Repetitive control of electrical stimulation for tremor suppression

Tremor is a rapid uncontrollable back-and-forth movement of a body part often seen in patients with neurological conditions such as Multiple Sclerosis (MS) and Parkinson’s disease. This debilitating oscillation can be suppressed by applying functional electrical stimulation (FES) within a closedloop control system. However current implementations use classical control methods and have proved capable of only limited performance. This paper develops a novel application of repetitive control (RC) that exploits the capability of learning from experience to enable complete suppression of the tremor. The proposed control structure is applied to suppress tremor at the wrist via FES regulated co-contraction of wrist extensors/flexors. Experimental evaluation is performed using a validated wristrig and results are compared against classical feedback control designs to establish the efficacy of the approach

System identification for FES-based tremor suppression

Tremor is an involuntary motion which is a common complication of Parkinson's disease and Multiple Sclerosis. A promising treatment is to artificially contract the muscle through application of induced electrical stimulation. However, existing controllers have either provided only modest levels of suppression or have been applied only in simulation. To enable more advanced, model-based control schemes, an accurate model of the relevant limb dynamics is required, together with identification procedures that are suitable for clinical application. This paper proposes such a solution, explicitly addressing limitations of existing methodologies. These include model structures that (i) neglect critical features, and (ii) restrict the range of admissible control schemes, together with identification procedures that (iii) employ stimulation inputs that are uncomfortable for patients, (iv) are overly complex and time-consuming for clinical use, and (v) cannot be automated. Experimental results confirm the efficacy of the proposed identification procedures, and show that high levels of accuracy can be achieved in a short identification time using test procedures that are suitable for future transference to the clinical domain

Nonlinear robust control of functional electrical stimulation system for paraplegia

The study was directed towards enhancing Functional Electrical Stimulation (FES) for sit-to-stand movement restoration in paraplegia subjects. The scarcity of FES assistive devices was due to the inability of the developed equipment to attain clinical acceptance. Applications of control systems have shown fruitful results. And based on the literature, further improvements in model, trajectory and control systems are needed. Model with a higher level of accuracy and continuous as well as bump-free trajectories are essential ingredients for better control systems. The control systems can be enhanced by giving considering to changes in mass of the subject, disturbance rejection and stability. Hence, the comprehensive control scheme is necessary for this application as well as a better model and trajectory. In modelling an additional joint has been considered to improve the accuracy. In trajectory planning, the six-order polynomial has been used to refine the desired trajectory. The comprehensive control systems have been designed with consideration of robustness, disturbance rejection, and stability. Three nonlinear control approaches have been investigated; the Sliding Mode Control (SMC), Feedback Linearisation Control (FLC), and Back-Stepping Control (BSC). Results reveal improvements in the accuracy of the kinematic model by 24%, and the dynamic model by 47%. The trajectory planning parameters are continuous, and not susceptible to jerks or spikes. Execution time enhanced by 11%, the upper and lower terminal velocities improved by 16.9% and 20.9% respectively. The system response without disturbance shows good results with the SMC, FLC, and BSC. Revelations by robustness examination also maintain remarkable enhancements in the parameters with both 53% and 126% mass. The results for disturbance rejection examinations with fatigue, spasm, tremor, and combined disturbance effects showed sustenance of refinement in the response parameters. Therefore, indicating improvements despite the changes to the system. The BSC showed the best performance, followed by the FLC, and the SMC. Hence, the BSC is recommended for such systems

Down-Conditioning of Soleus Reflex Activity using Mechanical Stimuli and EMG Biofeedback

Spasticity is a common syndrome caused by various brain and neural injuries, which can severely impair walking ability and functional independence. To improve functional independence, conditioning protocols are available aimed at reducing spasticity by facilitating spinal neuroplasticity. This down-conditioning can be performed using different types of stimuli, electrical or mechanical, and reflex activity measures, EMG or impedance, used as biofeedback variable. Still, current results on effectiveness of these conditioning protocols are incomplete, making comparisons difficult. We aimed to show the within-session task- dependent and across-session long-term adaptation of a conditioning protocol based on mechanical stimuli and EMG biofeedback. However, in contrast to literature, preliminary results show that subjects were unable to successfully obtain task-dependent modulation of their soleus short-latency stretch reflex magnitude

The Runbot: engineering control applied to rehabilitation in spinal cord injury patients

Human walking is a complicated interaction among the musculoskeletal system, nervous system and the environment. An injury affecting the neurological system, such as a spinal cord injury (SCI) can cause sensor and motor deficits, and can result in a partial or complete loss of their ambulatory functions. Functional electrical stimulation (FES), a technique to generate artificial muscle contractions with the application of electrical current, has been shown to improve the ambulatory ability of patients with an SCI. FES walking systems have been used as a neural prosthesis to assist patients walking, but further work is needed to establish a system with reduced engineering complexity which more closely resembles the pattern of natural walking. The aim of this thesis was to develop a new FES gait assistance system with a simple and efficient FES control based on insights from robotic walking models, which can be used in patients with neuromuscular dysfunction, for example in SCI. The understanding of human walking is fundamental to develop suitable control strategies. Limit cycle walkers are capable of walking with reduced mechanical complexity and simple control. Walking robots based on this principle allow bio-inspired mechanisms to be analysed and validated in a real environment. The Runbot is a bipedal walker which has been developed based on models of reflexes in the human central nervous system, without the need for a precise trajectory algorithm. Instead, the timing of the control pattern is based on ground contact information. Taking the inspiration of bio-inspired robotic control, two primary objectives were addressed. Firstly, the development of a new reflexive controller with the addition of ankle control. Secondly, the development of a new FES walking system with an FES control model derived from the principles of the robotic control system. The control model of the original Runbot utilized a model of neuronal firing processes based on the complexity of the central neural system. As a causal relationship between foot contact information and muscle activity during human walking has been established, the control model was simplified using filter functions that transfer the sensory inputs into motor outputs, based on experimental observations in humans. The transfer functions were applied to the RunBot II to generate a stable walking pattern. A control system for walking was created, based on linear transfer functions and ground reaction information. The new control system also includes ankle control, which has not been considered before. The controller was validated in experiments with the new RunBot III. The successful generation of stable walking with the implementation of the novel reflexive robotic controller indicates that the control system has the potential to be used in controlling the strategies in neural prosthesis for the retraining of an efficient and effective gait. To aid of the development of the FES walking system, a reliable and practical gait phase detection system was firstly developed to provide correct ground contact information and trigger timing for the control. The reliability of the system was investigated in experiments with ten able-bodied subjects. Secondly, an automatic FES walking system was implemented, which can apply stimulation to eight muscles (four in each leg) in synchrony with the user’s walking activity. The feasibility and effectiveness of this system for gait assistance was demonstrated with an experiment in seven able-bodied participants. This thesis addresses the feasibility and effectiveness of applying biomimetic robotic control principles to FES control. The interaction among robotic control, biology and FES control in assistive neural prosthesis provides a novel framework to developing an efficient and effective control system that can be applied in various control applications

Modeling the neurophysiology of tremor to develop a peripheral neuroprosthesis for tremor suppression

Pathological tremor is an involuntary oscillation of the body parts around joints. Pharmaceu- ticals and surgical treatments are approved approaches for tremor management; however, their side effects limit their usability. The main objective of this study is, therefore, to design a closed-loop non-invasive electrical stimulation system that could suppress tremor without serious side effects. We started our system design by investigating motor unit (MU) behaviors during postural tremor via decomposition of high-density surface electromyography (EMG) recordings of antagonist pairs of wrist muscles of essential tremor (ET) patients. The common input strength that influences voluntary and tremor movements and the phase difference between activation of motor neurons in antagonist pairs of muscles were assessed to find the correlation of the motor unit activity during different tasks. We observed that, during postural tremor, the motor units in antagonist pairs of muscles were activated with a phase difference that varies over time. An online EMG decomposition method and a phase-locked-loop system were, therefore, implemented in our tremor suppression system to real-timely discriminate motor unit discharge timings, track the phase of the motor unit activity and use that real-time phase estimation to control the stimulation timing. We applied sub-threshold stimulation to the muscle pairs in an out-of-phase manner. The system was validated offline with the data recorded from 13 ET patients before it was tested with an ET patient to prove the concept. Since the spinal cord is the termination of the afferent neurons from the peripheral nervous system and connection to the central nervous system and motor neurons, we hypothesized that electrical stimulation at the spinal cord could also modulate tremor-related neural commands. Russian currents with a 5 kHz-carrier frequency modulated with a slow burst at tremor frequencies were used with sub-threshold intensity to stimulate at C5-C6 cervical spine of 9 ET patients. The reduction of the tremor power was observed via an analysis of the wrist angle recorded using an accelerometer. We present, in this thesis, two electrical stimulation approaches for tremor suppression via the peripheral nerves and spinal cord, providing options for patients to utilize based on their preference.Open Acces

A Wearable Mechatronic Device for Hand Tremor Monitoring and Suppression: Development and Evaluation

Tremor, one of the most disabling symptoms of Parkinson\u27s disease (PD), significantly affects the quality of life of the individuals who suffer from it. These people live with difficulties with fine motor tasks, such as eating and writing, and suffer from social embarrassment. Traditional medicines are often ineffective, and surgery is highly invasive and risky. The emergence of wearable technology facilitates an externally worn mechatronic tremor suppression device as a potential alternative approach for tremor management. However, no device has been developed for the suppression of finger tremor that has been validated on a human. It has been reported in the literature that tremor can be selectively suppressed by mechanical loading. Therefore, the objectives of this thesis were to develop a wearable tremor suppression device that can suppress tremor at the wrist and the fingers, and to evaluate it on individuals with PD in a pre-clinical trial. To address these objectives, several experiments were performed to quantify hand tremor; an enhanced high-order tremor estimator was developed and evaluated for tremor estimation; and a wearable tremor suppression glove (WTSG) was developed to suppress tremor in the index finger metacarpophalangeal (MCP) joint, the thumb MCP joint, and the wrist. A total of 18 individuals with PD were recruited for characterizing tremor. The frequencies and magnitudes of the linear acceleration, angular velocity, and angular displacement of tremor in the index finger MCP joint, the thumb MCP joint, and the wrist were quantified. The results showed that parkinsonian tremor consists of multiple harmonics, and that the second and third harmonics cannot be ignored. With the knowledge of the tremor characteristics, an enhanced high-order tremor estimator was developed to acquire better tremor estimation accuracy than its lower-order counterpart. In addition, the evaluation of the WTSG was conducted on both a physical tremor simulator and on one individual with PD. The results of the simulation study proved the feasibility of using the WTSG to suppress tremor; and the results of the evaluation on a human subject showed that the WTSG can suppress tremor motion while allowing the user to perform voluntary motions. The WTSG developed as a result of this work has demonstrated the feasibility of managing hand tremor with a mechatronic device, and its validation on a human subject has provided useful insights from the user\u27s perspectives, which facilitate the transition of the WTSG from the lab to the clinic, and eventually to commercial use. Lastly, an evaluation studying the impact of suppressed tremor on unrestricted joints was conducted on 14 individuals with PD. The results showed a significant increase in tremor magnitude in the unrestricted distal joints when the motions of the proximal joints were restricted. The average increase of the tremor magnitude of the index finger MCP joint, the thumb MCP joint, the wrist and the elbow are 54%, 96%, 124%, and 98% for resting tremor, and 50%, 102%, 49%, and 107% for postural tremor, respectively. Such a result provided additional clinical justification for the significance of the development of a wearable mechatronic device for hand tremor management. Although the focus of this thesis is on hand tremor management, the development and evaluation of a full upper-limb tremor suppression device is required as a future step, in order to advance the use of wearable mechatronic devices as one of the valid tremor treatment approaches

Kinematics and Robot Design IV, KaRD2021

This volume collects the papers published on the special issue “Kinematics and Robot Design IV, KaRD2021” (https://www.mdpi.com/journal/robotics/special_issues/KaRD2021), which is the forth edition of the KaRD special-issue series, hosted by the open-access journal “MDPI Robotics”. KaRD series is an open environment where researchers can present their works and discuss all the topics focused on the many aspects that involve kinematics in the design of robotic/automatic systems. Kinematics is so intimately related to the design of robotic/automatic systems that the admitted topics of the KaRD series practically cover all the subjects normally present in well-established international conferences on “mechanisms and robotics”. KaRD2021, after the peer-review process, accepted 12 papers. The accepted papers cover some theoretical and many design/applicative aspects