Functional Electrical Stimulation mediated by Iterative Learning Control and 3D robotics reduces motor impairment in chronic stroke

Background: Novel stroke rehabilitation techniques that employ electrical stimulation (ES) and robotic technologies are effective in reducing upper limb impairments. ES is most effective when it is applied to support the patients’ voluntary effort; however, current systems fail to fully exploit this connection. This study builds on previous work using advanced ES controllers, and aims to investigate the feasibility of Stimulation Assistance through Iterative Learning (SAIL), a novel upper limb stroke rehabilitation system which utilises robotic support, ES, and voluntary effort. Methods: Five hemiparetic, chronic stroke participants with impaired upper limb function attended 18, 1 hour intervention sessions. Participants completed virtual reality tracking tasks whereby they moved their impaired arm to follow a slowly moving sphere along a specified trajectory. To do this, the participants’ arm was supported by a robot. ES, mediated by advanced iterative learning control (ILC) algorithms, was applied to the triceps and anterior deltoid muscles. Each movement was repeated 6 times and ILC adjusted the amount of stimulation applied on each trial to improve accuracy and maximise voluntary effort. Participants completed clinical assessments (Fugl-Meyer, Action Research Arm Test) at baseline and post-intervention, as well as unassisted tracking tasks at the beginning and end of each intervention session. Data were analysed using t-tests and linear regression. Results: From baseline to post-intervention, Fugl-Meyer scores improved, assisted and unassisted tracking performance improved, and the amount of ES required to assist tracking reduced. Conclusions: The concept of minimising support from ES using ILC algorithms was demonstrated. The positive results are promising with respect to reducing upper limb impairments following stroke, however, a larger study is required to confirm this

Norm Optimal Iterative Learning Control with Application to Problems in Accelerator based Free Electron Lasers and Rehabilitation Robotics

This paper gives an overview of the theoretical basis of the norm optimal approach to iterative learning control followed by results that describe more recent work which has experimentally benchmarking the performance that can be achieved. The remainder of then paper then describes its actual application to a physical process and a very novel application in stroke rehabilitation

Sparse Iterative Learning Control with Application to a Wafer Stage: Achieving Performance, Resource Efficiency, and Task Flexibility

Trial-varying disturbances are a key concern in Iterative Learning Control (ILC) and may lead to inefficient and expensive implementations and severe performance deterioration. The aim of this paper is to develop a general framework for optimization-based ILC that allows for enforcing additional structure, including sparsity. The proposed method enforces sparsity in a generalized setting through convex relaxations using $\ell_1$ norms. The proposed ILC framework is applied to the optimization of sampling sequences for resource efficient implementation, trial-varying disturbance attenuation, and basis function selection. The framework has a large potential in control applications such as mechatronics, as is confirmed through an application on a wafer stage.Comment: 12 pages, 14 figure

Upper limb electrical stimulation using input-output linearization and iterative learning control

A control scheme is developed for multi-joint upper limb reference tracking using functional electrical stimulation (FES). In accordance with the needs of stroke rehabilitation, FES is applied to a reduced set of muscles in the arm and shoulder, with support against gravity provided by a passive exoskeletal mechanism. The approach fuses input-output linearization with iterative learning control (ILC), one of the few techniques to have been applied in clinical treatment trials with patients. This powerful hybrid control structure hence extends performance and scope of clinically proven technology for widespread application in rehabilitation robotic and FES domains. In addition to simplifying tracking and convergence properties of the stimulated joints, the framework enables conditions for the stability of unstimulated joints to be derived for the first time. Experimental results confirm tracking performance of the stimulated joints, together with unstimulated joint stability

Optimisation of hand posture stimulation using an electrode array and iterative learning control.

Nonlinear optimisation-based search algorithms have been developed for the precise stimulation of muscles in the wrist and hand, to enable stroke patients to attain predefined gestures. These have been integrated in a system comprising a 40 element surface electrode array that is placed on the forearm, an electrogoniometer and data glove supplying position data from 16 joint angles, and custom signal generation and switching hardware to route the electrical stimulation to individual array elements. The technology will be integrated in a upper limb rehabilitation system currently undergoing clinical trials to increase their ability to perform functional tasks requiring fine hand and finger movement. Initial performance results from unimpaired subjects show the successful reproduction of six reference hand postures using the system

Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study

BACKGROUND: Brain injury survivors often present upper-limb motor impairment affecting the execution of functional activities such as reaching. A currently active research line seeking to maximize upper-limb motor recovery after a brain injury, deals with the combined use of functional electrical stimulation (FES) and mechanical supporting devices, in what has been previously termed hybrid robotic systems. This study evaluates from the technical and clinical perspectives the usability of an integrated hybrid robotic system for the rehabilitation of upper-limb reaching movements after a brain lesion affecting the motor function. METHODS: The presented system is comprised of four main components. The hybrid assistance is given by a passive exoskeleton to support the arm weight against gravity and a functional electrical stimulation device to assist the execution of the reaching task. The feedback error learning (FEL) controller was implemented to adjust the intensity of the electrical stimuli delivered on target muscles according to the performance of the users. This control strategy is based on a proportional-integral-derivative feedback controller and an artificial neural network as the feedforward controller. Two experiments were carried out in this evaluation. First, the technical viability and the performance of the implemented FEL controller was evaluated in healthy subjects (N = 12). Second, a small cohort of patients with a brain injury (N = 4) participated in two experimental session to evaluate the system performance. Also, the overall satisfaction and emotional response of the users after they used the system was assessed. RESULTS: In the experiment with healthy subjects, a significant reduction of the tracking error was found during the execution of reaching movements. In the experiment with patients, a decreasing trend of the error trajectory was found together with an increasing trend in the task performance as the movement was repeated. Brain injury patients expressed a great acceptance in using the system as a rehabilitation tool. CONCLUSIONS: The study demonstrates the technical feasibility of using the hybrid robotic system for reaching rehabilitation. Patients’ reports on the received intervention reveal a great satisfaction and acceptance of the hybrid robotic system

Robust iterative feedback tuning control of a compliant rehabilitation robot for repetitive ankle training

Robot-assisted rehabilitation offers benefits, such as repetitive, intensive, and task-specific training, as compared to traditional manual manipulation performed by physiotherapists. In this paper, a robust iterative feedback tuning (IFT) technique for repetitive training control of a compliant parallel ankle rehabilitation robot is presented. The robot employs four parallel intrinsically compliant pneumatic muscle actuators that mimic skeletal muscles for ankle's motion training. A multiple degrees-of-freedom normalized IFT technique is proposed to increase the controller robustness by obtaining an optimal value for the weighting factor and offering a method with learning capacity to achieve an optimum of the controller parameters. Experiments with human participants were conducted to investigate the robustness as well as to validate the performance of the proposed IFT technique. Results show that the normalized IFT scheme will achieve a better and better tracking performance during the robot repetitive control and provides more robustness to the system by adapting to various situations in robotic rehabilitation

The re-education of upper limb movement post stroke using iterative learning control mediated by electrical stimulation

An inability to perform tasks involving reaching is a common problem following stroke. Evidence supports the use of robotic therapy and electrical stimulation (ES) to reduce upper limb impairments following stroke, but current systems may not encourage maximal voluntary contribution from the participant. This study developed and tested iterative learning control (ILC) algorithms mediated by ES, using a purpose designed robotic workstation, for upper limb rehabilitation post stroke. Surface electromyography (EMG) which may be related to impaired performance and function was used to investigate seven shoulder and elbow muscle activation patterns in eight neurologically intact and five chronic stroke participants during nine tracking tasks. The participants’ forearm was supported using a hinged arm-holder, which constrained their hand to move in a two dimensional horizontal plane.Outcome measures taken prior to and after an intervention consisted of the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT), isometric force and error tracking. The intervention for stroke participants consisted of eighteen sessions in which a similar range of tracking tasks were performed with the addition of responsive electrical stimulation to their triceps muscle. A question set was developed to understand participants’ perceptions of the ILC system. Statistically significant improvements were measured (p?0.05) in: FMA motor score, unassisted tracking, and in isometric force. Statistically significant differences in muscle activation patterns were observed between stroke and neurologically intact participants for timing, amplitude and coactivation patterns. After the intervention significant changes were observed in many of these towards neurologically intact ranges. The robot–assisted therapy was well accepted and tolerated by the stroke participants. This study has demonstrated the feasibility of using ILC mediated by ES for upper limb stroke rehabilitation in the treatment of stroke patients with upper limb hemiplegia

Control of robot-assisted gait trainer using hybrid proportional integral derivative and iterative learning control

An inexpensive exoskeleton of the lower limb was designed and developed in this study. It can be used as a gait trainer for persons with lower limb problems. It plays an essential role in lower limb rehabilitation and aid for patients, and it can help them improve their physical condition. This paper proposes a hybrid controller for regulating the lower limb exoskeleton of a robot-assisted gait trainer that uses a proportional integral and derivative (PID) controller combined with an iterative learning controller (ILC). The direct current motors at the hip and knee joints are controlled by a microcontroller that uses a preset pattern for the trajectories. It can learn how to monitor a trajectory. If the trajectory or load is changed, it will be able to follow the change. The experiment showed that the PID controller had the smallest overshoot, and settling time, and was responsible for system stability. Even if there are occasional interruptions, the tracking performance improves with the ILC