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

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

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

Genetic Algorithms Based Approach for Designing Spring Brake Orthosis – Part Ii: Control of FES Induced Movement

Spring brake orthotic swing phase for paraplegic gait is initiated through releasing the brake on the knee mounted with a torsion spring. The stored potential energy in the spring, gained from the previous swing phase, is solely responsible for swing phase knee flexion. Hence the later part of the SBO operation, functional electrical stimulation (FES) assisted extension movement of the knee has to serve an additional purpose of restoring the spring potential energy on the fly. While control of FES induced movement as such is often a challenging task, a torsion spring, being antagonistically paired up with the muscle actuator, as in spring brake orthosis (SBO), only adds to the challenge. Two new schemes are proposed for the control of FES induced knee extension movement in SBO assisted swing phase. Even though the control schemes are closed-loop in nature, special attention is paid to accommodate the natural dynamics of the mechanical combination being controlled (the leg segment) as a major role playing feature. The schemes are thus found to be immune from some drawbacks associated with both closed-loop tracking as well as open-loop control of FES induced movement. A leg model including the FES knee joint model of the knee extensor muscle vasti along with the passive properties is used in the simulation. The optimized parameters for the SBO spring are obtained from the earlier part of this work. Genetic algorithm (GA) and multi-objective GA (MOGA) are used to optimize the parameters associated with the control schemes with minimum fatigue as one of the control objectives. The control schemes are evaluated in terms of three criteria based on their ability to cope with muscle fatigue

Effect of Dynamic Platform Lateral Step-Up versus Stable Platform Lateral Step-Up Weight Bearing Exercise in Hip Abductor Strengthening on Healthy Male Volunteers - Randomized Clinical Trial

Objective & Background: To determine the effect of the dynamic platform lateral step-up and stable platform lateral step-up weight bearing standing exercise in strengthening of hip abductor. Many researchers have reported that strengthening of hip muscles as important component especially hip abductors in lower extremity rehabilitation program. Study Design: Single blinded randomized comparative clinical trial. Methodology: Sixty five healthy college going male subjects (Age group of 18 – 24 years) volunteered for this study. They were randomly assigned to one of the 2 groups. One group received the dynamic platform lateral step-up and the other received stable platform lateral step-up weight bearing standing exercise. The strength measurements were recorded using hand held dynamometer. Results: The results indicate that both groups had a positive effect on the outcome measures. The strength of hip abductors in dynamic platform group improved from a mean value (SD) of 19.47(3.59) to 26.93(3.19) and in stable platform group from 19.07(2.32) to 22.67(2.46). Significant difference is also observed between the two groups at p value .05. Conclusion: The study shows that dynamic platform lateral step-up exercise is more beneficial than stable platform lateral step-up weight bearing standing exercise in improving hip abductor muscle strength

The Effects of Balance Retraining Exercises on the Neurocom Balance Master® in Subjects with Multiple Sclerosis

Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system (CNS) and is becoming an increasing concern for individuals between the ages of 15 to 50. Multiple sclerosis is a chronic, often progressive disease that may result in difficulties with vision, verbal communication, sensation, bowel and bladder function, balance, and ambulation. The purpose of this study was to determine if significant changes occurred in static steadiness, symmetry, and dynamic stability in subjects with MS following a retraining program using the NeuroCom Balance Master® (NBM®). Ten subjects (6 females, 4 males) were placed in a control or treatment group. The NBM® was used to assess each subject\u27s balance at week one and four, and was also used in the retraining program for the treatment group three times per week for four weeks. Results showed a significant difference between groups in two components of the dynamic stability tests: endpoint excursion forward (p = .042) and maximum excursion endpoint forward (p = .029). No significant difference was found in static steadiness or symmetry between groups. The variability among subjects in the MS population pool, the small sample size, and the four-week time frame may have been limiting factors in this study. Further research is needed to determine the effectiveness of a balance retraining program using the NBM®

Neuromotor Control of the Hand During Smartphone Manipulation

The primary focus of this dissertation was to understand the motor control strategy used by our neuromuscular system for the multi-layered motor tasks involved during smartphone manipulation. To understand this control strategy, we recorded the kinematics and multi-muscle activation pattern of the right limb during smartphone manipulation, including grasping with/out tapping, movement conditions (MCOND), and arm heights. In the first study (chapter 2), we examined the neuromuscular control strategy of the upper limb during grasping with/out tapping executed with a smartphone by evaluating muscle-activation patterns of the upper limb during different movement conditions (MCOND). There was a change in muscle activity for MCOND and segments. We concluded that our neuromuscular system generates the motor strategy that would allow smartphone manipulation involving grasping and tapping while maintaining MCOND by generating continuous and distinct multi-muscle activation patterns in the upper limb muscles. In the second study (chapter 3), we examined the muscle activity of the upper limb when the smartphone was manipulated at two arm heights: shoulder and abdomen to understand the influence of the arm height on the neuromuscular control strategy of the upper limb. Some muscles showed a significant effect for ABD, while some muscle showed a significant effect for SHD. We concluded that the motor control strategy was influenced by the arm height as there were changes in the shoulder and elbow joint angles along with the muscular activity of the upper limb. Further, shoulder position helped in holding the head upright while abdomen reduced the moment arm and moment and ultimately, muscle loading compared to the shoulder. Overall, our neuromuscular system generates motor command by activating a multi-muscle activation pattern in the upper limb, which would be dependent upon the task demands such as grasping with/out tapping, MCOND, and arm heights. Similarly, our neuromuscular system does not appear to increase muscle activation when there is a combined effect of MCOND and arm heights. Instead, it utilizes a simple control strategy that would select an appropriate muscle and activate them based on the levels of MCOND and arm heights