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

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

Interval Observer-based Feedback Control for Rehabilitation in Tremor

International audienceTremor, one of the most common health disorders , is defined as a chronic movement disorder. To reduce tremor in patients, the design of stabilizing techniques is critical. For this purpose, we consider an uncertain continuous-time linear time-varying oscillator model of tremor in this article. We design a state feedback control for deep brain stimulation technique by considering the practical case in which only sets of admissible values are given for the nominal values of the stimulation amplitude, the time-varying tremor's angular frequency and the tremor measurement noise. First, we estimate state signal bounds that include the true unknown value of the state. Next, we design a stabilizing control input based on the estimated bounds. The stability of the controlled system is verified using linear matrix inequalities (LMIs). We demonstrate the methodology's performance in numerical simulations

Dyadic behavior in co-manipulation :from humans to robots

To both decrease the physical toll on a human worker, and increase a robot’s environment perception, a human-robot dyad may be used to co-manipulate a shared object. From the premise that humans are efficient working together, this work’s approach is to investigate human-human dyads co-manipulating an object. The co-manipulation is evaluated from motion capture data, surface electromyography (EMG) sensors, and custom contact sensors for qualitative performance analysis. A human-human dyadic co-manipulation experiment is designed in which every human is instructed to behave as a leader, as a follower or neither, acting as naturally as possible. The experiment data analysis revealed that humans modulate their arm mechanical impedance depending on their role during the co-manipulation. In order to emulate the human behavior during a co-manipulation task, an admittance controller with varying stiffness is presented. The desired stiffness is continuously varied based on a scalar and smooth function that assigns a degree of leadership to the robot. Furthermore, the controller is analyzed through simulations, its stability is analyzed by Lyapunov. The resulting object trajectories greatly resemble the patterns seen in the human-human dyad experiment.Para tanto diminuir o esforço físico de um humano, quanto aumentar a percepção de um ambiente por um robô, um díade humano-robô pode ser usado para co-manipulação de um objeto compartilhado. Partindo da premissa de que humanos são eficientes trabalhando juntos, a abordagem deste trabalho é a de investigar díades humano-humano co-manipulando um objeto compartilhado. A co-manipulação é avaliada a partir de dados de um sistema de captura de movimentos, sinais de eletromiografia (EMG), e de sensores de contato customizados para análise qualitativa de desempenho. Um experimento de co-manipulação com díades humano-humano foi projetado no qual cada humano é instruído a se comportar como um líder, um seguidor, ou simplesmente agir tão naturalmente quanto possível. A análise de dados do experimento revelou que os humanos modulam a rigidez mecânica do braço a depender de que tipo de comportamento eles foram designados antes da co-manipulação. Para emular o comportamento humano durante uma tarefa de co-manipulação, um controle por admitância com rigidez variável é apresentado neste trabalho. A rigidez desejada é continuamente variada com base em uma função escalar suave que define o grau de liderança do robô. Além disso, o controlador é analisado por meio de simulações, e sua estabilidade é analisada pela teoria de Lyapunov. As trajetórias resultantes do uso do controlador mostraram um padrão de comportamento muito parecido ao do experimento com díades humano-humano

A neuroprothesis for tremor management

Tremor is the most common movement disorder, affecting ∼ 15 % of people over 50 years old according to some estimates. It appears due to a number of syndromes, being essential tremor and Parkinson's disease the most prevalent among them. None of these conditions is fully understood. Tremor is currently treated through drugs or neurosurgery, but unfortunately, it is not managed effectively in ∼25 % of the patients. Therefore, it constitutes a major cause of loss of independence and quality of life. Various alternative approaches for tremor management are reported in the literature. Among them, those devices that rely on the application of forces to the tremulous segments show a considerable potential. A number of prototypes that exploit this principle are available, spanning fixed devices and orthoses. However, none of them has fulfilled user's expectation for continuous use during daily living. This thesis presents the development and validation of a neuroprosthesis for tremor management. A neuroprosthesis is a system that restores or compensates for a neurological function that is lost. In this case, the neuroprosthesis aims at compensating the functional disability caused by the tremor. To this end, it applies forces to the tremulous limb through the control of muscle contraction, which is modulated according to the characteristics of the tremor. The concept design envisions the device as a textile that is worn on the affected limb, thus meeting the usability requirements defined by the patients. The development of the neuroprosthesis comprised the following tasks: 1. The development of a concept design of the neuroprosthesis, which incorporates state of the art knowledge on tremor, and user's needs. 2. The design and validation of a cognitive interface that parameterizes the tremor in functional contexts. This interface provides the information that the neuroprosthesis uses for tremor suppression. Two versions are developed: a multimodal interface that integrates the recordings of the whole neuromusculoskeletal system, and an interface incorporating only wearable movement sensors. The latter is intended for the functional validation of the neuroprosthesis, while the former is a proof of concept of an optimal interface for this type of applications. 3. The development of a novel approach for tremor suppression through transcutaneous neurostimulation. The approach relies on the modulation of muscle cocontraction as a means of attenuating the tremor without the need of conventional actuators. The experimental validation here provided demonstrates the feasibility and interest of the approach. In parallel with the validation of the neuroprosthesis, I performed a detailed study on the physiology of motoneurons in tremor, given the lack of a complete description of its behavior. The outcome of this study contributes to the interpretation of the results obtained with the neuroprosthesis, and opens new research lines, both related to alternative interventions and basic neuroscience. In summary, the results here presented demonstrate that tremor may be accurately parameterized while the patient performs functional activities, and that this information may be exploited to drive a neuroprosthesis for tremor management. Furthermore, the novel approach for tremor suppression presented in this dissertation constitutes a potential approach for treating upper limb tremor, either alone, or as a complement to pharmacotherapy. These results encourage the validation of the neuroprosthesis in a large cohort of patients, in order to enable its translation to the market. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------El temblor es el trastorno del movimiento más común, afectando, según algunas estimaciones, al ∼15 % de la población de más de 50 años. Existen diversos "síndromes" que causan temblor, siendo el temblor esencial y la enfermedad de Parkinson los que presentan mayor prevalencia. Además, cabe resaltar que no existe una descripción completa de ninguno de ellos. En la actualidad el temblor se trata mediante una serie de fármacos o neurocirugía. A pesar de ello, el ∼ 25 % de los pacientes sufren problemas funcionales debido a su condición. Por tanto, es evidente que el temblor constituye una de las principales causas de dependencia y pérdida de calidad de vida. Realizando una revisión de las publicaciones científicas sobre el temblor, se observa que se ha propuesto un considerable número de tratamientos alternativos. Entre ellos destacan los dispositivos que se fundamentan en la aplicación de fuerzas sobre los segmentos afectados por el temblor, de los que ya se ha evaluado una serie de prototipos. Estos abarcan desde dispositivos fijados a otras estructuras hasta ortesis. Sin embargo, ninguno de ellos satisface las expectativas de los usuarios para su uso durante el día a día. Esta tesis presenta el diseño y validación de una neruoprótesis para el tratamiento del temblor. Una neuroprótesis es un sistema que reemplaza o compensa una función neurológica perdida. En este caso, la neuroprótesis tiene como objetivo compensar la discapacidad motora causada por el temblor. Para ello aplica fuerzas al miembro afectado a través del control del nivel de contracción muscular, que se modula según las características del temblor. El diseño conceptual contempla al dispositivo como un textil que se viste en el brazo afectado, satisfaciendo los requisitos de usabilidad definidos por los pacientes. El desarrollo de la neuroprótesis abarcó las siguientes tareas: 1. El desarrollo del diseño conceptual de la neuroprótesis, que incorpora el conocimiento actual sobre el temblor, y las necesidades de los usuarios. 2. El diseño y validación de una interfaz cognitiva que parametriza el temblor durante tareas funcionales. La información obtenida con esta interfaz es usada por la neuroprótesis para modular la corriente aplicada mediante técnicas de neuroestimulación. Se desarrollan dos versiones de la interfaz cognitiva: una interfaz multimodal que integra información de todo el sistema neuromusculoesquelético, y una interfaz que implementa únicamente sensores vestibles de movimiento. La segunda interfaz fue la que se usó durante la validación funcional de la neuroprótesis, mientras que la primera es una prueba de concepto de una interfaz óptima para este tipo de aplicaciones. 3. El desarrollo de una nueva aproximación para la supresión del temblor mediante neuroestimulación transcutánea. Dicha aproximación se fundamenta en la modulación del grado de co-contracción de los músculos afectados como forma de atenuar el temblor, sin necesidad de usar actuadores convencionales. La evaluación experimental sirvió para demostrar la viabilidad e interés de la intervención. En paralelo a la validación de la neuroprótesis, llevé a cabo un estudio detallado de la fisiología de las motoneuronas en el caso del temblor, dado que no existe una descripción del funcionamiento de las mismas en el caso de este trastorno. Este estudio sirve para ayudar a la interpretación de los resultados de la neuroprótesis, y para abrir una serie de líneas futuras de investigación, tanto sobre nuevas intervenciones para el temblor, como sobre neurociencia básica. En resumen, los resultados que se presentan en esta tesis demuestran que es posible parametrizar de una forma precisa el temblor durante la realización de tareas funcionales, y que esta información sirve para controlar una neuroprótesis para el tratamiento del temblor. Además, la nueva aproximación para la compensación del temblor que se presenta tiene el potencial de convertirse en un tratamiento alternativo para el temblor de miembro superior, ya sea de forma independiente o como complemento a los fármacos. Estos resultados alientan la validación de la neuroprótesis en una cohorte grande de pacientes, con el objetivo de facilitar su transferencia al mercado

Topics in Neuromodulation Treatment

"Topics in Neuromodulation Treatment" is a book that invites to the reader to make an update in this important and well-defined area involved in the Neuroscience world. The book pays attention in some aspects of the electrical therapy and also in the drug delivery management of several neurological illnesses including the classic ones like epilepsy, Parkinson's disease, pain, and other indications more recently incorporated to this important tool like bladder incontinency, heart ischemia and stroke. The manuscript is dedicated not only to the expert, but also to the scientist that begins in this amazing field. The authors are physicians of different specialties and they guarantee the clinical expertise to provide to the reader the best guide to treat the patient

Assessment of a prototype energy-dissipating orthosis for the measurement and management of upper extremity intention tremor

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1992.Includes bibliographical references (leaves 236-242).by Allison Suzanne Arnold.M.S

Proceedings of the Second International Mobile Satellite Conference (IMSC 1990)

Presented here are the proceedings of the Second International Mobile Satellite Conference (IMSC), held June 17-20, 1990 in Ottawa, Canada. Topics covered include future mobile satellite communications concepts, aeronautical applications, modulation and coding, propagation and experimental systems, mobile terminal equipment, network architecture and control, regulatory and policy considerations, vehicle antennas, and speech compression