Alakananda Banerjee

Point-of-care-testing of standing posture with Wii balance board and microsoft kinect during transcranial direct current stimulation: A feasibility study

BACKGROUND Non-invasive brain stimulation (NIBS) is a promising tool for facilitating motor function. NIBS therapy in conjunction with training using postural feedback may facilitate physical rehabilitation following posture disorders (e.g., Pusher Syndrome). OBJECTIVES The objectives of this study were, 1) to develop a low-cost point-of-care-testing (POCT) system for standing posture, 2) to investigate the effects of anodal tDCS on functional reach tasks using the POCT system. METHODS Ten community-dwelling elderly (age >50 years) subjects evaluated the POCT system for standing posture during functional reach tasks where their balance score on Berg Balance Scale was compared with that from Center-of-Mass (CoM) - Center-of-Pressure (CoP) posturography. Then, in a single-blind, sham-controlled study, five healthy right-leg dominant subjects (age: 26.4 ± 5.3 yrs) were evaluated using the POCT system under two conditions - with anodal tDCS of primary motor representations of right tibialis anterior muscle and with sham tDCS. RESULTS The maximum CoP-CoM lean-angle was found to be well correlated with the BBS score in the elderly subjects The anodal tDCS strongly (p = 0.0000) affected the maximum CoP excursions but not the return reaction time in healthy. CONCLUSION It was concluded that the CoM-CoP lean-line could be used for posture feedback and monitoring during tDCS therapy in conjunction with balance training exercises.

Nonlinear analysis of electromyogram following gait training with myoelectrically triggered neuromuscular electrical stimulation in stroke survivors

Neuromuscular electrical stimulation (NMES) facilitates ambulatory function after paralysis by activating the muscles of the lower extremities. The NMES-assisted stepping can either be triggered by a heel-switch (switch-trigger), or by an electromyogram (EMG)-based gait event detector (EMG-trigger). The command sources—switch-trigger or EMG-trigger—were presented to each group of six chronic (>6 months post-stroke) hemiplegic stroke survivors. The switch-trigger group underwent transcutaneous NMES-assisted gait training for 1 h, five times a week for 2 weeks, where the stimulation of the tibialis anterior muscle of the paretic limb was triggered with a heel-switch detecting heel-rise of the same limb. The EMG-trigger group underwent transcutaneous NMES-assisted gait training of the same duration and frequency where the stimulation was triggered with surface EMG from medial gastrocnemius (MG) of the paretic limb in conjunction with a heel-switch detecting heel-rise of the same limb. During the baseline and post-intervention surface EMG assessment, a total of 10 s of surface EMG was recorded from bilateral MG muscle while the subjects tried to stand steady on their toes. A nonlinear tool—recurrence quantification analysis (RQA)—was used to analyze the surface EMG. The objective of this study was to find the effect of NMES-assisted gait training with switch-trigger or EMG-trigger on two RQA parameters—the percentage of recurrence (%Rec) and determinism (%Det), which were extracted from surface EMG during fatiguing contractions of the paretic muscle. The experimental results showed that during fatiguing contractions, (1) %Rec and %Det have a higher initial value for paretic muscle than the non-paretic muscle, (2) the rate of change in %Rec and %Det was negative for the paretic muscle but positive for the non-paretic muscle, (3) the rate of change in %Rec and %Det significantly increased from baseline for the paretic muscle after EMG-triggered NMES-assisted gait training. Therefore, the study showed an improvement in paretic muscle function during a fatiguing task following gait training with EMG-triggered NMES. This study also showed that RQA parameters—%Rec and %Det—were sensitive to changes in paretic/non-paretic muscle properties due to gait training and can be used for non-invasive muscle monitoring in stroke survivors undergoing rehabilitation.

A Low-Cost Point-of-Care Testing System for Psychomotor Symptoms of Depression Affecting Standing Balance: A Preliminary Study in India

The World Health Organization estimated that major depression is the fourth most significant cause of disability worldwide for people aged 65 and older, where depressed older adults reported decreased independence, poor health, poor quality of life, functional decline, disability, and increased chronic medical problems. Therefore, the objectives of this study were (1) to develop a low-cost point-of-care testing system for psychomotor symptoms of depression and (2) to evaluate the system in community dwelling elderly in India. The preliminary results from the cross-sectional study showed a significant negative linear correlation between balance and depression. Here, monitoring quantitative electroencephalography along with the center of pressure for cued response time during functional reach tasks may provide insights into the psychomotor symptoms of depression where average slope of the Theta-Alpha power ratio versus average slope of baseline-normalized response time may be a candidate biomarker, which remains to be evaluated in our future clinical studies. Once validated, the biomarker can be used for monitoring the outcome of a comprehensive therapy program in conjunction with pharmacological interventions. Furthermore, the frequency of falls can be monitored with a mobile phone-based application where the propensity of falls during the periods of psychomotor symptoms of depression can be investigated further.

Substrate integrated Lead-Carbon hybrid ultracapacitor with flooded, absorbent glass mat and silica-gel electrolyte configurations

AbstractLead-Carbon hybrid ultracapacitors (Pb-C HUCs) with flooded, absorbent-glass-mat (AGM) and silica-gel sulphuric acid electrolyte configurations are developed and performance tested. Pb-C HUCs comprise substrate-integrated PbO2 (SI-PbO2) as positive electrodes and high surface-area carbon with graphite-sheet substrate as negative electrodes. The electrode and silica-gel electrolyte materials are characterized by XRD, XPS, SEM, TEM, Rheometry, BET surface area, and FTIR spectroscopy in conjunction with electrochemistry. Electrochemical performance of SI-PbO2 and carbon electrodes is studied using cyclic voltammetry with constant-current charge and discharge techniques by assembling symmetric electrical-double-layer capacitors and hybrid Pb-C HUCs with a dynamic Pb(porous)/PbSO4 reference electrode. The specific capacitance values for 2 V Pb-C HUCs are found to be 166 F/g, 102 F/g and 152 F/g with a faradaic efficiency of 98%, 92% and 88% for flooded, AGM and gel configurations, respectively. Graphical AbstractSubstrate-integrated Lead–Carbon hybrid ultracapacitors are fabricated with varying electrolyte configurations, namely flooded, absorbent-glass-mat (AGM) and silica gel, and their performance tested. A cause and effect analysis of the various physical and electrical parameters pertaining to the aforesaid Lead-Carbon hybrid ultracapacitors is presented.

Feasibility of Functional Electrical Stimulation-Assisted Neurorehabilitation following Stroke in India: A Case Series

Functional Electrical Stimulation (FES) facilitates ambulatory function after paralysis by electrically activating the muscles of the lower extremities. The Odstock Dropped Foot Stimulator (ODFS, Odstock, UK) called ODFS Pace, was used for heel-switch triggered FES-assisted walking. The ODFS is recommended as an intervention for neurologically impaired gait in the Royal College of Physicians (UK) Clinical Guidelines on Stroke. Based on the guidelines by the National Institute of Clinical Excellence (NICE, UK), we started first clinical study in India on ODFS Pace as an orthotic intervention for daily use. In this preliminary study, we also investigated improvement in volitional walking following 6 sessions (3 times per week, for 2 weeks) of 30 minutes of FES-assisted treadmill walking on 7 chronic (>6 months after stroke) stroke survivors. We found that short-duration, moderately intensive FES-assisted gait therapy improved volitional gait in 3 out of 7 stroke survivors suffering from foot drop. Even in absence of improvement in volitional walking, there were no adverse effects and the subjects found heel-switch triggered FES-assisted walking mostly “easy” (6 out of 7). Therefore FES is promising as an orthotic intervention for daily use; however, tailoring the intensity and/or frequency based on patients ability may make it viable as a therapeutic intervention.

A Low-Cost Biofeedback System for Electromyogram-Triggered Functional Electrical Stimulation Therapy: An Indo-German Feasibility Study

Functional electrical stimulation (FES) facilitates ambulatory function after paralysis by activating the muscles of the lower extremities. The FES-assisted stepping can either be triggered by a heel-swich, or by an electromyogram-(EMG-) based gait event detector. A group of six chronic (>6 months poststroke) hemiplegic stroke survivors underwent transcutaneous FES-assisted training for 1 hour on stepping task with EMG biofeedback from paretic tibialis anterior (TA) and medial gastrocnemius (GM) muscles, where the stimulation of the paretic TA or GM was triggered with surface EMG from the same muscle. During the baseline, postintervention, and 2-day-postintervention assessments, a total of 5 minutes of surface EMG was recorded from paretic GM and TA muscles during volitional treadmill walking. Two-way ANOVA showed significant effects in terms of values for the 6 stroke subjects, 0.002, the 3 assessments, 0, and the interaction between subjects and assessments, . The study showed a significant improvement from baseline in paretic GM and TA muscles coordination during volitional treadmill walking. Moreover, it was found that the EMG-triggered FES-assisted therapy for stand-to-walk transition helped in convergence of the deviation in centroidal angular momentum from the normative value to a quasi-steady state during the double-support phase of the nonparetic. Also, the observational gait analysis showed improvement in ankle plantarflexion during late stance, knee flexion, and ground clearance of the foot during swing phase of the gait.

Strong absorption model for scattering of neutrons

The strong absorption model of Frahn and Venter has been used in analysing the angular distributions of about 14-MeV neutrons elastically scattered from a number of nuclei between Be and Pb over a wide range of scattering angles. From the best-fit parameters of the model the interaction radius and surface diffuseness were obtained. The parameter values were also used to analyse the inelastic scattering data leading to the quadrupole excitation of some even-even nuclei and the deformation parameter β2 was extracted in each case and compared with that from the DWBA analysis.

Influence of binder solvent on carbon-layer structure in electrical-double-layer capacitors

AbstractGraphical AbstractDielectric constant, viscosity and boiling point of binder solvent effect pore-size distribution and microstructure of carbon layer for electrodes in the electrochemical capacitor and influence its performance since carbon layer acts as electro-osmotic pump facilitating acid diffusion in electrical double-layer at high rates of charge and discharge. Porous activated-carbons with a large surface-area have been the most common materials for electrical-double-layer capacitors (EDLCs). These carbons having a wide pore distribution ranges from micropores to macropores in conjunction with a random pore connection that facilitates the high specific-capacitance values. Pore distribution plays a central role in controlling the capacitance value of EDLCs, since electrolyte distribution inside the active material mainly depends on the pore distribution. This has a direct influence on the distribution of resistance and capacitance values within the electrode. As a result, preparation of electrodes remains a vital issue in realising high-performance EDLCs. Generally, carbon materials along with some binders are dispersed into a solvent and coated onto the current collectors. This study examines the role of binder solvents used for the carbon-ink preparation on the microstructure of the electrodes and the consequent performance of the EDLCs. It is observed that the physical properties of the binder solvent namely its dielectric constant, viscosity and boiling point have important role in determining the pore-size distribution as well as the microstructure of electrodes which influence their specific capacitance values.

Recovery of Dysphagia in Lateral Medullary Stroke

Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.

Facilitating Myoelectric-Control with Transcranial Direct Current Stimulation

Neuromuscular Electrical Stimulation (NMES) can electrically activate paretic muscles of the lower extremities to assist walking following stroke. Here the electrical stimulation can be modulated, and controlled by residual muscle activity of the patients recorded by electromyogram (EMG) from the paretic muscles. However such direct EMG control of stimulation envelope assumes normative EMG patterns during walking. Unfortunately the muscle activity in the hemiparetic lower limb often suffers from delays in initiation and termination during walking. Thus patients have to learn movement-related muscle contraction for fine-tuning of NMES. The objective of this study in 10 healthy volunteers was to investigate the effect of an intervention at the central nervous system level - anodal transcranial direct current stimulation (tDCS) of primary motor cortex (M1) and cerebellar cortex - on delays in initiation and termination of isometric tibialis anterior (TA) contraction following audible prompt. The results suggested that, 1. Cerebellar anodal tDCS increased the delay in initiation of TA contraction while M1 anodal tDCS decreased the same when compared to sham tDCS, 2. Cerebellar anodal tDCS decreased the delay in termination of TA contraction while M1 anodal tDCS increased the same when compared to Sham. These preliminary results from healthy subjects may have significant clinical implications on EMG-controlled NMES-assisted gait therapy, however controlled interventional trials are needed to elucidate the optimal therapy protocol in stroke survivors.