A model of selective activation of the femoral nerve with a flat interface nerve electrode for a lower extremity neuroprosthesis.

Functional electrical stimulation (FES) can restore limb movements through electrically initiated, coordinated contractions of paralyzed muscles. The peripheral nerve is an attractive site for stimulation using cuff electrodes. Many applications will require the electrode to selectively activate many smaller populations of axons within a common nerve trunk. The purpose of this study is to computationally model the performance of a flat interface nerve electrode (FINE) on the proximal femoral nerve for standing and stepping applications. Simulations investigated multiple FINE configurations to determine the optimal number and locations of contacts for the maximum muscular selectivity. Realistic finite element method (FEM) models were developed from digitized cross sections from cadaver femoral nerve specimens. Electrical potentials were calculated and interpolated voltages were applied to a double-cable axon model. Model output was analyzed to determine selectivity and estimate joint moments with a musculoskeletal model. Simulations indicated that a 22-contact FINE will produce the greatest selectivity. Simulations predicted that an eight-contact FINE can be expected to selectively stimulate each of the six muscles innervated by the proximal femoral nerve, producing a sufficient knee extension moment for the sit-to-stand transition and contributing 60% of the hip flexion moment needed during gait. We conclude that, whereas more contacts produce greater selectivity, eight channels are sufficient for standing and stepping with an FES system using a FINE on the common femoral nerve.     

Model-based control of FES-induced single joint movements

A crucial issue of functional electrical stimulation (FES) is the control of motor function by the artificial activation of paralyzed muscles. Major problems that limit the success of current FES systems are the nonlinearity of the target system and the rapid change of muscle properties due to fatigue. In this study, four different strategies, including an adaptive algorithm, to control the movement of the freely swinging shank were developed on the basis of computer simulations and experimentally evaluated on two subjects with paraplegia due to a complete thoracic spinal cord injury. After developing a nonlinear, physiologically based model describing the dynamic behavior of the knee joint and muscles, an open-loop approach, a closed-loop approach, and a combination of both were tested. In order to automate the individual adjustments cited, we further evaluated the performance of an adaptive feedforward controller. The two parameters chosen for the adaptation were the threshold pulse width and the scaling factor for adjusting the active moment produced by the stimulated muscle to the fitness of the muscle. These parameters have been chosen because of their significant time variability. The first three controllers with fixed parameters yielded satisfactory result. An additional improvement was achieved by applying the adaptive algorithm that could cope with problems due to muscle fatigue, thus permitting on-line identification of critical parameters of the plant. Although the present study is limited to a simplified experimental setup, its applicability to more complex and functional movements can be expected     

基于GA-SVR模型的肌力康复电刺激系统的设计研究

为了实现康复电刺激系统治疗参数的个性化定制及实时调整,提出了一种基于调制中频电刺激的下肢肌力康复闭环电刺激系统。设计低频调制中频刺激电路,基于遗传算法建立了电刺激参数与膝关节角度之间的支持向量机回归预测模型,并搭建基于模糊内模控制PID的闭环反馈系统,以达到更精确稳定的参数设置效果。通过膝关节运动实验表明,被试者在无痛感的前提下更接近预期的关节运动轨迹,30组膝关节运动角度与预期值最大均方根误差为10.21°,最小均方根误差为5.48°。相比传统低频电刺激,肌电平均振幅具有20μV以上提升。本文提出的电刺激系统参数可实现因人而异,且可根据闭环反馈结果进行实时调整,该系统能有效活化肌肉、提升肌力,在肌力康复步态训练中有较好的应用前景。     

Strategies for generating prolonged functional standing using intramuscular stimulation or intraspinal microstimulation.

Spinal cord injury (SCI) often results in the loss of the ability to stand. The goal of this study was to implement a functional electrical stimulation (FES) system for restoring prolonged periods of standing after SCI. For this purpose, we tested two control strategies: open-loop and closed-loop control, and two stimulation paradigms: non-interleaved intramuscular stimulation (IM-S) and interleaved intraspinal microstimulation (ISMS). The experiments were conducted in anesthetized cats. Stimulation was applied to the muscles through IM-S electrodes implanted in the main knee and ankle extensor muscles, or to the spinal cord through ultra-fine ISMS wires implanted within the ventral horn of the lumbosacral enlargement. The cats were partially supported over parallel force plates and accelerometers were secured to the hindlimbs above and below the ankle joint. Ground reaction forces and knee and ankle joint angles were measured by the force plates and accelerometers, respectively. The closed-loop controller used these feedback signals to modulate the amplitude of stimulation applied to the extensor muscles. The open-loop controller applied constant levels of stimulation which were determined before the onset of each trial. The duration of standing achieved using closed-loop control of IM-S was significantly longer than that achieved with open-loop control (approximately 2 times longer). The increase in the duration of standing corresponded with a decrease in the rate of force decay and a lower average injected current during closed-loop control. Standing was further improved with the use of ISMS. Closed-loop control of interleaved ISMS resulted in a period of standing > 3 times longer than the best trial generated using non-interleaved IM-S. There was also a significant improvement in the balance of force between the two hindlimbs. The results suggest that a system which uses closed-loop control in conjunction with interleaved ISMS could achieve prolonged FES standing in people with SCI.     

The effects of long-term FES-assisted walking on intrinsic and reflex dynamic stiffness in spastic spinal-cord-injured subjects

The effects of long-term functional electrical stimulation (FES)-assisted walking on ankle dynamic stiffness were examined in spinal cord-injured (SCI) subjects with incomplete motor function loss. A parallel-cascade system identification method was used to identify intrinsic and reflex contributions to dynamic ankle stiffness at different ankle positions while subjects remained relaxed. Intrinsic stiffness dynamics were well modeled by a linear second-order model relating intrinsic torque to joint position. Reflex stiffness dynamics were accurately described by a linear third-order model relating halfwave rectified velocity to reflex torque. We examined four SCI subjects before and after long-term FES-assisted walking (>16 mo). Another SCI subject, who used FES for only five months was examined 12 mo latter to serve as a non-FES, SCI control. Reflex stiffness decreased in FES subjects by an average of 53% following FES-assisted walking, intrinsic stiffness also dropped by 45%. In contrast, both reflex and intrinsic stiffness increased in the non-FES, SCI control. These findings suggest that FES-assisted walking may have therapeutic effects, helping to reduce abnormal joint stiffness.     

The effect of joint angle on the timing of muscle contractions elicited by neuromuscular electrical stimulation

Neuromuscular electrical stimulation was used to evoke isometric knee extension contractions in seven individuals with spinal cord injury (SCI) and the time for knee extension torque to rise and fall was measured across a range of knee angles. The stimulated muscles took more than twice as long to develop 50% of maximum torque at an angle of 15 degrees, compared to an angle of 90 degrees. This time difference comprised both an increased delay before torque rose above resting levels (31 +/- 3 ms at 90 degrees, 67 +/- 24 ms at 15 degrees), and a prolonged duration over which torque was rising (72 +/- 14 ms at 90 degrees, 140 +/- 62 ms at 15 degrees). There was no change, however, in the time taken for torque to fall after cessation of stimulation at different knee angles (58 +/- 5-ms delay, 60 +/- 11-ms fall time). The difference in torque rise time with joint angle has implications for modeling functional activities that differ greatly in their joint angles. This study provides regression equations whereby activation times for the quadriceps muscles of individuals with SCI can be predicted for specific angles of knee flexion.     

Recruitment and comfort of BION implanted electrical stimulation: implications for FES applications.

Restoration of motor function to paralyzed limbs by functional electrical stimulation (FES) has been hampered by the lack of precise and gradual control over muscle recruitment. A suitable interface should provide selective stimulation of individual muscles with graded recruitment of force. The BION was developed to enable neuromuscular stimulation through a miniature, self-contained implant designed to be injected in or near muscles and peripheral nerves. In this study, recruitment properties and comfort of the BION implanted electrical stimulation were systematically evaluated in subjects who participated in a clinical trial. Recruitment properties were qualitatively similar to other methods of implanted neuromuscular stimulation: thresholds and steepness of recruitment were negatively correlated and depended on stimulus charge (product of pulse current and duration). Perceived comfort was not affected by the choice of stimulus parameters, thus their choice can be based purely on technical considerations such as efficiency or resolution of recruitment.     

Feasibility of EMG-Based Neural Network Controller for an Upper Extremity Neuroprosthesis

The overarching goal of this project is to provide shoulder and elbow function to individuals with C5/C6 spinal cord injury (SCI) using functional electrical stimulation (FES), increasing the functional outcomes currently provided by a hand neuroprosthesis. The specific goal of this study was to design a controller based on an artificial neural network (ANN) that extracts information from the activity of muscles that remain under voluntary control sufficient to predict appropriate stimulation levels for several paralyzed muscles in the upper extremity. The ANN was trained with activation data obtained from simulations using a musculoskeletal model of the arm that was modified to reflect C5 SCI and FES capabilities. Several arm movements were recorded from able-bodied subjects and these kinematics served as the inputs to inverse dynamic simulations that predicted muscle activation patterns corresponding to the movements recorded. A system identification procedure was used to identify an optimal reduced set of voluntary input muscles from the larger set that are typically under voluntary control in C5 SCI. These voluntary activations were used as the inputs to the ANN and muscles that are typically paralyzed in C5 SCI were the outputs to be predicted. The neural network controller was able to predict the needed FES paralyzed muscle activations from “voluntary” activations with less than a 3.6% RMS prediction error.      

The effect of random modulation of functional electrical stimulation parameters on muscle fatigue.

Muscle contractions induced by functional electrical stimulation (FES) tend to result in rapid muscle fatigue, which greatly limits activities such as FES-assisted standing and walking. It was hypothesized that muscle fatigue caused by FES could be reduced by randomly modulating parameters of the electrical stimulus. Seven paraplegic subjects participated in this study. While subjects were seated, FES was applied to quadriceps and tibialis anterior muscles bilaterally using surface electrodes. The isometric force was measured, and the time for the force to drop by 3 dB (fatigue time) and the normalized force-time integral (FTI) were determined. Four different modes of FES were applied in random order: constant stimulation, randomized frequency (mean 40 Hz), randomized current amplitude, and randomized pulsewidth (mean 250 micros). In randomized trials, stimulation parameters were stochastically modulated every 100 ms in a range of +/-15% using a uniform probability distribution. There was no significant difference between the fatigue time measurements for the four modes of stimulation. There was also no significant difference in the FTI measurements. Therefore, our particular method of stochastic modulation of the stimulation parameters, which involved moderate (15%) variations updated every 100 ms and centered around 40 Hz, appeared to have no effect on muscle fatigue. There was a strong correlation between maximum force measurements and stimulation order, which was not apparent in the fatigue time or FTI measurements. It was concluded that a 10-min rest period between stimulation trials was insufficient to allow full recovery of muscle strength.     

Optimal control of walking with functional electrical stimulation: a computer simulation study.

Bipedal locomotion was simulated to generate a pattern of activating muscles for walking using electrical stimulation in persons with spinal cord injury (SCI) or stroke. The simulation presented in this study starts from a model of the body determined with user-specific parameters, individualized with respect to the lengths, masses, inertia, muscle and joint properties. The trajectory used for simulation was recorded from an able-bodied subject while walking with ankle-foot orthoses. A discrete mathematical model and dynamic programming were used to determine the optimal control. A cost function was selected as the sum of the squares of the tracking errors from the desired trajectories, and the weighted sum of the squares of agonist and antagonist activations of the muscle groups acting around the hip and knee joints. The aim of the simulation was to study plausible trajectories keeping in mind the limitations imposed by the spinal cord injury or stroke (e.g., spasticity, decreased range of movements in some joints, limited strength of paralyzed, externally activated muscles). If the muscles were capable of generating the movements required and the trajectory was achieved, then the simulation provided two kinds of information: 1) timing of the onset and offset of muscle activations with respect to the various gait events and 2) patterns of activation with respect to the maximum activation. These results are important for synthesizing a rule-based controller.     

Nerve cuff recordings of muscle afferent activity from tibial and peroneal nerves in rabbit during passive ankle motion.

Activity from muscle afferents regarding ankle kinesthesia was recorded using cuff electrodes in a rabbit preparation in which tactile input from the foot was eliminated. The purpose was to determine if such activity can provide information useful in controlling functional electrical stimulation (FES) systems that restore mobility in spinal injured man. The rabbit's ankle was passively flexed and extended while the activity of the tibial and peroneal nerves was recorded. Responses to trapezoidal stimulus profiles were investigated for excursions from 10 degrees to 60 degrees using velocities from 5 degrees/s to 30 degrees/s and different initial ankle positions. The recorded signals mainly reflect activity from primary and secondary muscle afferents. Dorsiflexion stretched the ankle extensors and produced velocity dependent activity in the tibial nerve, and this diminished to a tonic level during the stimulus plateau. The peroneal nerve was silent during dorsiflexion, but was activated by stretch of the peroneal muscles during ankle extension. The responses of the two nerves behaved in a reciprocal manner, but exhibited considerable hysteresis, since motion that relaxed the stretch to the driving muscle produced an immediate cessation of the prior stretch induced activity. A noted difference between the tibial and peroneal nerve responses is that the range of joint position change that activated the flexor afferents was greater then for the extensor afferents. Ankle rotation at higher velocities increased the dynamic stretch evoked responses during the stimulus ramp but showed no effect on the tonic activity during the stimulus plateau. Prestretching the muscles by altering the initial position increased the response to the ramp movement, however, for the peroneal nerve, when the prestretch brought the flexor muscles near to their maximal lengths, the response to additional stretch provided by the ramp movement was diminished. The results indicate that the whole nerve recorded muscle afferent activity may be useful for control of FES assisted standing, because it can indicate the direction of rotation of the passively moved ankle joint, along with coarse information regarding the rate of movement and static joint position.     

Musculoskeletal Model-Guided, Customizable Selection of Shoulder and Elbow Muscles for a C5 SCI Neuroprosthesis

Individuals with C5/C6 spinal cord injury (SCI) have a number of paralyzed muscles in their upper extremities that can be electrically activated in a coordinated manner to restore function. The selection of a practical subset of paralyzed muscles for stimulation depends on the specific condition of the individual, the functions targeted for restoration, and surgical considerations. This paper presents a musculoskeletal model-based approach for optimizing the muscle set used for functional electrical stimulation (FES) of the shoulder and elbow in this population. Experimentally recorded kinematics from able-bodied subjects served as inputs to a musculoskeletal model of the shoulder and elbow, which was modified to reflect the reduced muscle force capacities of an individual with C5 SCI but also the potential of using FES to activate paralyzed muscles. A large number of inverse dynamic simulations mimicking typical activities of daily living were performed that included (1) muscles with retained voluntary control and (2) many different combinations of stimulated paralyzed muscles. These results indicate that a muscle set consisting of the serratus anterior, infraspinatus and triceps would enable the greatest range of relevant movements. This set will become the initial target in a C5SCI neuroprosthesis to restore shoulder and elbow function.     

Cycling by means of functional electrical stimulation.

The goal of this paper was the development of an optimized stimulation pattern of leg muscles that would allow paraplegic subjects to perform the movement of pedaling and thereby to drive a tricycle by means of functional electrical stimulation (FES). To obtain maximum average power output with minimum muscle force, the start, duration and amplitude of the stimulation signal applied to the individual muscles had to be optimized depending on the pedaling frequency. For the basic theoretical investigations the rider-tricycle system was modeled as a rigid body system on which the muscle forces are applied as joint moments. The muscles gluteus maximus, rectus femoris, vastii, and hamstrings were stimulated and the passive forces of some other muscles were considered. The modeling and simulation approach was then used to produce maximum power pedaling and steady-state pedaling at 35 rpm. Hamstrings (41.9%) and vastii (35.8%) were the primary contributors to the optimization cost function of maximum power with minimum muscle loading. Based on these theoretical investigations an efficient stimulation pattern could be provided, taking into account the realistic possibilities of today's practical applications.     

Preliminary evaluation of a controlled-brake orthosis for FES-aided gait

A hybrid functional-electrical stimulation (FES) gait system that incorporates a computer-controlled orthosis system has been developed to address the problems of rapid muscle fatigue and poor movement control that are characteristic of FES-aided gait. The orthosis is a long-leg brace that contains controllable friction brakes at both hip and knee joints. The system achieves desirable limb trajectories by utilizing the stimulated muscles as a source of unregulated power and regulating the power at each joint by computer control of the friction brakes. Muscle fatigue is reduced by locking the controllable brakes to provide the isometric joint torques necessary during stance. The hybrid gait system was evaluated and compared to conventional four channel FES-aided gait using four subjects with paraplegia. The results demonstrated significant reduction in muscle fatigue and improvement in trajectory control when using the orthosis combined with FES compared to using FES alone. Results for distance and speed improvements varied across subjects. Considerable work remains in the design of the hardware before the system is feasible for use outside the laboratory.     

Control of the Lower Leg During Walking: A Versatile Model of the Foot

An improved biomechanical model has been implemented for use in gait simulations and functional electrical stimulation (FES). The novelty includes longitudinal bending of the foot which implements geometrical changes that appear “healthy-like” during the stance phase of gait. The simulation uses optimal control which minimizes the activation of flexor and extensor muscles, as well as the tracking error. Correspondingly, the results of the bending foot model, contrasted against a rigid foot biomechanical model, show that torques in the knee during foot contact were as much as 36.9 Nm (46.1%) lower, while muscle excitation was on average 6.1% lower. The simulation also shows that the shank angle of the bending foot model was virtually identical to that of the rigid foot model. However, this model's worth is most prevalent in its use for stance phase control in individuals who use multichannel FES. Notably, it can also be used for simulating the gait of individuals who lack ankle articulation and use an active transfemoral prosthesis.      

A Three-Dimensional Biomechanical Evaluation of Quadriceps and Hamstrings Function Using Electrical Stimulation

Neurological disorders such as stroke impair locomotor control and result in abnormal 3-D gait kinematics. Establishment of effective rehabilitation strategies requires an understanding of how individual muscles contribute to pathological movement. Forward dynamic simulations account for complexities of interjoint coupling and can be used to predict dynamic muscle function. However to date, limited experimental validations of dynamic models have been performed. Our objective was to measure 3-D movement induced by the biceps femoris (BF), rectus femoris (RF), and vastus lateralis (VL) in limb configurations corresponding to the swing phase of gait, and to assess the biomechanical factors that affect dynamic function. Subjects were positioned in a robotic gait orthosis that included a compliant interface. Electrical stimulation was introduced into individual muscles while induced hip and knee joint movements were recorded. Measured hip to knee sagittal plane acceleration ratios were consistent with dynamic musculoskeletal model simulations. However RF and VL induced substantially larger frontal plane hip movements than model-based predictions. Sensitivity analyses on musculoskeletal model parameters revealed that muscle function depends primarily on moment arm assumptions. Though generic musculoskeletal models are suitable for predicting sagittal plane muscle function, improvements in moment arm accuracy are essential for investigation of 3-D pathological gait.     

Isometric torque about the knee joint generated by microstimulation of the cat L6 spinal cord.

Isometric torque was generated about the knee joint by microstimulation of the cat L6 spinal cord using a single microelectrode. The torque responses varied with microstimulation location. Appreciable extension torque was generated by microstimulation in ventrolateral locations of the L6 spinal cord. Stimulation parameters (intensity, frequency and pulse-width) also influenced the extension torque. Specific stimulation parameters (100 microA intensity, 40 Hz frequency and 0.20 ms pulse-width) appear best suited for mapping the spinal cord based on knee joint torque responses. Low levels of cocontraction of the extensor and flexor could be achieved when extension torque was produced, but also varied with the stimulation locations. There are locations in the L6 ventral horn where microstimulation could evoke sustained extension for at least 4 min with only a slight change in torque. This study suggests the possibility of restoring lower limb function in patients with spinal cord injury above the lumbar level.     

Development of an indoor rowing machine with manual FES controller for total body exercise in paraplegia

Concept 2 indoor rowing machine (Concept 2 Inc., USA) was modified for functional electrical stimulation (FES) rowing exercise in paraplegia. A new seating system provides trunk stability and constrains the leg motion to the sagittal plane. A 4-channel electrical stimulator activates the quadriceps and hamstrings in Drive and Recovery phases of the rowing cycle, respectively. Two force-sensing resistors (FSR) on the handle measure the thumb press as the command signal to the electrical stimulator. Optical encoders measure the positions of the seat and handle during rowing. To synchronize the voluntarily controlled upper body movement with the FES controlled leg movement, a novel manual control system was developed. It uses the voluntary thumb presses to control the timing of the stimulation to the paralyzed leg muscles. The manual control system was intuitive and easy to learn and resulted in well-coordinated rowing. Evaluation of the modified rower by paraplegic volunteers showed that it is effective, safe, and affordable exercise alternative for paraplegics.     

Dynamic simulation of FES-cycling: influence of individual parameters

Cycling by means of functional electrical simulation (FES) is an attractive training method for spinal cord injured (SCI) subjects. FES-cycling performance is influenced by a number of parameters like seating position, physiological parameters, conditions of surface stimulation, and pedaling rate. The objective of this paper was the determination of the influence of the most important parameters on optimal muscle stimulation patterns and power output of FES-cycling on a noncircular pedal path. The rider-cycle system was modeled as a planar articulated rigid body linkage on which the muscle forces are applied via joint moments and implemented into a forward dynamic simulation of FES-cycling. For model validation, the generated drive torques that are predicted by the simulation were compared to measurements with an individual paraplegic subject. Then, a sensitivity analysis was carried out to determine the influences of the most important parameters for surface stimulation of gluteus maximus, quadriceps, hamstrings, and peroneus reflex. The results show how optimal stimulation patterns and the expected mean active power output can be estimated based on measured individual parameters and adjusted geometry and stimulation parameters for a particular SCI-subject. This can considerably improve FES-cycling performance and relieve the patients by shortening the time that is necessary for experimental adaptation of the stimulation patterns.