Functional Rehabilitation: Coordination of Artificial and Natural Controllers

International audienceWalking and standing abilities, though important for quality of life and participation in social and economic activities, can be adversely affected by central nervous system (CNS) disorders such as spinal cord injury, stroke or traumatic brain injury. One characteristic of motor deficiencies which affect lower extremities is their impact on both static and dynamic postural equilibrium. Depending on the impairment level, functional rehabilitation techniques may be needed for a patient to stand up and walk (Popovic and Sinkjær, 2003). Functional electrical stimulation (FES) can induce contraction of skeletal muscles by applying electrical stimuli to sensory-motor system via electrodes which can be placed on the skin (Kralj et al., 1983), or implanted (Guiraud et al., 2006). FES applications applied to lower limbs include foot drop correction, single joint control, cycling, standing up, walking... (Zhang and Zhu, 2007)..

Nonlinear robust control of functional electrical stimulation system for paraplegia

The study was directed towards enhancing Functional Electrical Stimulation (FES) for sit-to-stand movement restoration in paraplegia subjects. The scarcity of FES assistive devices was due to the inability of the developed equipment to attain clinical acceptance. Applications of control systems have shown fruitful results. And based on the literature, further improvements in model, trajectory and control systems are needed. Model with a higher level of accuracy and continuous as well as bump-free trajectories are essential ingredients for better control systems. The control systems can be enhanced by giving considering to changes in mass of the subject, disturbance rejection and stability. Hence, the comprehensive control scheme is necessary for this application as well as a better model and trajectory. In modelling an additional joint has been considered to improve the accuracy. In trajectory planning, the six-order polynomial has been used to refine the desired trajectory. The comprehensive control systems have been designed with consideration of robustness, disturbance rejection, and stability. Three nonlinear control approaches have been investigated; the Sliding Mode Control (SMC), Feedback Linearisation Control (FLC), and Back-Stepping Control (BSC). Results reveal improvements in the accuracy of the kinematic model by 24%, and the dynamic model by 47%. The trajectory planning parameters are continuous, and not susceptible to jerks or spikes. Execution time enhanced by 11%, the upper and lower terminal velocities improved by 16.9% and 20.9% respectively. The system response without disturbance shows good results with the SMC, FLC, and BSC. Revelations by robustness examination also maintain remarkable enhancements in the parameters with both 53% and 126% mass. The results for disturbance rejection examinations with fatigue, spasm, tremor, and combined disturbance effects showed sustenance of refinement in the response parameters. Therefore, indicating improvements despite the changes to the system. The BSC showed the best performance, followed by the FLC, and the SMC. Hence, the BSC is recommended for such systems

Novel instrumented frame for standing exercising of users with complete spinal cord injuries

This paper describes a Functional Electrical Stimulation (FES) standing system for rehabilitation of bone mineral density (BMD) in people with Spinal Cord Injury (SCI). BMD recovery offers an increased quality of life for people with SCI by reducing their risk of fractures. The standing system developed comprises an instrumented frame equipped with force plates and load cells, a motion capture system, and a purpose built 16-channel FES unit. This system can simultaneously record and process a wide range of biomechanical data to produce muscle stimulation which enables users with SCI to safely stand and exercise. An exergame provides visual feedback to the user to assist with upper-body posture control during exercising. To validate the system an alternate weight-shift exercise was used; 3 participants with complete SCI exercised in the system for 1 hour twice-weekly for 6 months. We observed ground reaction forces over 70% of the full body-weight distributed to the supporting leg at each exercising cycle. Exercise performance improved for each participant by an increase of 13.88 percentage points of body-weight in the loading of the supporting leg during the six-month period. Importantly, the observed ground reaction forces are of higher magnitude than other studies which reported positive effects on BMD. This novel instrumentation aims to investigate weight bearing standing therapies aimed at determining the biomechanics of lower limb joint force actions and postural kinematics

Adaptive control for wearable robots in human-centered rehabilitation tasks

Robotic rehabilitation therapies have been improving by providing the needed assistance to the patient, in a human-centered environment, and also helping the therapist to choose the necessary procedure. This thesis presents an adaptive "Assistance-as-needed" strategy which adheres to the specific needs of the patient and with the inputs from the therapist, whenever needed. The exertion of assistive and responsive behavior of the lower limb wearable robot is dedicated for the rehabilitation of incomplete spinal cord injury (SCI) patients. The main objective is to propose and evaluate an adaptive control model on a wearable robot, assisting the user and adhering to their needs, with no or less combination of external devices. The adaptation must be more interactive to understand the user needs and their volitional orders. Similarly, by using the existing muscular strength, in incomplete SCI patients, as a motivation to pursue the movement and assist them, only when needed. The adaptive behavior of the wearable robot is proposed by monitoring the interaction and movement of the user. This adaptation is achieved by modulating the stiffness of the exoskeleton in function of joint parameters, such as positions and interaction torques. These joint parameters are measured from the user independently and then used to update the new stiffness value. The adaptive algorithm performs with no need of external sensors, making it simple in terms of usage. In terms of rehabilitation, it is also desirable to be compatible with combination of assistive devices such as muscle stimulation, neural activity (BMI) and body balance (Wii), to deliver a user friendly and effective therapy. Combination of two control approaches has been employed, to improve the efficiency of the adaptive control model and was evaluated using a wearable lower limb exoskeleton device, H1. The control approaches, Hierarchical and Task based approach have been used to assist the patient as needed and simultaneously motivate the patient to pursue the therapy. Hierarchical approach facilitates combination of multiple devices to deliver an effective therapy by categorizing the control architecture in two layers, Low level and High level control. Task-based approaches engage in each task individually and allow the possibility to combine them at any point of time. It is also necessary to provide an interaction based approach to ensure the complete involvement of the user and for an effective therapy. By means of this dissertation, a task based adaptive control is proposed, in function of human-orthosis interaction, which is applied on a hierarchical control scheme. This control scheme is employed in a wearable robot, with the intention to be applied or accommodated to different pathologies, with its adaptive capabilities. The adaptive control model for gait assistance provides a comprehensive solution through a single implementation: Adaptation inside a gait cycle, continuous support through gait training and in real time. The performance of this control model has been evaluated with healthy subjects, as a preliminary study, and with paraplegic patients. Results of the healthy subjects showed a significant change in the pattern of the interaction torques, elucidating a change in the effort and adaptation to the user movement. In case of patients, the adaptation showed a significant improvement in the joint performance (flexion/extension range) and change in interaction torques. The change in interaction torques (positive to negative) reflects the active participation of the patient, which also explained the adaptive performance. The patients also reported that the movement of the exoskeleton is flexible and the walking patterns were similar to their own distinct patterns. The presented work is performed as part of the project HYPER, funded by Ministerio de Ciencia y Innovación, Spain. (CSD2009 - 00067 CONSOLIDER INGENIOLas terapias de rehabilitación robóticas han sido mejoradas gracias a la inclusión de la asistencia bajo demanda, adaptada a las variaciones de las necesidades del paciente, así como a la inclusión de la ayuda al terapeuta en la elección del procedimiento necesario. Esta tesis presenta una estrategia adaptativa de asistencia bajo demanda, la cual se ajusta a las necesidades específicas del paciente junto a las aportaciones del terapeuta siempre que sea necesario. El esfuerzo del comportamiento asistencial y receptivo del robot personal portátil para extremidades inferiores está dedicado a la rehabilitación de pacientes con lesión de la médula espinal (LME) incompleta. El objetivo principal es proponer y evaluar un modelo de control adaptativo en un robot portátil, ayudando al usuario y cumpliendo con sus necesidades, en ausencia o con reducción de dispositivos externos. La adaptación debe ser más interactiva para entender las necesidades del usuario y sus intenciones u órdenes volitivas. De modo similar, usando la fuerza muscular existente (en pacientes con LME incompleta) como motivación para lograr el movimiento y asistirles solo cuando sea necesario. El comportamiento adaptativo del robot portátil se propone mediante la monitorización de la interacción y movimiento del usuario. Esta adaptación conjunta se consigue modulando la rigidez en función de los parámetros de la articulación, tales como posiciones y pares de torsión. Dichos parámetros se miden del usuario de forma independiente y posteriormente se usan para actualizar el nuevo valor de la rigidez. El desempeño del algoritmo adaptativo no requiere de sensores externos, lo que favorece la simplicidad de su uso. Para una adecuada rehabilitación, efectiva y accesible para el usuario, es necesaria la compatibilidad con diversos mecanismos de asistencia tales como estimulación muscular, actividad neuronal y equilibrio corporal. Para mejorar la eficiencia del modelo de control adaptativo se ha empleado una combinación de dos enfoques de control, y para su evaluación se ha utilizado un exoesqueleto robótico H1. Los enfoques de control Jerárquico y de Tarea se han utilizado para ayudar al usuario según sea necesario, y al mismo tiempo motivarle para continuar el tratamiento. Enfoque jerárquico facilita la combinación de múltiples dispositivos para ofrecer un tratamiento eficaz mediante la categorización de la arquitectura de control en dos niveles : el control de bajo nivel y de alto nivel. Los enfoques basados en tareas involucran a la persona en cada tarea individual, y ofrecen la posibilidad de combinarlas en cualquier momento. También es necesario proporcionar un enfoque basado en la interacción con el usuario, para asegurar su participación y lograr así una terapia eficaz. Mediante esta tesis, proponemos un control adaptativo basado en tareas y en función de la interacción persona-ortesis, que se aplica en un esquema de control jerárquico. Este esquema de control se emplea en un robot portátil, con la intención de ser aplicado o acomodado a diferentes patologías, con sus capacidades de adaptación. El modelo de control adaptativo propuesto proporciona una solución integral a través de una única aplicación: adaptación dentro de la marcha y apoyo continúo a través de ejercicios de movilidad en tiempo real. El rendimiento del modelo se ha evaluado en sujetos sanos según un estudio preliminar, y posteriormente también en pacientes parapléjicos. Los resultados en sujetos sanos mostraron un cambio significativo en el patrón de los pares de interacción, elucidando un cambio en la energía y la adaptación al movimiento del usuario. En el caso de los pacientes, la adaptación mostró una mejora significativa en la actuación conjunta (rango de flexión / extensión) y el cambio en pares de interacción. El cambio activo en pares de interacción (positivo a negativo) refleja la participación activa del paciente, lo que también explica el comportamiento adaptativo

Biped locomotion control through a biologically-inspired closed-loop controller

Dissertação de mestrado integrado em Engenharia BiomédicaCurrently motor disability in industrialized countries due to neural and physical impairments is an increasingly worrying phenomenon and the percentage of patients is expected to be increasing continuously over the coming decades due to a process of ageing the world is undergoing. Additionally, rising retirement ages, higher demand of elderly people for an independent, dignified life and mobility, huge cost in the provision of health care are some other determinants that motivate the restoration of motor function as one of the main goals of rehabilitation. Modern concepts of motor learning favor a task-specific training in which all movements in daily life should be trained/assisted repetitively in a physically correct fashion. Considering the functional activity of the neuronal circuits within the spinal cord, namely the central pattern generator (CPG), as the foundation to human locomotion, motor relearning should be based on intensive training strategies directed to the stimulation and reorganization of such neural pathways through mechanisms addressed by neural plasticity. To this end, neuromodelings are required to simulate the human locomotion control to overcome the current technological challenges such as developing smaller, intelligent and cost-effective devices for home and work rehabilitation scenarios which can enable a continuous therapy/ assistance to guide the impaired limbs in a gentle manner, avoiding abrupt perturbations and providing as little assistance as necessary. Biomimetic models, taking neurological and biomechanical inspiration from biological animals, have been embracing these challenges and developing effective solutions on refining the locomotion models in terms of energy efficiency, simplicity in the structure and robust adaptability to environment changes and unexpected perturbations. Thus, the aim target of this work is to study the applicability of the CPG model for gait rehabilitation, either for assistance and/or therapy purposes. Focus is developed on the locomotion control to increase the knowledge of the underlying principles useful for gait restoration, exploring the brainstem-spinal-biomechanics interaction more fully. This study has great application in the project of autonomous robots and in the rehabilitation technology, not only in the project of prostheses and orthoses, but also in the searching of procedures that help to recuperate motor functions of human beings. Encouraging results were obtained which pave the way towards the simulation of more complex behaviors and principles of human locomotion, consequently contributing for improved automated motor rehabilitation adapted to the rehabilitation emerging needs.Actualmente a debilidade motora em países industrializados devido a deficiências neurais e físicas é um fenómeno crescente de apreensão sendo expectável um contínuo aumento do rácio de pacientes nas próximas décadas devido ao processo de envelhecimento. Inclusivé, o aumento da idade de reforma, a maior procura por parte dos idosos para uma mobilidade e vida autónoma e condigna, o elevado custo nos cuidados de saúde são incentivos para a restauração da função motora como um dos objectivos principais da reabilitação. Conceitos recentes de aprendizagem motora apoiam um treino de tarefas específicas no qual movimentos no quotidiano devem ser treinados/assistidos de forma repetitiva e fisicamente correcta. Considerando a actividade funcional dos circuitos neurais na medula, nomeadamente o gerador de padrão central (CPG), como a base da locomoção, a reaprendizagem motora deve-se basear em estratégias intensivas de treino visando a estimulação e reorganização desses vias neurais através de mecanismos abordados pela plasticidade neural. Assim, são necessários modelos neurais para simular o controlo da locomoção humana de modo a superar desafios tecnológicos actuais tais como o desenvolvimento de dispositivos mais compactos, inteligentes e económicos para os cenários de reabilitação domiciliar e laboral que podem permitir uma terapia/assistência contínua na guia dos membros debilitados de uma forma suave, evitando perturbações abruptas e fornecendo assistência na medida do necessário. Modelos biomiméticos, inspirando-se nos princípios neurológicos e biomecânicos dos animais, têm vindo a abraçar esses desafios e a desenvolver soluções eficazes na refinação de modelos de locomoção em termos da eficiência de energia, da simplicidade na estrutura e da adaptibilidade robusta face a alterações ambientais e perturbações inesperadas. Então, o objectivo principal do trabalho é estudar a aplicabilidade do modelo de CPG para a reabilitação da marcha, para efeitos de assistência e/ou terapia. É desenvolvido um foco no controlo da locomoção para maior entendimento dos princípios subjacentes úteis para a recuperação da marcha, explorando a interacção tronco cerebral-espinal medula-biomecânica de forma mais detalhada. Este estudo tem potencial aplicação no projecto de robôs autónomos e na tecnologia de reabilitação, não só no desenvolvimento de ortóteses e próteses, mas também na procura de procedimentos úteis para a recuperação da função motora. Foram obtidos resultados promissores susceptíveis de abrir caminho à simulação de comportamentos e princípios mais complexos da marcha, contribuindo consequentemente para uma aprimorada reabilitação motora automatizada adaptada às necessidades emergentes

The Development of an assistive chair for elderly with sit to stand problems

A thesis submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Doctor of PhilosophyStanding up from a seated position, known as sit-to-stand (STS) movement, is one of the most frequently performed activities of daily living (ADLs). However, the aging generation are often encountered with STS issues owning to their declined motor functions and sensory capacity for postural control. The motivated is rooted from the contemporary market available STS assistive devices that are lack of genuine interaction with elderly users. Prior to the software implementation, the robot chair platform with integrated sensing footmat is developed with STS biomechanical concerns for the elderly. The work has its main emphasis on recognising the personalised behavioural patterns from the elderly users’ STS movements, namely the STS intentions and personalised STS feature prediction. The former is known as intention recognition while the latter is defined as assistance prediction, both achieved by innovative machine learning techniques. The proposed intention recognition performs well in multiple subjects scenarios with different postures involved thanks to its competence of handling these uncertainties. To the provision of providing the assistance needed by the elderly user, a time series prediction model is presented, aiming to configure the personalised ground reaction force (GRF) curve over time which suggests successful movement. This enables the computation of deficits between the predicted oncoming GRF curve and the personalised one. A multiple steps ahead prediction into the future is also implemented so that the completion time of actuation in reality is taken into account

Physical Capacity, Function and Quality of Life in Participants with Stroke and Spinal Cord Injury in a Community Exercise Program

The primary aim of this thesis is to examine the effect of exercise training and physical capacity on function and quality of life in people with spinal cord injury (SCI) and stroke participating in a community-based exercise program. To achieve this aim, this thesis includes a systematic review on SCI and a systematic review on stroke. Based on a combination of aerobic and muscle strength training we defined the criteria for both systematic reviews to analyse the effectiveness of this type of intervention in improving aerobic fitness, muscle strength, physical activity levels, function and quality of life in people with SCI and in people following stroke. Results from the systematic review on SCI provide initial evidence of significant improvements in muscle strength with this type of intervention and also that the ideal dose for muscle strength training would be 50 to 80% 1RM with progression applied. The systematic review on stroke revealed that this type of intervention was effective in improving muscle strength, but only when the training was specific to target muscle groups. Two cross-sectional studies were conducted for people with SCI and people with stroke examining the relationship between exercise training and physical capacity on function and quality of life. Muscle strength seemed to be an important determinant of functional outcomes in both people with SCI and people with stroke. As far as aerobic fitness, physical activity level and its relationship with functional outcomes, further research is needed for conclusions in both SCI and stroke. Finally, influence of functional outcomes on quality of life needs further research to allow any conclusions