Design and evaluation of artificial controllers assisting voluntary balance performance in paraplegia and in stroke

The mobility impairment caused by a paralysis like a spinal cord injury or a stroke has, beside many other impacts, an influence on the transfer of signals between the muscles of the lower extremities and the brain. In a paraplegic person, this means that she or he can not stand without holding onto a support or standing in a standing frame while the impact on the ability to balance in a hemiplegic person can be less severe. Although the connection between the muscles and the brain is impaired by the injury, the muscles still retain the ability to contract if innervated. This thesis describes control approaches which combine the remaining voluntary control of the paraplegic and stroke patients with the artificially controlled stimulation of the muscles of the paralysed limbs to aid the subject in balancing. The aim was to develop new control approaches which would assist balance in paraplegic subjects and in stroke. To support standing in paraplegic subjects, the moment generated at the ankle using electrical stimulation of the shank muscles was integrated with the voluntary control of the upper body, resulting in the concept of Integrated Voluntary Control (IVC). In the outer loop the ankle moment produced by the paraplegic subject due to his voluntary upper body movement was estimated using a mathematical model based on the inclination angles of upper and lower body. This estimated ankle moment was then compared with the actual moment applied at the force plates the subject was standing on, and an appropriate stimulation signal was applied to the paralysed shank muscles. Experimental evaluation initially involved four able bodied volunteers in which base line results with stiffness and stiffness-viscosity controllers using a rotating standing platform were obtained. This was extended to the paraplegic subject, where electrical muscle stimulation was used to generate the required ankle moment. The IVC concept was then evaluated with the paraplegic subject and compared to the base line results. Due to the nature of the system and implied perturbation onto the control system controlling the posture of the paraplegic subject the known evaluation values (e.g. rise time, steady state value, overshoot value etc.) are not suitable. Therefore, the variance of a time signal around its mean value was used as an evaluation value which allowed to compare the achieved performance of the paraplegic subject employing the new control approach with the stiffness and stiffness-viscosity controllers directly. To assist balance in stroke patients, a new training approach was introduced based on the concept of integrating the voluntary abilities of the patient with mechanical balance support and sensory electrical stimulation. This concept was evaluated in a training program with one stroke subject which demonstrated the feasibility and potential balance improvement resulting from this approach.EThOS - Electronic Theses Online ServiceGBUnited Kingdo