied to the deltoids and the biceps muscles and integrated with a three degrees of freedom (DoFs) passive exoskeleton, which partially compensates gravitational forces and allows to lock each DOF. The user is able to choose the target hand position and to trigger actions using an eyetracker system. The target position is selected by using the eyetracker and determined by a marker-based tracking system using Microsoft Kinect. A central controller, i.e., a finite state machine, issues a sequence of basic movement commands to the real-time arm controller. The NMES control algorithm sequentially controls each joint angle while locking the other DoFs. Daily activities, such as drinking, brushing hair, pushing an alarm button, etc., can be supported by the system. The robust and easily tunable control approach was evaluated with five healthy subjects during a drinking task. Subjects were asked to remain passive and to allow NMES to induce the movements. In all of them, the controller was able to perform the task, and a mean hand positioning error of less than five centimeters was achieved. The average total time duration for moving the hand from a rest position to a drinking cup, for moving the cup to the mouth and back, and for finally returning the arm to the rest position was 71 s.
Collapse
Affiliation(s)
- Christian Klauer
- Control Systems Group, Technische Universität Berlin Berlin, Germany
| | - Thomas Schauer
- Control Systems Group, Technische Universität Berlin Berlin, Germany
| | - Werner Reichenfelser
- Research Group for Machine Design and Rehabilitation, Vienna University of Technology Vienna, Austria
| | - Jakob Karner
- Research Group for Machine Design and Rehabilitation, Vienna University of Technology Vienna, Austria
| | | | - Marta Gandolla
- NeuroEngineering and Medical Robotics Laboratory, NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano Milan, Italy
| | - Emilia Ambrosini
- NeuroEngineering and Medical Robotics Laboratory, NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano Milan, Italy
| | - Simona Ferrante
- NeuroEngineering and Medical Robotics Laboratory, NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano Milan, Italy
| | - Marco Hack
- Fraunhofer Institute for Experimental Software Engineering Kaiserslautern, Germany
| | - Andreas Jedlitschka
- Fraunhofer Institute for Experimental Software Engineering Kaiserslautern, Germany
| | | | - Margit Gföhler
- Research Group for Machine Design and Rehabilitation, Vienna University of Technology Vienna, Austria
| | - Alessandra Pedrocchi
- NeuroEngineering and Medical Robotics Laboratory, NearLab, Department of Electronics, Information, and Bioengineering, Politecnico di Milano Milan, Italy
| |
Collapse
|
38
|
Grahn PJ, Mallory GW, Berry BM, Hachmann JT, Lobel DA, Lujan JL. Restoration of motor function following spinal cord injury via optimal control of intraspinal microstimulation: toward a next generation closed-loop neural prosthesis. Front Neurosci 2014; 8:296. [PMID: 25278830 PMCID: PMC4166363 DOI: 10.3389/fnins.2014.00296] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/31/2014] [Indexed: 11/13/2022] Open
Abstract
Movement is planned and coordinated by the brain and carried out by contracting muscles acting on specific joints. Motor commands initiated in the brain travel through descending pathways in the spinal cord to effector motor neurons before reaching target muscles. Damage to these pathways by spinal cord injury (SCI) can result in paralysis below the injury level. However, the planning and coordination centers of the brain, as well as peripheral nerves and the muscles that they act upon, remain functional. Neuroprosthetic devices can restore motor function following SCI by direct electrical stimulation of the neuromuscular system. Unfortunately, conventional neuroprosthetic techniques are limited by a myriad of factors that include, but are not limited to, a lack of characterization of non-linear input/output system dynamics, mechanical coupling, limited number of degrees of freedom, high power consumption, large device size, and rapid onset of muscle fatigue. Wireless multi-channel closed-loop neuroprostheses that integrate command signals from the brain with sensor-based feedback from the environment and the system's state offer the possibility of increasing device performance, ultimately improving quality of life for people with SCI. In this manuscript, we review neuroprosthetic technology for improving functional restoration following SCI and describe brain-machine interfaces suitable for control of neuroprosthetic systems with multiple degrees of freedom. Additionally, we discuss novel stimulation paradigms that can improve synergy with higher planning centers and improve fatigue-resistant activation of paralyzed muscles. In the near future, integration of these technologies will provide SCI survivors with versatile closed-loop neuroprosthetic systems for restoring function to paralyzed muscles.
Collapse
Affiliation(s)
- Peter J. Grahn
- Mayo Clinic College of Medicine, Mayo ClinicRochester, MN, USA
| | | | | | - Jan T. Hachmann
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
| | | | - J. Luis Lujan
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo ClinicRochester, MN, USA
| |
Collapse
|
39
|
Di Pino G, Maravita A, Zollo L, Guglielmelli E, Di Lazzaro V. Augmentation-related brain plasticity. Front Syst Neurosci 2014; 8:109. [PMID: 24966816 PMCID: PMC4052974 DOI: 10.3389/fnsys.2014.00109] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/23/2014] [Indexed: 12/11/2022] Open
Abstract
Today, the anthropomorphism of the tools and the development of neural interfaces require reconsidering the concept of human-tools interaction in the framework of human augmentation. This review analyses the plastic process that the brain undergoes when it comes into contact with augmenting artificial sensors and effectors and, on the other hand, the changes that the use of external augmenting devices produces in the brain. Hitherto, few studies investigated the neural correlates of augmentation, but clues on it can be borrowed from logically-related paradigms: sensorimotor training, cognitive enhancement, cross-modal plasticity, sensorimotor functional substitution, use and embodiment of tools. Augmentation modifies function and structure of a number of areas, i.e., primary sensory cortices shape their receptive fields to become sensitive to novel inputs. Motor areas adapt the neuroprosthesis representation firing-rate to refine kinematics. As for normal motor outputs, the learning process recruits motor and premotor cortices and the acquisition of proficiency decreases attentional recruitment, focuses the activity on sensorimotor areas and increases the basal ganglia drive on the cortex. Augmentation deeply relies on the frontoparietal network. In particular, premotor cortex is involved in learning the control of an external effector and owns the tool motor representation, while the intraparietal sulcus extracts its visual features. In these areas, multisensory integration neurons enlarge their receptive fields to embody supernumerary limbs. For operating an anthropomorphic neuroprosthesis, the mirror system is required to understand the meaning of the action, the cerebellum for the formation of its internal model and the insula for its interoception. In conclusion, anthropomorphic sensorized devices can provide the critical sensory afferences to evolve the exploitation of tools through their embodiment, reshaping the body representation and the sense of the self.
Collapse
Affiliation(s)
- Giovanni Di Pino
- Institute of Neurology and Fondazione Alberto Sordi - Research Institute for Ageing, Campus Bio Medico University of Rome Rome, Italy ; Laboratory of Biomedical Robotics and Biomicrosystems CIR - Centre for Integrated Research, Campus Bio Medico University of Rome Rome, Italy
| | - Angelo Maravita
- Department of Psycology, Università di Milano-Bicocca Milano, Italy
| | - Loredana Zollo
- Laboratory of Biomedical Robotics and Biomicrosystems CIR - Centre for Integrated Research, Campus Bio Medico University of Rome Rome, Italy
| | - Eugenio Guglielmelli
- Laboratory of Biomedical Robotics and Biomicrosystems CIR - Centre for Integrated Research, Campus Bio Medico University of Rome Rome, Italy
| | - Vincenzo Di Lazzaro
- Institute of Neurology and Fondazione Alberto Sordi - Research Institute for Ageing, Campus Bio Medico University of Rome Rome, Italy
| |
Collapse
|
40
|
Lee B, Attenello FJ, Liu CY, McLoughlin MP, Apuzzo ML. Recapitulating Flesh with Silicon and Steel: Advancements in Upper Extremity Robotic Prosthetics. World Neurosurg 2014; 81:730-41. [DOI: 10.1016/j.wneu.2014.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
|
41
|
Makowski NS, Knutson JS, Chae J, Crago PE. Functional electrical stimulation to augment poststroke reach and hand opening in the presence of voluntary effort: a pilot study. Neurorehabil Neural Repair 2014; 28:241-9. [PMID: 24270058 PMCID: PMC4128408 DOI: 10.1177/1545968313505913] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hemiparesis after stroke can severely limit an individual's ability to perform activities of daily living. Functional electrical stimulation (FES) has the potential to generate functional arm and hand movements. We have observed that FES can produce functional hand opening when a stroke patient is relaxed, but the FES-produced hand opening is often overpowered by finger flexor coactivation in response to patient attempts to reach and open the hand. OBJECTIVE To determine if stimulating both reaching muscles and hand opening muscles makes it possible to achieve useful amounts of simultaneous reach and hand opening even in the presence of submaximal reaching effort. METHODS We measured reach and hand opening during a reach-then-open the hand task under different combinations of voluntary effort and FES for both reach and hand opening. RESULTS As effort was reduced and stimulation generated more movement, a greater amount of reach and hand opening was achieved. For the first time, this study quantified the effect of voluntary effort for reach and hand opening on stimulated hand opening. It also showed variability in the interaction of voluntary effort and stimulation between participants. Additionally, when participants were instructed to reach with partial effort during simultaneous FES, they achieved greater reach and hand opening. CONCLUSIONS Simultaneous reaching and FES hand opening is improved by including FES for reach and reducing voluntary effort. In the future, an upper extremity neuroprosthesis that uses a combination of voluntary effort and FES assistance may enable users to perform activities of daily living.
Collapse
|
42
|
IJzerman MJ, Renzenbrink GJ, Geurts ACH. Neuromuscular stimulation after stroke: from technology to clinical deployment. Expert Rev Neurother 2014; 9:541-52. [DOI: 10.1586/ern.09.6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
43
|
Hoffman L, Field-Fote E. Effects of practice combined with somatosensory or motor stimulation on hand function in persons with spinal cord injury. Top Spinal Cord Inj Rehabil 2013; 19:288-99. [PMID: 24244094 DOI: 10.1310/sci1904-288] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Individuals with chronic tetraplegia prioritize recovery of hand function as an important factor in improving their quality of life. Interventions that may improve hand function and increase corticomotor excitability are functional electrical stimulation (FES), somatosensory stimulation (SS), and task-oriented training. OBJECTIVE We compared functional and corticomotor outcomes in a control condition to changes associated with FES (triggered via electromygraphic signals) and with SS (constant trains), each combined with either unimanual or bimanual training. METHODS Using a randomized, clinical trial design, comparisons were made to a delayed intervention control group. Participants (n = 24) had chronic tetraplegia, with the ability to activate thenar muscles, and were randomly assigned to either the immediate intervention (intervention) or control/ delayed intervention groups. Primary analyses compared intervention (FES or SS) to control/delayed intervention. Secondary analyses compared subgroups of FES versus SS (regardless of uni- or bilateral training) and uni- versus bimanual training (regardless of stimulation type). Outcomes were assessed before and after the control and the intervention period. RESULTS Compared to control/delayed intervention, the intervention group had greater changes in unimanual function and corticomotor area, regardless of whether practice was combined with FES or with SS. Irrespective of stimulation type, the bimanual subgroups improved to a greater extent than the unimanual subgroups on the bimanual hand function test. CONCLUSIONS Hand training combined with either SS or FES was associated with improved hand use and corticomotor activity in persons with chronic tetraplegia. Both interventions appear to be equally effective.
Collapse
Affiliation(s)
- Larisa Hoffman
- School of Physical Therapy, Regis University , Denver, Colorado
| | | |
Collapse
|
44
|
Collinger JL, Foldes S, Bruns TM, Wodlinger B, Gaunt R, Weber DJ. Neuroprosthetic technology for individuals with spinal cord injury. J Spinal Cord Med 2013; 36:258-72. [PMID: 23820142 PMCID: PMC3758523 DOI: 10.1179/2045772313y.0000000128] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
CONTEXT Spinal cord injury (SCI) results in a loss of function and sensation below the level of the lesion. Neuroprosthetic technology has been developed to help restore motor and autonomic functions as well as to provide sensory feedback. FINDINGS This paper provides an overview of neuroprosthetic technology that aims to address the priorities for functional restoration as defined by individuals with SCI. We describe neuroprostheses that are in various stages of preclinical development, clinical testing, and commercialization including functional electrical stimulators, epidural and intraspinal microstimulation, bladder neuroprosthesis, and cortical stimulation for restoring sensation. We also discuss neural recording technologies that may provide command or feedback signals for neuroprosthetic devices. CONCLUSION/CLINICAL RELEVANCE Neuroprostheses have begun to address the priorities of individuals with SCI, although there remains room for improvement. In addition to continued technological improvements, closing the loop between the technology and the user may help provide intuitive device control with high levels of performance.
Collapse
|
45
|
Nishimura Y, Perlmutter SI, Fetz EE. Restoration of upper limb movement via artificial corticospinal and musculospinal connections in a monkey with spinal cord injury. Front Neural Circuits 2013; 7:57. [PMID: 23596396 PMCID: PMC3622884 DOI: 10.3389/fncir.2013.00057] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/13/2013] [Indexed: 12/03/2022] Open
Abstract
Functional loss of limb control in individuals with spinal cord injury or stroke can be caused by interruption of corticospinal pathways, although the neural circuits located above and below the lesion remain functional. An artificial neural connection that bridges the lost pathway and connects cortical to spinal circuits has potential to ameliorate the functional loss. We investigated the effects of introducing novel artificial neural connections in a paretic monkey that had a unilateral spinal cord lesion at the C2 level. The first application bridged the impaired spinal lesion. This allowed the monkey to drive the spinal stimulation through volitionally controlled power of high-gamma activity in either the premotor or motor cortex, and thereby to acquire a force-matching target. The second application created an artificial recurrent connection from a paretic agonist muscle to a spinal site, allowing muscle-controlled spinal stimulation to boost on-going activity in the muscle. These results suggest that artificial neural connections can compensate for interrupted descending pathways and promote volitional control of upper limb movement after damage of descending pathways such as spinal cord injury or stroke.
Collapse
Affiliation(s)
- Yukio Nishimura
- Department of Physiology & Biophysics, University of Washington Seattle, WA, USA ; Washington National Primate Research Center, University of Washington Seattle, WA, USA ; Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency Tokyo, Japan
| | | | | |
Collapse
|
46
|
Kapadia N, Zivanovic V, Popovic MR. Restoring voluntary grasping function in individuals with incomplete chronic spinal cord injury: pilot study. Top Spinal Cord Inj Rehabil 2013; 19:279-87. [PMID: 24244093 PMCID: PMC3816722 DOI: 10.1310/sci1904-279] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Functional electrical stimulation (FES) therapy has been shown to be one of the most promising approaches for improving voluntary grasping function in individuals with subacute cervical spinal cord injury (SCI). OBJECTIVE To determine the effectiveness of FES therapy, as compared to conventional occupational therapy (COT), in improving voluntary hand function in individuals with chronic (≥24 months post injury), incomplete (American Spinal Injury Association Impairment Scale [AIS] B-D), C4 to C7 SCI. METHODS Eight participants were randomized to the intervention group (FES therapy; n = 5) or the control group (COT; n = 3). Both groups received 39 hours of therapy over 13 to 16 weeks. The primary outcome measure was the Toronto Rehabilitation Institute-Hand Function Test (TRI-HFT), and the secondary outcome measures were Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Functional Independence Measure (FIM) self-care subscore, and Spinal Cord Independence Measure (SCIM) self-care subscore. Outcome assessments were performed at baseline, after 39 sessions of therapy, and at 6 months following the baseline assessment. RESULTS After 39 sessions of therapy, the intervention group improved by 5.8 points on the TRI-HFT's Object Manipulation Task, whereas the control group changed by only 1.17 points. Similarly, after 39 sessions of therapy, the intervention group improved by 4.6 points on the FIM self-care subscore, whereas the control group did not change at all. CONCLUSION The results of the pilot data justify a clinical trial to compare FES therapy and COT alone to improve voluntary hand function in individuals with chronic incomplete tetraplegia.
Collapse
Affiliation(s)
- Naaz Kapadia
- Spinal Cord Injury Research Program, Toronto Rehabilitation Institute, University Health Network , Toronto, Ontario , Canada
| | | | | |
Collapse
|
47
|
Askari S, Chao T, de Leon RD, Won DS. The effect of timing electrical stimulation to robotic-assisted stepping on neuromuscular activity and associated kinematics. ACTA ACUST UNITED AC 2013; 50:875-92. [DOI: 10.1682/jrrd.2012.06.0111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Ray D. de Leon
- School of Kinesiology and Nutritional Science, California State University, Los Angeles, CA
| | | |
Collapse
|
48
|
Affiliation(s)
- Heinrich Binder
- Department of Neurology, Otto Wagner Hospital, Vienna, Austria.
| |
Collapse
|
49
|
Sasaki K, Matsunaga T, Tomite T, Yoshikawa T, Shimada Y. Effect of electrical stimulation therapy on upper extremity functional recovery and cerebral cortical changes in patients with chronic hemiplegia. ACTA ACUST UNITED AC 2012; 33:89-96. [PMID: 22572383 DOI: 10.2220/biomedres.33.89] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Hemiplegia is a common sequel of stroke and assisted living care is needed in many cases. The purpose of this study was to evaluate the effect of using surface electrode stimulation device in rehabilitation, in terms of functional improvement in upper limb and the changes in brain activation related to central nervous system reconstruction. Five patients with chronic hemiplegia received electrical stimulation therapy using the orthosis-type surface electrode stimulation device for 12 weeks. Training time was 30 min/day for the first weeks, and increased 30 min/day in every 4 weeks. Upper limb outcome measures included Brunnstrom stage, range of motion, Fugl-Meyer assessment and manual function test. Brain activation was measured using functional MRI. After therapy with therapeutic electrical stimulation (TES) for 12 weeks upper limb function improved in all cases. The results of brain activation showed two patterns. In the first, the stimulation produced an activity in the bilateral somatosensory cortices (SMC), which was seen to continue over time. The second, activation was bilateral and extensive before stimulation, but localized to the SMC after intervention. Treatment with TES using an orthosis-type electrode stimulation device improves upper limb function in chronic hemiplegia patients. The present findings suggest that there are not only efferent but also afferent effects that may promote central nervous system remodeling.
Collapse
Affiliation(s)
- Kana Sasaki
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan.
| | | | | | | | | |
Collapse
|
50
|
Brunetti F, Garay Á, Moreno JC, Pons JL. Enhancing functional electrical stimulation for emerging rehabilitation robotics in the framework of HYPER project. IEEE Int Conf Rehabil Robot 2012; 2011:5975370. [PMID: 22275574 DOI: 10.1109/icorr.2011.5975370] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper presents the development of a novel functional electrical stimulation (FES) system. New approaches in emerging rehabilitation robotics propose the use of residual muscular activity or limbs movements during the rehabilitation process of neuromotor. More ambitious projects propose the use of FES systems to restore or compensate motor capabilities by controlling existing muscles or subject limbs. These emerging approaches require more sophisticated FES devices in terms of channels, signals controls and portability. In the framework of HYPER project, such devices are being developed to support the main objective of the project: the development of neurorobots and neuroprosthetics to restore functional motor capabilities in patients who suffered cerebrovascular accidents or spinal cord injury. The presented portable FES system includes novel elec-trostimulator circuits and improved channel switching capacities to enable emerging approaches in rehabilitation robotics.
Collapse
|