Motion control of musculoskeletal systems with redundancy

Motion control of musculoskeletal systems for functional electrical stimulation (FES) is a challenging problem due to the inherent complexity of the systems. These include being highly nonlinear, strongly coupled, time-varying, time-delayed, and redundant. The redundancy in particular makes it difficult to find an inverse model of the system for control purposes. We have developed a control system for multiple input multiple output (MIMO) redundant musculoskeletal systems with little prior information. The proposed method separates the steady-state properties from the dynamic properties. The dynamic control uses a steady-state inverse model and is implemented with both a PID controller for disturbance rejection and an artificial neural network (ANN) feedforward controller for fast trajectory tracking. A mechanism to control the sum of the muscle excitation levels is also included. To test the performance of the proposed control system, a two degree of freedom ankle–subtalar joint model with eight muscles was used. The simulation results show that separation of steady-state and dynamic control allow small output tracking errors for different reference trajectories such as pseudo-step, sinusoidal and filtered random signals. The proposed control method also demonstrated robustness against system parameter and controller parameter variations. A possible application of this control algorithm is FES control using multiple contact cuff electrodes where mathematical modeling is not feasible and the redundancy makes the control of dynamic movement difficult.     

Hybrid FES orthosis incorporating closed loop control and sensory feedback

A hybrid functional electrical stimulation (FES) orthosis is described, comprising a rigid ankle-foot brace, a multi-channel FES stimulator with surface electrodes, body mounted sensors, a ‘rule-based’ controller and an electro-cutaneous display for supplementary sensory feedback. The mechanical brace provides stability, without FES activation of muscles, for standing postures normally adopted by patients. This avoids inducing muscle fatigue during prolonged upright activity. However, stability is conditional upon the position of the ground reaction vector (GRV) relative to the knee joint. The finite state FES controller reacts automatically to destabilizing shifts of the GRV by stimulating appropriate anti-gravity musculature to brace the leg. The FES system also features a control mode to initiate and terminate flexion of the leg during forward progression. A simple mode of supplementary sensory feedback was used during the laboratory standing tests to assist the patient in maintaining a set posture. Preliminary results of laboratory tests for two spinal cord injured subjects are presented.     

Current topics in clinical FES in Japan

This paper reviews recent topics of clinical application of functional electrical stimulation (FES) for the paralyzed extremities in Japan. Transcutaneous and percutaneous FES systems have been clinically used in Japan. Candidates of extremity FES arer mostly stroke and spinal cord injury patients. By using percutaneous FES system, all of the joints of the upper extremity including the shoulder have been controlled for activities of daily living in the hemiplegic patient. Simultaneous FES control of the hand and wrist and the bilateral hands have also been achieved in C5 and C6 quadriplegics, respectively. Hybrid FES systems using percutaneous and surface electrodes, where FES is used in combination with orthoses, have been applied to the paraplegics because they are highly practical for assisting their locomotive activities. Percutaneous FES have been also provided the amyotropic lateral sclerosis patients with standing up motion. A total implant FES system with 16 output channels is currently developing as a next generation FES system.     

A biomechanical model to estimate corrective changes in muscle activation patterns for stroke patients

We have created a model to estimate the corrective changes in muscle activation patterns needed for a person who has had a stroke to walk with an improved gait-nearing that of an unimpaired person. Using this model, we examined how different functional electrical stimulation (FES) protocols would alter gait patterns. The approach is based on an electromyographically (EMG)-driven model to estimate joint moments. Different stimulation protocols were examined, which generated different corrective muscle activation patterns. These approaches grouped the muscles together into flexor and extensor groups (to simulate FES using surface electrodes) or left each muscle to vary independently (to simulate FES using intramuscular electrodes). In addition, we limited the maximal change in muscle activation (to reduce fatigue). We observed that with the two protocols (grouped and ungrouped muscles), the calculated corrective changes in muscle activation yielded improved joint moments nearly matching those of unimpaired subjects. The protocols yielded different muscle activation patterns, which could be selected based on practical condition. These calculated corrective muscle activation changes can be used in studying FES protocols, to determine the feasibility of gait retraining with FES for a given subject and to determine which protocols are most reasonable.     

Stabilization of human standing posture using functional neuromuscular stimulation

Functional neuromuscular stimulation (FNS)/functional electrical stimulation (FES) is a potential way to restore some functionality to the limbs of patients with spinal cord injury through direct/indirect stimulation of the motoneuron. One of the constraints for wider use of FNS on paraplegic patients is the lack of efficient control algorithm. Most of the published works on FNS/FES control are based on oversimplified models of human body dynamics. An innovative control strategy for stabilizing the standing posture of paraplegic patients is proposed here which is a combination of a proportional-plus-derivative controller for motions of the skeletal system and a control action prediction mechanism to produce musculotendon activation. The goal is to produce musculotendon torque which can approximate those demanded by the controller for the skeletal system. In computer simulations, using a detailed skeletal–musculotendon–muscle activation dynamics model of human body, this FNS/FES control approach can stabilize a paraplegic patient's standing posture with the minimum number of musculotendon groups. Also, it is found that this control strategy can maintain stability even in the presence of reasonable variations in the controller's musculotendon parameters.     

EMG monitoring in functional electrostimulation]

When using functional electrical stimulation (FES), correct adjustment of stimulation parameters, and monitoring of the stimulated muscle is mandatory if tissue damage is to be avoided. Although several FES systems are already in regular use, a method for direct muscle monitoring is still lacking. This paper investigates the suitability of the electromyogram (EMG) for such a purpose. In six sheep, the right latissimus dorsi muscle (LDM) and the associated thoracodorsal nerve were exposed. Stimulation was effected via electrodes placed on the nerve. Three electrodes were placed in the LDM for EMG recording, and the tendon was connected to a force transducer for isometric force measurement. Stimulation was applied for one second (burst), followed by a three-second pause. The stimulation current was increased in 0.2 mA steps, starting at 0 mA and ending at 4 mA. Throughout the investigation, the EMG signal was monitored with an oscilloscope. In addition, the EMG signal and the force transducer signal were recorded for subsequent analysis. An analysis of the data of all six sheep revealed an almost linear relationship between muscle force and m-wave amplitude (magnitude of r = 0.95, p < 0.001). M-wave monitoring during EMG recording with three intramuscular electrodes is a reliable method of monitoring FES-induced muscle activity, but the absolute force cannot be measured.     

A musculoskeletal model of the upper extremity for use in the development of neuroprosthetic systems

Upper extremity neuroprostheses use functional electrical stimulation (FES) to restore arm motor function to individuals with cervical level spinal cord injury. For the design and testing of these systems, a biomechanical model of the shoulder and elbow has been developed, to be used as a substitute for the human arm. It can be used to design and evaluate specific implementations of FES systems, as well as FES controllers. The model can be customized to simulate a variety of pathological conditions. For example, by adjusting the maximum force the muscles can produce, the model can be used to simulate an individual with tetraplegia and to explore the effects of FES of different muscle sets. The model comprises six bones, five joints, nine degrees of freedom, and 29 shoulder and arm muscles. It was developed using commercial, graphics-based modeling and simulation packages that are easily accessible to other researchers and can be readily interfaced to other analysis packages. It can be used for both forward-dynamic (inputs: muscle activation and external load; outputs: motions) and inverse-dynamic (inputs: motions and external load; outputs: muscle activation) simulations. Our model was verified by comparing the model calculated muscle activations to electromyographic signals recorded from shoulder and arm muscles of five subjects. As an example of its application to neuroprosthesis design, the model was used to demonstrate the importance of rotator cuff muscle stimulation when aiming to restore humeral elevation. It is concluded that this model is a useful tool in the development and implementation of upper extremity neuroprosthetic systems.     

A musculo-skeletal model of rat ankle motion and its experimental test on rat

A biomechanical musculo-skeletal model of functional electrical stimulation (FES)-induced rat ankle motion was implemented and tested in rat experiments. The muscle model is a new Hill-based model which includes established physiological relations of force-velocity and force-length-frequency. However, the series-elastic component and the activation component of previous Hill-based models are replaced by a new component which accounts for dynamic time delays and recruitment that occur in real muscle force generation during limb movements. The skeletal model includes gravity and dynamic forces that occur in real rat ankle motions. In computer simulations, various FES patterns were applied to the tibialis anterior (TA) and soleus (SO) model muscles to produce walk-like ankle motions. In lab experiments, the same stimulation patterns were applied by epimysial electrodes implanted in the TA and SO muscles of live rats cordotomized at level T7. The resulting rat motions were recorded by video camera. Video data was converted to ankle angle-vs-time files for comparison with corresponding model angle-vs-time files. Over a physiologically significant range of ankle motions, model parameters were adjustable to yield model motions that agreed with rat motions to within 2 degrees (root mean square differences of rat and model ankle angles). This is shown in plots of model and rat motions presented here for representative cases of FES. The accuracy of our model in reproducing real ankle motions supports the hypothesis that our new muscle model generates correct muscle forces over a useful range of limb motions. It suggests that the model may be useful in the design of FES neural prostheses.     

Observer-based tracking control of abnormal oscillations in demyelination symptom

Fast axonal conduction of action potentials in mammals relies on myelin insulation. Demyelination can cause slowed, blocked, desynchronized, or paradoxically excessive spiking that underlies the symptoms observed in demyelination diseases. Feedback control via functional electrical stimulation (FES) seems to be a promising treatment modality in such diseases. However, there are challenges to implementing such method for neurons: high nonlinearity, biological tissue constrains and unobservable ion channel states. To address this problem, we propose an estimating and tracking control strategy for systems based on Kalman filter, in order to enhance the action potential propagation reliability of demyelinated neuron via FES. Unscented Kalman filter (UKF) is employed to estimate the unobservable states and parameters in the demyelination neuron model from membrane potential dynamics. Our method could promote the design of new closed-loop electrical stimulation systems for patients suffering from different nerve system dysfunctions.     

Attempts to optimise functional electrical stimulation of antagonistic muscles by mathematical modelling

The mathematical relationship between the kinetic data of joint motion and the functional electrical stimulation (FES) voltage of the corresponding antagonistic pair of muscles is given on the basis of a dynamic ankle joint model. The mathematical model is solved with the aid of state variables, while the resulting electrical stimulation voltage is found as a solution of the Volterra integral equation. The calculated stimulation voltage was applied to the plantar and dorsiflexors of the ankle joint of a hemiplegic patient. The measured ground reaction forces and goniograms during walking with and without electrical stimulation showed a significant improvement of the patient's gait. The problems of low saturation muscle force during FES, the need for individual determination of model parameters, nonlinearities of the system and the variability of gait are discussed.     

Deafferentation of the urinary bladder and implantation of a sacral anterior root stimulator (SARS) for treatment of the neurogenic bladder in paraplegic patients.

Since 25 years electrical stimulation has become an established and widely acknowledged therapy option. Today, FES is widely employed, e.g. for cardiostimulation, diaphragm stimulation, kinetotherapy, for treatment of tremor in Parkinson patients, and finally for bladder stimulation in patients with bladder voiding dysfunctions. Brindley was the first researcher who succeeded in stimulating the spinal nerves via implanted electrodes in an animal model. In the years 1978/79 Brindley implanted five paraplegic patients with so-called sacral anterior root stimulators; all of them were able to void under stimulation. This method of sacral anterior root stimulation (SARS) proved an alternative to frequent one-way catheterisation for patients with severe voiding dysfunctions, without achieving complete continence, however. The following study is to provide an overview over the latest insights in the context of implanting sacral anterior root stimulators; it discusses the preconditions required for such interventions and presents criteria to decide in which cases there is a contraindication for sacral deafferentation of the posterior roots. Moreover, it contrasts advantages and disadvantages of the intradural and extradural implantation methods and presents the currently available long-term follow-up results with SDAF and SARS for treatment of bladder voiding dysfunctions.     

Effects of stimulation frequency versus pulse duration modulation on muscle fatigue.

During functional electrical stimulation (FES), both the frequency and intensity can be increased to increase muscle force output and counteract the effects of muscle fatigue. Most current FES systems, however, deliver a constant frequency and only vary the stimulation intensity to control muscle force. This study compared muscle performance and fatigue produced during repetitive electrical stimulation using three different strategies: (1) constant pulse-duration and stepwise increases in frequency (frequency-modulation); (2) constant frequency and stepwise increases in pulse-duration (pulse-duration-modulation); and (3) constant frequency and pulse-duration (no-modulation). Surface electrical stimulation was delivered to the quadriceps femoris muscles of 12 healthy individuals and isometric forces were recorded. Muscle performance was assessed by measuring the percent changes in the peak forces and force-time integrals between the first and the last fatiguing trains. Muscle fatigue was assessed by measuring percent declines in peak force between the 60Hz pre- and post-fatigue testing trains. The results showed that frequency-modulation showed better performance for both peak forces and force-time integrals in response to the fatiguing trains than pulse-duration-modulation, while producing similar levels of muscle fatigue. Although frequency-modulation is not commonly used during FES, clinicians should consider this strategy to improve muscle performance.     

Involuntary,Forced and Voluntary Exercises Equally Attenuate Neurocognitive Deficits in Vascular Dementia by the BDNF–pCREB Mediated Pathway

Neurochemical Research - A rat model of vascular dementia was used to compare the effects of involuntary exercise induced by functional electrical stimulation (FES), forced exercise and voluntary...     

Control of functional electrical stimulation with extended physiological proprioception

The use of functional electrical stimulation (FES) of muscle for paraplegic locomotion, or grasp augmentation in tetraplegia, is limited by the variability in muscle response to stimulation as a result of several external and internal factors. Previous approaches to this problem have used position-servo controllers, which have been shown to function satisfactorily in the laboratory. However, such systems will fail should obstacles be encountered or should the stimulation hardware develop a fault. To prevent such potentially dangerous failures some form of sensory feedback is required. This paper describes the first application of a technique known as extended physiological proprioception (EPP) to the control of FES to compensate for muscle response variability and provide proprioceptive feedback via the appropriate sensory pathways. In the experimental system described, a paraplegic subject controlled the extension of his paralysed knee by shoulder protraction. A Bowden cable linked the two joints, and a dynamometer in this cable was used to derive the control signal for a computer-controlled stimulator which delivered surface stimulation to the quadriceps muscle group. Modelling and parameter identification were performed by analysis of the step response, and the controller was designed from consideration of the root locus. The advantages of the system, in terms of improved proprioceptive feedback and reduced limb-positioning error were assessed in a test of joint positioning accuracy with vision occluded. The EPP system showed improvements over both open and closed-loop position-servo controllers.     

Modeling biological motor control for human locomotion with functional electrical stimulation

This paper develops a novel control system for functional electrical stimulation (FES) locomotion, which aims to generate normal locomotion for paraplegics via FES. It explores the possibility of applying ideas from biology to engineering. The neural control mechanism of the biological motor system, the central pattern generator, has been adopted in the control system design. Some artificial control techniques such as neural network control, fuzzy logic, control and impedance control are incorporated to refine the control performance. Several types of sensory feedback are integrated to endow this control system with an adaptive ability. A musculoskeletal model with 7 segments and 18 muscles is constructed for the simulation study. Satisfactory simulation results are achieved under this FES control system, which indicates a promising technique for the potential application of FES locomotion in future.     

Functional electrical stimulation of intrinsic laryngeal muscles under varying loads in exercising horses

Bilateral vocal fold paralysis (BVCP) is a life threatening condition and appears to be a good candidate for therapy using functional electrical stimulation (FES). Developing a working FES system has been technically difficult due to the inaccessible location and small size of the sole arytenoid abductor, the posterior cricoarytenoid (PCA) muscle. A naturally-occurring disease in horses shares many functional and etiological features with BVCP. In this study, the feasibility of FES for equine vocal fold paralysis was explored by testing arytenoid abduction evoked by electrical stimulation of the PCA muscle. Rheobase and chronaxie were determined for innervated PCA muscle. We then tested the hypothesis that direct muscle stimulation can maintain airway patency during strenuous exercise in horses with induced transient conduction block of the laryngeal motor nerve. Six adult horses were instrumented with a single bipolar intra-muscular electrode in the left PCA muscle. Rheobase and chronaxie were within the normal range for innervated muscle at 0.55±0.38 v and 0.38±0.19 ms respectively. Intramuscular stimulation of the PCA muscle significantly improved arytenoid abduction at all levels of exercise intensity and there was no significant difference between the level of abduction achieved with stimulation and control values under moderate loads. The equine larynx may provide a useful model for the study of bilateral fold paralysis.     

Design and simulation of a pneumatic, stored-energy, hybrid orthosis for gait restoration

Loss of mobility due to lower limb paralysis is a common result of thoracic level spinal cord injury. Functional electrical stimulation (FES) can restore primitive gait in the vicinity of a wheelchair by using electrical stimulation to generate muscle contractions. A new concept for FES-assisted gait is presented that combines electrical stimulation with an orthosis that contains a fluid power system to store and transfer energy during the gait cycle. The energy storage orthosis (ESO) can be driven through a complete gait cycle using only stimulation of the quadriceps muscles. The conceptual design of the ESO was completed and implemented in a dynamic simulation model and in a benchtop prototype for engineering measurements. No studies were conducted with human subjects. The results demonstrate the potential of the ESO concept for a feasible gait-assist system and the validity of the simulation model as a means for designing the system.     

Fatigue compensation during FES using surface EMG

Muscle fatigue limits the effectiveness of FES when applied to regain functional movements in spinal cord injured (SCI) individuals. The stimulation intensity must be manually increased to provide more force output to compensate for the decreasing muscle force due to fatigue. An artificial neural network (ANN) system was designed to compensate for muscle fatigue during functional electrical stimulation (FES) by maintaining a constant joint angle. Surface electromyography signals (EMG) from electrically stimulated muscles were used to determine when to increase the stimulation intensity when the muscle’s output started to drop.

In two separate experiments on able-bodied subjects seated in hard back chairs, electrical stimulation was continuously applied to fatigue either the biceps (during elbow flexion) or the quadriceps muscle (during leg extension) while recording the surface EMG. An ANN system was created using processed surface EMG as the input, and a discrete fatigue compensation control signal, indicating when to increase the stimulation current, as the output. In order to provide training examples and test the systems’ performance, the stimulation current amplitude was manually increased to maintain constant joint angles. Manual stimulation amplitude increases were required upon observing a significant decrease in the joint angle. The goal of the ANN system was to generate fatigue compensation control signals in an attempt to maintain a constant joint angle.

On average, the systems could correctly predict 78.5% of the instances at which a stimulation increase was required to maintain the joint angle. The performance of these ANN systems demonstrates the feasibility of using surface EMG feedback in an FES control system.     

Activation of human quadriceps femoris muscle during dynamic contractions: effects of load on fatigue.

Muscle fatigue is both multifactorial and task dependent. Electrical stimulation may assist individuals with paralysis to perform functional activities [functional electrical stimulation (FES), e.g., standing or walking], but muscle fatigue is a limiting factor. One method of optimizing force is to use stimulation patterns that exploit the catchlike property of skeletal muscle [catchlike-inducing trains (CITs)]. Although nonisometric (dynamic) contractions are important parts of both normal physiological activation of skeletal muscles and FES, no previous studies have attempted to identify the effect that the load being lifted by a muscle has on the fatigue produced. This study examined the effects of load on fatigue during dynamic contractions and the augmentation produced by CITs as a function of load. Knee extension in healthy subjects was electrically elicited against three different loads. The highest load produced the least excursion, work, and average power, but it produced the greatest fatigue. CIT augmentation was greatest at the highest load and increased with fatigue. Because CITs were effective during shortening contractions for a variety of loads, they may be of benefit during FES applications.     

A distributed three-channel wireless Functional Electrical Stimulation system for automated triggering of stimulation to enable coordinated task execution by patients with neurological disease

Functional Electrical Stimulation (FES) is a technique used to improve mobility and function for patients suffering some neurological related diseases such us Multiple Sclerosis (MS) and stroke. Some patients might require FES applied in more than one location depending on the extent of the neurological condition. Currently, this can be achieved using multi-channel FES systems. However, these systems can be bulky and impractical in daily usage. This research investigates using a wireless distributed FES system to overcome some of the limitations of the current multi-channel systems. A prototype of a three-channel FES system was built and tested. The prototype is used for drop foot stimulation and reciprocal arm swing stimulation while the user is walking, and for elbow extension and wrist/fingers opening stimulation if triggered while standing or sitting. A pilot study was designed to evaluate the reliability and repeatability of the system with 11 healthy volunteers without applying stimulation. This was followed by a case study with a hemiplegic person. The results indicate that the system can successfully detect and generate output responses appropriate to the input signals from the body sensors.