William K. Durfee

Reducing muscle fatigue in FES applications by stimulating with N-let pulse trains

Applications of electrical stimulation for restoration of functional movements such as standing, gait, and grasp have always been hindered by the rapid fatigue of stimulated muscle. This paper describes an experimental investigation of stimulation with N-lets (a set of N closely spaced stimulation pulses) as a means of producing contractions with improved fatigue characteristics. Experiments were conducted on 27 able-bodied and four SCI human subjects using surface stimulation of the quadriceps muscle to produce isometric knee joint torque. Based upon evidence from the literature on muscle fatigue, parameters of the N-let trains for N=1-6 were optimized to produce the most force per pulse. The results demonstrated that: 1) nonlinear summation of the twitch response occurs in human subjects with N-let surface stimulation; 2) for most subjects, doublet stimulation (N=2) with a pulse interval of about 5 ms produced the maximum torque-time integral per pulse of the resulting twitch; and 3) on average, optimal N-let stimulation resulted in a 36% increase in isometric torque tracking when compared to traditional singlet stimulation. The results have immediate implications for alleviating the problem of premature fatigue during functional electrical stimulation.<<ETX>>

Force field effects on cerebellar Purkinje cell discharge with implications for internal models

The cerebellum has been hypothesized to provide internal models for limb movement control. If the cerebellum is the site of an inverse dynamics model, then cerebellar neural activity should signal limb dynamics and be coupled to arm muscle activity. To address this, we recorded from 166 task-related Purkinje cells in two monkeys performing circular manual tracking under varying viscous and elastic loads. Hand forces and arm muscle activity increased with the load, and their spatial tuning differed markedly between the viscous and elastic fields. In contrast, the simple spike firing of 91.0% of the Purkinje cells was not significantly modulated by the force nor was their spatial tuning affected. For the 15 cells with a significant force effect, changes were small and isolated. These results do not support the hypothesis that Purkinje cells represent the output of an inverse dynamics model of the arm. Instead these neurons provide a kinematic representation of arm movements.

Methods for estimating isometric recruitment curves of electrically stimulated muscle

Three methods were tested experimentally in isolated tibialis anterior and medial gastrocnemius muscles of cats. The three methods are steady-state step response, peak impulse response, and deconvolved ramp response. A fourth method, described but not tested, is a stochastic iteration technique. The results demonstrate that estimations of recruitment curves depend on the method used and that all methods are sensitive to short-term and long-term time variations in muscle properties. While the step-response technique is the traditional method for estimating recruitment curves, the ramp-deconvolution method appears to offer acceptable accuracy with much shorter testing times.<<ETX>>

Comparison of Finger Tracking Versus Simple Movement Training via Telerehabilitation to Alter Hand Function and Cortical Reorganization After Stroke

Objective. To compare 2 telerehabilitation training strategies, repetitive tracking movements versus repetitive simple movements, to promote brain reorganization and recovery of hand function. Methods. Twenty subjects with chronic stroke and 10 degrees of voluntary finger extension were randomly assigned to receive 1800 telerehabilitation trials over 2 weeks of either computerized tracking training (track group) with the affected finger and wrist involving temporospatial processing to achieve accuracy or movement training (move group) with no attention to accuracy. Following movement training, the move group crossed over to receive an additional 2 weeks of tracking training. Behavioral changes were measured with the Box and Block test, Jebsen Taylor test, and finger range of motion, along with a finger-tracking activation paradigm during fMRI. Results. The track group showed significant improvement in all 4 behavioral tests; the move group improved in the Box and Block and Jebsen Taylor tests. The improvement for the track group in the Box and Block and Jebsen Taylor tests did not surpass that for the move group. A consistent group pattern of brain reorganization was not evident. The move group, after crossing over, did not show further significant improvements. Conclusion . Telerehabilitation may be effective in improving performance in subjects with chronic stroke. Tracking training with reinforcement to enhance learning, however, did not produce a clear advantage over the same amount of practice of random movements. Two weeks of training may be insufficient to demonstrate a behavioral advantage and associated brain reorganization.

A portable powered ankle-foot orthosis for rehabilitation

Innovative technological advancements in the field of orthotics, such as portable powered orthotic systems, could create new treatment modalities to improve the functional out come of rehabilitation. In this article, we present a novel portable powered ankle-foot orthosis (PPAFO) to provide untethered assistance during gait. The PPAFO provides both plantar flexor and dorsiflexor torque assistance by way of a bidirectional pneumatic rotary actuator. The system uses a portable pneumatic power source (compressed carbon dioxide bottle) and embedded electronics to control the actuation of the foot. We collected pilot experimental data from one impaired and three nondisabled subjects to demonstrate design functionality. The impaired subject had bilateral impairment of the lower legs due to cauda equina syndrome. We found that data from nondisabled walkers demonstrated the PPAFOs capability to provide correctly timed plantar flexor and dorsiflexor assistance during gait. Reduced activation of the tibialis anterior during stance and swing was also seen during assisted nondisabled walking trials. An increase in the vertical ground reaction force during the second half of stance was present during assisted trials for the impaired subject. Data from nondisabled walkers demonstrated functionality, and data from an impaired walker demonstrated the ability to provide functional plantar flexor assistance.

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.

Design of a controlled-brake orthosis for FES-aided gait

Functional electrical stimulation (FES) is a means of restoring gait to individuals with spinal cord injury, but the performance of most FES-aided gait systems is hampered by the rapid muscle fatigue which results from stimulated muscle contraction and the inadequate control of joint torques necessary to produce desired limb trajectories. The controlled-brake orthosis (CBO) addresses these limitations by utilizing FES in combination with a long-leg brace that contains controllable friction brakes at the knees and hips. A laboratory version of the CBO utilizing computer-controlled magnetic particle brakes at the joints was designed and constructed, and preliminary results with a single spinal cord injury (SCI) subject have demonstrated reduced fatigue and more repeatable gait trajectories when compared to FES-aided gait without the brace. Significant work remains to demonstrate the efficacy of the concept across a wide range of SCI subjects and to design a system which meets appropriate user requirements of size, weight, cosmesis, ease of use and cost. The primary purpose of the paper is to detail the design of the CBO.

Open-loop position control of the knee joint using electrical stimulation of the quadriceps and hamstrings

The clinical acceptability of functional electrical stimulation (FES) as an aid for restoration of paraplegic gait is limited by the inability to accurately and repeatedly position the lower extremity. To gain insight into the causes of and possible solutions to this problem, the responses of the quadriceps and hamstrings to FES were studied in able-bodied subjects. Isometric torque was dependent on knee angle and changed unpredictably with time. An open-loop feedforward knee-joint position controller was also tested. The results demonstrated that it is beneficial to account for the dependence of torque on position, that modifications to this openloop controller might improve accuracy and that closed-loop control may be essential for functional restoration of gait.

Surface EMG as a Fatigue Indicator During FES-induced Isometric Muscle Contractions

The electromyogram (EMG) signal has potential as an indicator of stimulated muscle fatigue in applications of functional electrical stimulation (FES). In particular, it could be used to detect near lower limb collapse due to the associated muscle fatigue in FES-aided standing systems and thereby prevent falling. Surface EMG measurement, however, is hampered by stimulation artifact during FES. Modified surface stimulation and EMG detection equipment were designed and built to minimize this artifact and to permit detection of the electrical signal generated by the muscle during contraction. Artifact reduction techniques included shorting stimulator output leads between stimulus pulses and limiting and blanking slew rate in the EMG processing stage. Isometric fatigue experiments were performed by stimulating the quadriceps muscle of 20 able-bodied (a total of 125 trials) and three spinal cord injured (18 trials) subjects. Fatigue-tracking performance indicators were derived from the root-mean-square (RMS) of the EMG amplitude and from the median frequency (MF) of the EMG power spectral content. The results demonstrate that reliable fatigue tracking indicators for practical FES applications will be difficult to obtain, but that amplitude-based measures in spinal cord injured subjects show promise.

Technologies for Powered Ankle-Foot Orthotic Systems: Possibilities and Challenges

Ankle-foot orthoses (AFOs) can be used to ameliorate the impact of impairments to the lower limb neuromuscular motor system that affect gait. Existing AFO technologies include passive devices with fixed and articulated joints, semiactive devices that modulate damping at the joint, and active devices that make use of a variety of technologies to produce power to move the foot. Emerging technologies provide a vision for fully powered, untethered AFOs. However, the stringent design requirements of light weight, small size, high efficiency, and low noise present significant engineering challenges before such devices will be realized. Once such devices appear, they will present new opportunities for clinical treatment of gait abnormalities.