Muscle selection and walking performance of multichannel FES systems for ambulation in paraplegia

Kobetic, Rudi; Triolo, Ronald J.; Marsolais, E.B.

doi:10.1109/86.559346

Cited by 161 publications

(93 citation statements)

References 9 publications

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“…6,7,9,31,32 However, up to now the implanted FES systems did not achieve a break-through mainly due to the fact that they can be implanted only 18 ± 24 months after injury when the patients are in chronic state. However, after this time the rehabilitation and the training of ADL have been completed and the patient and his/her family are already accustomed to the actual impairment of the patient.…”

Section: Implanted Versus Surface Fes Systemsmentioning

confidence: 99%

“…Since 1961 a number of neuroprostheses for walking have been designed and tested with various patients. These devices can be divided into the systems that were designed to compensate for the`drop foot' problem such as Fepa, 42 MikroFES, 43 WalkAid, 29 and Odstock 2, 30 and the systems that facilitate walking in subjects who have both legs paralyzed such as Parastep, 27,28 RGO,44,45 HAS, 46 Praxis 24,31 and the systems proposed by Kralj et al 47 and Kobetic et al 9,32 The`drop foot' FES systems predominantly apply the surface stimulation technology (one generation of the Fepa system had an implanted electrode but this idea was abandoned in favor of the surface stimulation 42 ) with one, or at most two, stimulation channels. The stimulation sequences are triggered with a push button, foot switch, or a pendulum resistor.…”

Section: Existing Neuroprosthesesmentioning

confidence: 99%

“…Both these systems were designed to provide walking and standing functions similar to the previously mentioned surface stimulation systems. 9,32,47 The di erence is that these two systems are implanted and therefore should provide better stimulation selectivity and more natural walking patterns. Both the Praxis24 and the system proposed by Kobetic et al 32 are used for research purposes and are not commercially available.…”

Section: Existing Neuroprosthesesmentioning

confidence: 99%

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Functional electrical stimulation for grasping and walking: indications and limitations

et al. 2001

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This review describes the state of art in the ®eld of Functional Electrical Stimulation (FES) and its impact on improving grasping and walking functions in acute and chronic Spinal Cord Injured (SCI) patients. It is argued that during the early rehabilitation period the FES systems with surface stimulation electrodes should be used to assist training of hand and leg movements in SCI patients. Our clinical trials have shown that a number of acute SCI patients with impaired walking and grasping functions could improve these functions due to training with an adjustable FES system to the point that they ®nally did not need the FES system to carry out these tasks. Other acute SCI patients, who did not recover the desired function, were enabled to perform either walking or grasping with the FES assistance. We believe that the subjects who can perform grasping or walking with the help of FES, and still use the neuroprosthesis 6 months after being subjected to the FES training, should consider the FES system as a prosthetic device in Activities of Daily Living (ADL). Despite the signi®cant technical progress achieved in the last 10 to 15 years in the FES ®eld, there is a general consensus that these systems are not su ciently advanced and that they need further development. The limited acceptance of the FES technology can be in part explained by the fact that it is not completely mature and that the patients still require daily assistance to use the FES systems. Nevertheless the present FES treatments combined with conventional occupational and physical therapy still remain the most promising approach in rehabilitating SCI patients. In this review, advantages and limitations of di erent FES systems that are used to restore grasping and walking functions are discussed. Spinal Cord (2001) 39, 403 ± 412

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Section: Implanted Versus Surface Fes Systemsmentioning

confidence: 99%

Section: Existing Neuroprosthesesmentioning

confidence: 99%

Section: Existing Neuroprosthesesmentioning

confidence: 99%

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Functional electrical stimulation for grasping and walking: indications and limitations

et al. 2001

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“…The FES system developed by Kralj et al in 1983 proposed closed-loop stimulation of the quadriceps muscle group and the peroneal nerves to achieve paraplegic gait [30]. The last two decades have seen the development of several FES systems based on the designs of Kantrowitz and Liberson [31][32][33][34][35][36][37][38], and the recent advances in FES technology offer the possibility of achieving more complex and efficient stimulation. The control of FES systems has been improved through multichannel stimulators that can be combined with percutaneous and implanted electrodes.…”

Section: Functional Electrical Stimulation-aided Gaitmentioning

confidence: 99%

Review of hybrid exoskeletons to restore gait following spinal cord injury

del-Ama¹,

Koutsou²,

Moreno³

et al. 2012

JRRD

146

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Abstract-Different approaches are available to compensate gait in persons with spinal cord injury, including passive orthoses, functional electrical stimulation (FES), and robotic exoskeletons. However, several drawbacks arise from each specific approach. Orthotic gait is energy-demanding for the user and functionally ineffective. FES uses the muscles as natural actuators to generate gait, providing not only functional but also psychological benefits to the users. However, disadvantages are also related to the early appearance of muscle fatigue and the control of joint trajectories. Robotic exoskeletons that provide joint moment compensation or substitution to the body during walking have been developed in recent years. Significant advances have been achieved, but the technology itself is not mature yet because of many limitations related to both physical and cognitive interaction as well as portability and energy-management issues. Meanwhile, the combination of FES technology and exoskeletons has emerged as a promising approach to both gait compensation and rehabilitation, bringing together technologies, methods, and rehabilitation principles that can overcome the drawbacks of each individual approach. This article presents an overview of hybrid lower-limb exoskeletons, related technologies, and advances in actuation and control systems. Also, we highlight the functional assessment of individuals with spinal cord injury.

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“…Participant iSCI-2 received an IRS with eight stimulating electrodes only on his left side to recruit iliopsoas, vastus intermedius and lateralis, tensor fasciae latae, gluteus medius (GM), gluteus maximus, posterior portion of adductor magnus, and TA (two electrodes). We customized temporal patterns of stimulation to activate the muscles for their particular gait deficits according to established tuning procedures to achieve forward stepping in a rolling walker [18][19]. The participants completed 6 weeks of overground gait training (2 h sessions, 3 times a week) using the implanted FES system with the help of a physical therapist.…”

Section: Participantsmentioning

confidence: 99%

An objective method for selecting command sources for myoelectrically triggered lower-limb neuroprostheses

Dutta¹,

Kobetic²,

Triolo³

2011

JRRD

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Abstract-Functional electrical stimulation (FES) facilitates ambulatory function after paralysis of persons with spinal cord injury (SCI) by exciting the peripheral motor nerves to activate the muscles of the lower limbs. This study identified a process for selecting command sources for triggering FES with the surface electromyogram (EMG) from muscles partially paralyzed by incomplete SCI, given its high degree of intersubject variability. We found Discriminability Index (DI) to be a good metric to evaluate the potential of controlling FES-assisted ambulation in four nondisabled volunteers and two participants with incomplete paralysis. The left erector spinae (ES) (mean DI = 0.87) for triggering the left step and the right ES (mean DI = 0.83) for triggering the right step were the best command sources for participant 1. The left ES (mean DI = 0.93) for triggering the left step and the right medial gastrocnemius (mean DI = 0.88) for triggering the right step were the best command sources for participant 2. Our results showed that command sources can be selected objectively from surface EMG before a fully implantable EMG-triggered FES system for walking is implemented.

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Muscle selection and walking performance of multichannel FES systems for ambulation in paraplegia

Cited by 161 publications

References 9 publications

Functional electrical stimulation for grasping and walking: indications and limitations

Functional electrical stimulation for grasping and walking: indications and limitations

Review of hybrid exoskeletons to restore gait following spinal cord injury

An objective method for selecting command sources for myoelectrically triggered lower-limb neuroprostheses

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