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

New results in feedback control of unsupported standing in paraplegia

The aim of this study was to implement a new approach to feedback control of unsupported standing and to evaluate it in tests with an intact and a paraplegic subject. In our setup, all joints above the ankles are braced and stabilizing torque at the ankle is generated by electrical stimulation of the plantarflexor muscles. A previous study showed that short periods of unsupported standing with a paraplegic subject could be achieved. In order to improve consistency and reliability and to prolong the duration of standing, we have implemented several modifications to the control strategy. These include a simplified control structure and a different controller design method. While the reliability of standing is mainly limited by the muscle characteristics such as reduced strength and progressive fatigue, the results presented here show that the new strategy allows much longer periods (up to several minutes) of unsupported standing in paraplegia

A model-based approach to stabilizing crutch supported paraplegic standing by artifical hip joint stiffness

The prerequisites for stable crutch supported standing were analyzed in this paper. For this purpose, a biomechanical model of crutch supported paraplegic stance was developed assuming the patient was standing with extended knees. When using crutches during stance, the crutches will put a position constraint on the shoulder, thus reducing the number of degrees of freedom. Additional hip-joint stiffness was applied to stabilize the hip joint and, therefore, to stabilize stance. The required hip-joint stiffness for changing crutch placement and hip-joint offset angle was studied under static and dynamic conditions. Modeling results indicate that, by using additional hip-joint stiffness, stable crutch supported paraplegic standing can be achieved, both under static as well as dynamic situations. The static equilibrium postures and the stability under perturbations were calculated to be dependent on crutch placement and stiffness applied. However, postures in which the hip joint was in extension (C postures) appeared to the most stable postures. Applying at least 60 N /spl middot/ m/rad hip-joint stiffness gave stable equilibrium postures in all cases. Choosing appropriate hip-joint offset angles, the static equilibrium postures changed to more erect postures, without causing instability or excessive arm forces to occur

Paraplegic standing supported by FES-controlled ankle stiffness

The objective of this paper was to investigate whether a paraplegic subject-is able to maintain balance during standing by means of voluntary and reflex activity of the upper body while being supported by closed loop controlled ankle stiffness using FES. The knees and hips of the subject were held in extended positions by a mechanical apparatus, which restricted movement to the sagittal plane. The subject underwent several training sessions where the appropriate level of stiffness around the ankles was maintained by the mechanical apparatus. This enabled the subject to learn how to use the upper body for. balancing. After the subject gained adequate skills closed-loop FES was employed to regulate ankle stiffness, replacing the stiffness provided by the apparatus. A method to control antagonist muscle moment was implemented. In subsequent standing sessions, the subject had no difficulties in maintaining balance. When the FES, support was withheld, the ability to balance was lost

Feedback control of unsupported standing

This paper presents the results of continuing work on feedback control of unsupported standing in paraplegia. Our experimental setup considers a situation in which all joints above the ankle are braced, and stabilising torque at the ankle is generated by stimulation of the plantarflexors. A previous study showed that short periods of unsupported standing with paraplegic subjects could be achieved. In order to improve consistency and reliability of unsupported standing we are currently investigating several modifications to the control strategy. The paper reports progress towards this goal

A Robust Nonlinear Control Strategy for Unsupported Paraplegic Standing Using Functional Electrical Stimulation: Controller Synthesis and Simulation

Background: Functional electrical stimulation (FES) is known as a promising technique for movement generation in the paralyzed limbs through electrical stimulation of the muscle nerves. This paper focuses on the FES based control of upright standing in paraplegic patients. In this study a new approach for controlling the upright posture has been proposed. The posture control strategies proposed in the previous works were based on controlling the angular joint position, and none of them were focused on controlling the CoP dynamics directly. Since the CoP is representative of posture balance dynamics, in this study the adopted FES based control strategy was designed to control the CoP dynamics directly.Method: In the proposed strategy, the controller has determined the stimulation intensity of ankle muscles in a manner to restrict the center of pressure (CoP) in a specific zone to guarantee the posture balance during unsupported standing. The proposed approach is based on a new cooperative based combination between two different controllers. Utilizing this strategy, until the CoP is confined within the stable zone, an adaptive controller is active and tries to preserve the posture stability. When the CoP goes out the stable zone, sliding mode control, as a nonlinear control technique presenting remarkable properties of robustness, is activated and tries to back the CoP within the preference zone. In this manner, not only the posture balance can be guaranteed but also the balance dynamics can be similar to the elicited dynamic postural behavior in the normal subjects.Results: Extended evaluations carried out through the simulation studies on a musculoskeletal model. According to the achieved results, the proposed control strategy is not only robust against the external disturbances but also insensitive to the initial postural conditions.Conclusion: The achieved results prove the acceptable performance of the proposed control strategy

Biomechanics

Biomechanics is a vast discipline within the field of Biomedical Engineering. It explores the underlying mechanics of how biological and physiological systems move. It encompasses important clinical applications to address questions related to medicine using engineering mechanics principles. Biomechanics includes interdisciplinary concepts from engineers, physicians, therapists, biologists, physicists, and mathematicians. Through their collaborative efforts, biomechanics research is ever changing and expanding, explaining new mechanisms and principles for dynamic human systems. Biomechanics is used to describe how the human body moves, walks, and breathes, in addition to how it responds to injury and rehabilitation. Advanced biomechanical modeling methods, such as inverse dynamics, finite element analysis, and musculoskeletal modeling are used to simulate and investigate human situations in regard to movement and injury. Biomechanical technologies are progressing to answer contemporary medical questions. The future of biomechanics is dependent on interdisciplinary research efforts and the education of tomorrow’s scientists

Feedback Control of an Exoskeleton for Paraplegics: Toward Robustly Stable Hands-free Dynamic Walking

This manuscript presents control of a high-DOF fully actuated lower-limb exoskeleton for paraplegic individuals. The key novelty is the ability for the user to walk without the use of crutches or other external means of stabilization. We harness the power of modern optimization techniques and supervised machine learning to develop a smooth feedback control policy that provides robust velocity regulation and perturbation rejection. Preliminary evaluation of the stability and robustness of the proposed approach is demonstrated through the Gazebo simulation environment. In addition, preliminary experimental results with (complete) paraplegic individuals are included for the previous version of the controller.Comment: Submitted to IEEE Control System Magazine. This version addresses reviewers' concerns about the robustness of the algorithm and the motivation for using such exoskeleton

On the control of paraplegic standing using functional electrical stimulation

This thesis is concerned with the restoration of upright standing after spinal cord injury (SCI) by the means of Functional Electrical Stimulation. In particular, the work presented in this thesis is concerned with unsupported standing, i.e. standing without any support by the arms for stabilisation. Firstly, the experimental apparatus and feedback control approach is described. Secondly, the experimental work is divided into three parts. The motivation, experimental setup and procedure as well as results and conclusions are given for each of them. The feasibility of the investigated approach was usually tested on a neurologically intact subject. The results were subsequently confirmed with a paraplegic subject. First the feasibility and fundamental limitations of unsupported standing were investigated. Assuming the subject as a single-link inverted pendulum, an improved fully dynamic control approach was employed in the first step, confirming existing results. Here, the voluntary influence by the central nervous system was minimised. However, it is naturally desirable to take advantage of the residual sensory-motor abilities of the paraplegic subject to ease the task of stabilising the body. Ankle stiffness control has been proposed in the literature to accomplish this task. Hitherto, ankle stiffness was provided by artificial actuators. In the second part we investigated the feasibility and limitations of ankle stiffness control by means of FES. The same single-link approach was employed as above. Ankle stiffness control by FES was used in the third part to enable paraplegic standing. Here, the subject was required to participate actively in the task of stable standing and, while doing so, behaving like a double-link inverted pendulum. It could be shown that FES-controlled ankle stiffness contributed crucially to the subject's ability to stand. The thesis concludes with propositions for future work

Ekonomicky dostupný aktivní exoskeleton pro dolní končetiny pro paraplegiky

After a broad introduction to the medical and biomechanical background and detailed review of orthotic devices, two newly developed lower limbs exoskeletons for paraplegics are presented in this study. There was found out the main challenges of designing devices for paraplegic walking can be summarized into three groups, stability and comfort, high efficiency or low energy consumption, dimensions and weight. These all attributes have to be moreover considered and maintained during manufacturing of affordable device while setting a reasonable price of the final product. A new economical device for people with paraplegia which tackles all problems of the three groups is introduced in this work. The main idea of this device is based on HALO mechanism. HALO is a compact passive medial hip joint orthosis with contralateral hip and ankle linkage, which keeps the feet always parallel to the ground and assists swinging the leg. The medial hip joint is equipped with one actuator in the new design and the new active exoskeleton is called @halo. Due to this update, we can achieve more stable and smoother walking patterns with decreased energy consumption of the users, yet maintain its compact and lightweight features. It was proven by the results from preliminary experiments with able-bodied subjects during which the same device with and without actuator was evaluated. Waddling and excessive vertical elevation of the centre of gravity were decreased by 40% with significantly smaller standard deviations in case of the powered exoskeleton. There was 52% less energy spent by the user wearing @halo which was calculated from the vertical excursion difference. There was measured 38.5% bigger impulse in crutches while using passive orthosis, which produced bigger loads in upper extremities musculature. The inverse dynamics approach was chosen to calculate and investigate the loads applied to the upper extremities. The result of this calculation has proven that all main muscle groups are engaged more aggressively and indicate more energy consumption during passive walking. The new @halo device is the first powered exoskeleton for lower limbs with just one actuated degree of freedom for users with paraplegia.První část práce je věnována obsáhlému úvodu do zdravotnické a biomechanické terminologie a detailnímu souhrnnému představení ortopedických pomůcek. Následně jsou představeny dva nově vyvinuté exoskelety aplikovatelné na dolní končetiny paraplegiků. Bylo zjištěno, že hlavní úskalí konstrukčního návrhu asistenčních zařízení pro paraplegiky lze shrnout do tří hlavních skupin, jako první je stabilita a komfort, druhá je vysoká účinnost a nízká energetická náročnost uživatele a do třetí lze zahrnout rozměry a hmotnost zařízení. Toto všechno je navíc podmíněno přijatelnou výslednou cenou produktu. Nový ekonomicky dostupný exoskelet pro paraplegiky, který řeší problematiku všech tří zmíněných skupin je představen v této práci. Hlavní myšlenka tohoto zařízení je postavena na mechanismu HALO ortézy. HALO je kompaktní pasivní ortéza s mediálním kyčelním kloubem umístěným uprostřed mezi dolními končetinami. Speciální mediální kyčelní kloub je kontralaterálně propojen s kotníkem soustavou ocelových lanek což zajištuje paralelní polohu chodidla se zemí v každém okamžiku chůze a navíc asistuje zhoupnutí končetiny. Tento mediální kyčelní kloub je redesignován a v novém provedení je vybaven jedním aktuátorem, nové řešení aktivního exoskeletu dostalo název @halo. Díky tomuto vylepšení lze dosáhnout stabilnější a plynulejší chůze s výrazně redukovanou energetickou náročností uživatele přičemž dochází k zachování nízké hmotnosti a kompaktnosti zařízení. Toto bylo dokázáno během předběžných experimentů se zdravými subjekty, během kterých byla testována aktivní chůze se zařízením vybaveným odnímatelnou pohonnou jednotkou a pasivní chůze se stejným zařízením bez této aktivní jednotky. Nadměrné naklánění se během chůze ze strany na stranu a nadměrná výchylka pohybu těžiště těla ve vertikálním směru byly sníženy o necelých 40% s velmi významně menšími standardními odchylkami v případě chůze s pohonem. Z rozdílu výchylky pohybu těžiště těla ve vertikální poloze bylo vypočítáno snížení energetické náročnosti uživatele o 52% při chůzi s aktivní konfiguraci @halo. Při pohybu s pasivní ortézou byl naměřen o 38,5% větší reakční silový impuls v berlích, což znamená nárůst zátěže pro svalový aparát horních končetin. Pro podrobné vyšetření zátěže ramenních kloubů byl aplikován model inverzní dynamiky. Výsledek tohoto výpočtu jednoznačně indikuje agresivnější a hlubší zapojení všech svalových skupin ramenního kloubu a tím vyšší spotřebu energie uživatelem během pasivní chůze. Nové asistenční zařízení @halo je prvním exoskeletem svého druhu pro paraplegiky s jediným poháněným stupněm volnosti.354 - Katedra robotikyvyhově