Closed-Loop Functional Electrical Stimulation for Gait Training for Patients with Paraplegia

This paper presents a novel functional electrical stimulation paradigm to generate locomotion in paraplegic patients. We propose a closed-loop surface functional electrical stimulation (sFES) of 16 lower-limb muscles to produce all subphases of the gait. The reproduction of cyclic and coordinated joint-movements is a challenge, especially if synchronic and synergic lower-limbs muscular contraction is considered. This paper presents the implementation and validation of a sFES closed-loop position control and the pilot clinical tests with a chronic, motor complete (ASIA B) SCI patient. We demonstrate that the patient can safely use our setup to produce a physiologically correct gait with minimal external help. The implemented sFES-gait training was beneficial to see an improvement in gait kinematics. The integration of the proposed setup with a neurorehabilitation protocol has the potential to become a valuable locomotion therapy for SCI patients.

[1]  Muhammad Abd-El-Barr,et al.  Long-term Training With a Brain-Machine Interface-Based Gait Protocol Induces Partial Neurological Recovery in Paraplegic Patients. , 2016, Neurosurgery.

[2]  E. Chaplin.  Functional neuromuscular stimulation for mobility in people with spinal cord injuries. The Parastep I System. , 1996, The journal of spinal cord medicine.

[3]  D. Graupe,et al.  Functional neuromuscular stimulator for short-distance ambulation by certain thoracic-level spinal-cord-injured paraplegics. , 1998, Surgical neurology.

[4]  Thierry Keller,et al.  Sliding mode closed-loop control of FES controlling the shank movement , 2004, IEEE Transactions on Biomedical Engineering.

[5]  T S Kuo,et al.  The development of a closed-loop controlled functional electrical stimulation (FES) in gait training. , 2001, Journal of medical engineering & technology.

[6]  A. J. del-Ama,et al.  Review of hybrid exoskeletons to restore gait following spinal cord injury. , 2012, Journal of rehabilitation research and development.

[7]  D. Popović,et al.  Distributed low‐frequency functional electrical stimulation delays muscle fatigue compared to conventional stimulation , 2010, Muscle & nerve.

[8]  M. Bouri,et al.  Improvement of rehabilitation possibilities with the MotionMaker TM , 2006, The First IEEE/RAS-EMBS International Conference on Biomedical Robotics and Biomechatronics, 2006. BioRob 2006..

[9]  J. Greve,et al.  Functional electrical stimulation (FES): muscle histochemical analysis , 1993, Paraplegia.

[10]  Kamiar Aminian,et al.  A new approach to accurate measurement of uniaxial joint angles based on a combination of accelerometers and gyroscopes , 2005, IEEE Transactions on Biomedical Engineering.

[11]  J. Lehmann,et al.  The quantitative measurement of spasticity: effect of cutaneous electrical stimulation. , 1994, Archives of physical medicine and rehabilitation.

[12]  Glen M. Davis,et al.  Strategies for Rapid Muscle Fatigue Reduction during FES Exercise in Individuals with Spinal Cord Injury: A Systematic Review , 2016, PloS one.

[13]  R. Clavel,et al.  A Novel Verticalized Reeducation Device for Spinal Cord Injuries: the WalkTrainer, from Design to Clinical Trials , 2010 .

[14]  C. L. Lynch,et al.  A Comparison of Closed-Loop Control Algorithms for Regulating Electrically Stimulated Knee Movements in Individuals With Spinal Cord Injury , 2012, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[15]  G. P. Braz,et al.  Functional Electrical Stimulation Control of Standing and Stepping After Spinal Cord Injury: A Review of Technical Characteristics , 2009, Neuromodulation : journal of the International Neuromodulation Society.

[16]  G M Davis,et al.  Benefits of FES gait in a spinal cord injured population , 2007, Spinal Cord.

[17]  Michael Goldfarb,et al.  An Approach for the Cooperative Control of FES With a Powered Exoskeleton During Level Walking for Persons With Paraplegia , 2016, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[18]  T. Schauer,et al.  Gait Training by FES , 2018 .

[19]  D. Sutherland.  The evolution of clinical gait analysis part l: kinesiological EMG. , 2001, Gait & posture.

[20]  J. Mcdonald,et al.  Activity-based restorative therapies: concepts and applications in spinal cord injury-related neurorehabilitation. , 2009, Developmental disabilities research reviews.

[21]  Kei Masani,et al.  Closed-loop control of standing neuroprosthesis using PID controller , 2017, 2017 IEEE International Conference on Systems, Man, and Cybernetics (SMC).

[22]  Patrick Métrailler.  Système robotique pour la mobilisation des membres inférieurs d"une personne paraplégique , 2005 .

[23]  Tobias Nef,et al.  ZeroG: overground gait and balance training system. , 2011, Journal of rehabilitation research and development.

[24]  K. Mauritz,et al.  Stellenwert der funktionellen Elektrostimulation bei Patienten mit Querschnittlähmung , 1998, Der Nervenarzt.

[25]  F. Reynard,et al.  The WalkTrainer—A New Generation of Walking Reeducation Device Combining Orthoses and Muscle Stimulation , 2009, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[26]  [Value of functional electrostimulation in patients with paraplegia]. , 1998, Der Nervenarzt.

[27]  M. Morari,et al.  Robotic Orthosis Lokomat: A Rehabilitation and Research Tool , 2003, Neuromodulation : journal of the International Neuromodulation Society.

[28]  K. Ragnarsson.  Functional electrical stimulation after spinal cord injury: current use, therapeutic effects and future directions , 2008, Spinal Cord.

[29]  R. Shields,et al.  Feedback-controlled stimulation enhances human paralyzed muscle performance. , 2006, Journal of applied physiology.

[30]  T. A. Thrasher,et al.  Functional electrical stimulation of walking: function, exercise and rehabilitation. , 2008, Annales de readaptation et de medecine physique : revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique.

[31]  E. Condie,et al.  Functional Electrical Stimulation: Standing and Walking After Spinal Cord Injury , 1990 .