Online identification and nonlinear control of the electrically stimulated quadriceps muscle

A new approach for estimating nonlinear models of the electrically stimulated quadriceps muscle group under nonisometric conditions is investigated. The model can be used for designing controlled neuro-prostheses. In order to identify the muscle dynamics (stimulation pulsewidth-active knee moment relation) from discrete-time angle measurements only, a hybrid model structure is postulated for the shank-quadriceps dynamics. The model consists of a relatively well known time-invariant passive component and an uncertain time-variant active component. Rigid body dynamics, described by the Equation of Motion (EoM), and passive joint properties form the time-invariant part. The actuator, i.e. the electrically stimulated muscle group, represents the uncertain time-varying section. A recursive algorithm is outlined for identifying online the stimulated quadriceps muscle group. The algorithm requires EoM and passive joint characteristics to be known a priori. The muscle dynamics represent the product of a continuous-time nonlinear activation dynamics and a nonlinear static contraction function described by a Normalised Radial Basis Function (NRBF) network which has knee-joint angle and angular velocity as input arguments. An Extended Kalman Filter (EKF) approach is chosen to estimate muscle dynamics parameters and to obtain full state estimates of the shank-quadriceps dynamics simultaneously. The latter is important for implementing state feedback controllers. A nonlinear state feedback controller using the backstepping method is explicitly designed whereas the model was identified a priori using the developed identification procedure

Control of posture with FES systems

One of the major obstacles in restoration of functional FES supported standing in paraplegia is the lack of knowledge of a suitable control strategy. The main issue is how to integrate the purposeful actions of the non-paralysed upper body when interacting with the environment while standing, and the actions of the artificial FES control system supporting the paralyzed lower extremities. In this paper we provide a review of our approach to solving this question, which focuses on three inter-related areas: investigations of the basic mechanisms of functional postural responses in neurologically intact subjects; re-training of the residual sensory-motor activities of the upper body in paralyzed individuals; and development of closed-loop FES control systems for support of the paralyzed joints

Feedback control of cycling in spinal cord injury using functional electrical stimulation

This thesis is concerned with the realisation of leg cycling by means of FES in SCI individuals with complete paraplegia. FES lower-limb cycling can be safely performed by paraplegics on static ergometers or recumbent tricycles. In this work, different FES cycling systems were developed for clinical and home use. Two design approaches have been followed. The first is based on the adaptation of commercially available recumbent tricycles. This results in devices which can be used as static trainers or for mobile cycling. The second design approach utilises a commercially available motorised ergometer which can be operated while sitting in a wheelchair. The developed FES cycling systems can be operated in isotonic (constant cycling resistance) or isokinetic mode (constant cadence) when used as static trainers. This represents a novelty compared to existing FES cycling systems. In order to realise isokinetic cycling, an electric motor is needed to assist or resist the cycling movement to maintain a constant cadence. Repetitive control technology is applied to the motor in this context to virtually eliminate disturbance caused by the FES activated musculature which are periodic with respect to the cadence. Furthermore, new methods for feedback control of the patient’s work rate have been introduced. A one year pilot study on FES cycling with paraplegic subjects has been carried out. Effective indoor cycling on a trainer setup could be achieved for long periods up to an hour, and mobile outdoor cycling was performed over useful distances. Power output of FES cycling was in the range of 15 to 20 W for two of the three subjects at the end of the pilot study. A muscle strengthening programme was carried out prior and concurrent to the FES cycling. Feedback control of FES assisted weight lifting exercises by quadriceps stimulation has been studied in this context

Real-time simulation of three-dimensional shoulder girdle and arm dynamics

Electrical stimulation is a promising technology for the restoration of arm function in paralyzed individuals. Control of the paralyzed arm under electrical stimulation, however, is a challenging problem that requires advanced controllers and command interfaces for the user. A real-time model describing the complex dynamics of the arm would allow user-in-the-loop type experiments where the command interface and controller could be assessed. Real-time models of the arm previously described have not included the ability to model the independently controlled scapula and clavicle, limiting their utility for clinical applications of this nature. The goal of this study therefore was to evaluate the performance and mechanical behavior of a real-time, dynamic model of the arm and shoulder girdle. The model comprises seven segments linked by eleven degrees of freedom and actuated by 138 muscle elements. Polynomials were generated to describe the muscle lines of action to reduce computation time, and an implicit, first-order Rosenbrock formulation of the equations of motion was used to increase simulation step-size. The model simulated flexion of the arm faster than real time, simulation time being 92% of actual movement time on standard desktop hardware. Modeled maximum isometric torque values agreed well with values from the literature, showing that the model simulates the moment-generating behavior of a real human arm. The speed of the model enables experiments where the user controls the virtual arm and receives visual feedback in real time. The ability to optimize potential solutions in simulation greatly reduces the burden on the user during development

Control systems for function restoration, exercise, fitness and health in spinal cord injury

We describe original research contributions to the engineering development of systems which aim to restore function and enable effective exercise for people with spinal cord injury (SCI). Our work utilises functional electrical stimulation (FES) of paralysed muscle. Improving function and general health through participation in exercise is vital to the enhancement of quality of life, well-being and promotion of longevity. Crucial to the development of this research has been judicious use of advanced methods of feedback control engineering; this has been a key enabling factor in many of our original contributions. The consequences of a spinal cord injury can be severe. The primary effects may include; paralysis and loss of sensation in the legs, arms and trunk; disruption of bladder and bowel function; and disruption of the autonomic regulation of blood pressure, heart rate and lung function. If the abdominal and chest muscles are paralysed, breathing will be compromised, and patients with a high-level cervical injury may require mechanical ventilation. These primary effects of a spinal cord injury may, over time, lead to a range of debilitating secondary medical complications. These include reduced cardiovascular fitness, urinary tract infection and an associated risk of kidney disease, reduced bone mineral density, the possible development of pressure sores, and muscle spasticity. People with paralysed chest and abdominal muscles are at increased risk of respiratory infection. Consideration of these factors has led us to focus our research programme in this field on novel engineering solutions which have relevance to the secondary consequences of spinal cord injury, and which may help to alleviate some of their effects. In this thesis we describe our contributions in the following areas: 1. Control of Paraplegic Standing; This work concerns upright stance, and aims to provide; (i) automatic feedback control of balance during stance, with the arms free for functional tasks; (ii) methods and apparatus for dynamic standing therapy, which may help to enhance the individual's retained balance skills. This area of work has successfully demonstrated the automatic control of balance during quiet standing in paraplegic subjects. Further, we have established the feasibility of ankle stiffness control in paraplegic subjects using FES, and we have shown that this can be combined with volitional upper-body inputs to achieve stable, arm-free balance. 2. Lower-limb Cycling: Lower-limb cycling, achieved through electrical stimulation of paralysed leg-actuating muscles, is an effective exercise intervention. We have described refinements to the engineering design of an FES-cycling system, based upon the adaptation of commercially-available recumbent tricycles (of various designs), some of which are equipped with an auxiliary electric motor. We have contributed new methods of feedback control of key variables including cycle cadence and exercise workrate. These contributions have facilitated further detailed study of the effect of the exercise on cardiopulmonary fitness, bone integrity, spasticity, muscle condition, and factors relating to the likelihood of skin breakdown (i.e. the development of pressure sores). 3. Upper-limb Exercise in Tetraplegia; We have developed a new exercise modality for patients with a cervical-level injury and significant loss of arm function. The system allows effective arm ergometry by combining volitional motion with electrical stimulation of the paralysed upper-arm muscles. This work has developed new apparatus and exercise testing protocols, and has examined the effect of the exercise on cardiopulmonary fitness and muscle strength in experiments with tetraplegic subjects. 4. Modelling and Control of Stimulated Muscle; This fundamental area of research has investigated dynamic modelling and feedback control design approaches for electrically-stimulated muscle. This work has been applied in the three areas mentioned above. We identify promising areas for future research. These include extension of work on lower- limb cycling to patients with incomplete injuries, to those with cervical-level injuries, and to children with SCI. We wish to participate in a multi-centre clinical study of implanted nerve- root stimulation technology for restoration of bladder and bowel control, and for lower-limb exercise (including cycling). We have initiated a study of treadmill-based gait therapy for incomplete-lesion patients. The goals of this study are to develop test protocols for accurate characterisation of cardiopulmonary status, and to determine whether this form of cyclical lower-limb exercise has a positive impact on retained voluntary leg function. It is often the case that it is those people most severely affected by neurological impairment who stand to gain the most from these approaches (e.g. high-level tetraplegia, paediatric spinal cord injury, etc.). We must therefore continue to seek ways in which the work can be developed for the maximum benefit of these patients. In conclusion, this thesis has described original research contributions to the engineering development of systems which aim to restore important function and to enable effective exercise for people with spinal cord injury. An important facet of our work has been the application of feedback control methods; this has been an enabling factor in several areas of study. We have focused on areas which promise improved fitness and general health, and which may alleviate some of the secondary consequences of spinal cord injury. This work encompasses fundamental research, clinical studies, and the pursuit of technology transfer into clinical practice. Finally, we recognise the growing awareness of and interest in central nervous system plasticity, and in the broad field of central neural regeneration and repair. It is therefore timely to ask whether cyclical exercise interventions can lead to improvement of volitional function in patients with incomplete or discomplete lesions. Such improvements may, we speculate, result from the strengthening of muscles which retain at least partial volitional control, or from neural plasticity and re-organisation, or from regeneration effects (neurogenesis and functional connectivity). A key requirement in this line of investigation, and a major challenge, will be to develop or to utilise methods which can detect changes in a patient's volitional function and neurological status, and which can isolate the source of such changes. Should reliable methods become available, the way to the study of recovery of function through cyclical exercise would be opened. These considerations will remain, we propose, an indispensable complement to cell-based surgical interventions which may become available in the future

Knee joint impedance hybrid modeling and control of Functional Electrical Stimulation (FES)-cyclingfor paraplegic: free swinging trajectory

Functional electrical stimulation (FES) has been used to restore the function of paralyzed muscles due to spinal cord injury (SCI). FES induced movement control is a significantly challenging area due to complexity and non�linearity of musculoskeletal system. A crucial issue of FES is the control of motor function by the artificial activation of paralyzed muscles due to the various characteristics of the underlying physiological/biomechanical system. Muscle response characteristics are nonlinear and time-varying with fatigue issues. In this approach only the quadriceps muscle is stimulated to perform the trajectory motion. This paper presents the initial development of control strategies using FLC and GA in order to optimize the system by FES�cycling trajectory control via Analog Digital Converter,ADC

Development and assessment of novel methods of exercise testing during treadmill gait in incomplete spinal cord injury

The main study of this thesis monitors changes in cardiopulmonary fitness, peak voluntary force and CAR of the quadriceps and hamstring muscles, and lower limb BMD in two incomplete SCI subjects who participated in a 20-week BWS treadmill training (BWSTT) programme. The main outcomes of the BWSTT study were: a substantial improvement in performance parameters (training work rate, peak work rate (WRpeak) and the distance walked in 15 minutes), an overall increase in VO2peak and peak heart rate (HRpeak), a substantial decrease in ?VO2/?WR and a decrease in the VO2 and HR associated with a step increase in work rate. Accurate identification of an LT, tVO2, and the voluntary peak force and CAR was not established. An increase in lower limb BMD was not identified in the subject who was 2 years post injury. However, encouragingly an increase was shown in the trabecular BMD of the right and left tibia of the subject who was 14.5 years post injury. A novel non-robot-assisted treadmill IET which incorporated nonlinear, equally smooth increases in both speed and gradient was also developed and assessed. The benefits of BWSTT in those with an incomplete SCI have been highlighted in this thesis. It has also been shown that cardiopulmonary exercise testing can potentially be utilised in this population. Whether or not the IETs assessed throughout this thesis provide a true indication of the subjects’ actual cardiopulmonary capacity is debatable due to limitations in their gait pattern and lower limb muscle fatigue. Therefore, the accurate detection of an LT and tVO2 may be key to determining improvements in cardiopulmonary fitness in this population. It is therefore suggested that further study in a larger subject group be carried out to determine the repeatability and reliability of the outcome measures obtained

Development and assessment of methods for arm-cranking exercise assisted by functional electrical stimulation (FES) in tetraplegia

In this pilot study, a new avenue for exercise in tetraplegia, involving FES applied to upper limb muscles, is suggested. The main motivation for developing methods for FES-assisted arm-cranking exercise is to provide an exercise modality specifically designed for tetraplegia that might address cardiopulmonary issues, as well as work with remaining voluntary control of upper body musculature. One primary aim of this thesis was to determine the feasibility of using these systems in tetraplegia. To investigate this, standard protocols for exercise training, and incremental and constant-load exercise testing, were adapted to make them suitable for this population and this exercise modality. These novel protocols are described here, and represent one of the contributions of the thesis. The implementation of these protocols for an experimental evaluation of the proposed systems for FES-assisted arm-cranking exercise makes up the main part of the thesis. Five volunteers with tetraplegia participated in this experimental evaluation, and their data are presented as two main case studies, and additional case reports. The first outcome of thesis evaluation is that it shows the feasibility of the proposed methods for FES-assisted arm-cranking exercise training and testing in tetraplegia. Secondly, benefits of regular use of the systems are illustrated for some individuals with tetraplegia, based on key indicators of cardiopulmonary fitness and measures of upper limb strength. Thirdly, the limitations of the current set-up for FES-assisted arm-cranking exercise in higher level tetraplegia are identified. In summary, this thesis describes new systems and protocols for FES-assisted arm-cranking exercise in tetraplegia, and provides a preliminary assessment of these methods