The application of precisely controlled functional electrical stimulation to the shoulder, elbow and wrist for upper limb stroke rehabilitation: a feasibility study

Abstract

BackgroundFunctional electrical stimulation (FES) during repetitive practice of everyday tasks can facilitate recovery of upper limb function following stroke. Reduction in impairment is strongly associated with how closely FES assists performance, with advanced iterative learning control (ILC) technology providing precise upper-limb assistance. The aim of this study is to investigate the feasibility of extending ILC technology to control FES of three muscle groups in the upper limb to facilitate functional motor recovery post-stroke.MethodsFive stroke participants with established hemiplegia undertook eighteen intervention sessions, each of one hour duration. During each session FES was applied to the anterior deltoid, triceps, and wrist/finger extensors to assist performance of functional tasks with real-objects, including closing a drawer and pressing a light switch. Advanced model-based ILC controllers used kinematic data from previous attempts at each task to update the FES applied to each muscle on the subsequent trial. This produced stimulation profiles that facilitated accurate completion of each task while encouraging voluntary effort by the participant. Kinematic data were collected using a Microsoft Kinect, and mechanical arm support was provided by a SaeboMAS. Participants completed Fugl-Meyer and Action Research Arm Test clinical assessments pre- and post-intervention, as well as FES-unassisted tasks during each intervention session.ResultsFugl-Meyer and Action Research Arm Test scores both significantly improved from pre- to post-intervention by 4.4 points. Improvements were also found in FES-unassisted performance, and the amount of arm support required to successfully perform the tasks was reduced.ConclusionsThis feasibility study indicates that technology comprising low-cost hardware fused with advanced FES controllers accurately assists upper limb movement and may reduce upper limb impairments following stroke.

Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study

“…The main advantage of this approach is the simplicity of the setup, with only 1 Degree of Freedom (DoF). However, to maximize the treatment’s outcomes and achieve functional improvement it is necessary to train actions with higher range of motion (> 1 DoF) and functional connotations [8, 9]. Yet, the complexity for driving a successful movement execution in such scenarios requires the implementation of a robust and reliable FES controller.…”

Iterative learning control with applications in energy generation, lasers and health care

“…Clearly, the three-dimensional robotic system described in this section is not suitable for this purpose but there has been research undertaken using a Kinect motion capture device that could with sufficient onward development produce equipment that can be taken home by the patient. Progress to-date is given in [11] and supporting clinical trial data in [45].…”

Robust compensation of electromechanical delay during neuromuscular electrical stimulation of antagonistic muscles

“…Similarly, upper-limb movements such as elbow or wrist flexion and extension would require FES of antagonistic pairs (e.g., biceps and triceps muscles). In recent years, iterative learning control (ILC) was used for FES applications for upper limbs [22][23][24][25]. In these studies, the stimulation was applied to triceps and anterior-deltoids muscles.…”

“…A proportional-derivative (PD)-type closed-loop controller with delay compensation (DC) to deal with the EMD was designed for stimulating antagonistic muscle pairs in a musculoskeletal system. Unlike previous controllers that produce joint flexion with the help of gravity [9,18,19] or controlled by correctional forces such as robot arms [22,24], the developed controller will flex and extend a limb joint by stimulating agonist and antagonist muscles. The controller is designed to transition smoothly between the stimulation of the antagonist muscles.…”