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Biomedical subjects

P H Veltink

Publications and source records attributed to P H Veltink.

At least 19 recordsLinked to original sources
PubMed2006

Ambulatory measurement of arm orientation.

In order to evaluate the impact of neuromuscular disorders affecting the upper extremities, the functional use of the arm need to be evaluated during daily activities. A system suitable for measuring arm kinematics should be ambulatory and not interfere with activities of daily living. A measurement system based on miniature accelerometers and gyroscopes is adequate because the sensors are small and do not suffer from line of sight problems. A disadvantage of such sensors is the cumulative drift around the vertical and the problems with aligning the sensor with the segment. A method that uses constraints in the elbow to measure the orientation of the lower arm with respect to the upper arm is described. This requires a calibration method to determine the exact orientation of each of the sensors with respect to the segment. Some preliminary measurements were analyzed and they indicated a strong reduction in orientation error around the vertical. It seemed that the accuracy of the method is limited by the accuracy of the sensor to segment calibration.

Acceleration↗
PubMed2005

Measuring orientation of human body segments using miniature gyroscopes and accelerometers.

In the medical field, there is a need for small ambulatory sensor systems for measuring the kinematics of body segments. Current methods for ambulatory measurement of body orientation have limited accuracy when the body moves. The aim of the paper was to develop and validate a method for accurate measurement of the orientation of human body segments using an inertial measurement unit (IMU). An IMU containing three single-axis accelerometers and three single-axis micromachined gyroscopes was assembled in a rectangular box, sized 20 x 20 x 30 mm. The presented orientation estimation algorithm continuously corrected orientation estimates obtained by mathematical integration of the 3D angular velocity measured using the gyroscopes. The correction was performed using an inclination estimate continuously obtained using the signal of the 3D accelerometer. This reduces the integration drift that originates from errors in the angular velocity signal. In addition, the gyroscope offset was continuously recalibrated. The method was realised using a Kalman filter that took into account the spectra of the signals involved as well as a fluctuating gyroscope offset. The method was tested for movements of the pelvis, trunk and forearm. Although the problem of integration drift around the global vertical continuously increased in the order of 0.50 degrees s(-1), the inclination estimate was accurate within 3 degrees RMS. It was shown that the gyroscope offset could be estimated continuously during a trial. Using an initial offset error of 1 rad s(-1), after 2 min the off-set error was roughly 5% of the original offset error. Using the Kalman filter described, an accurate and robust system for ambulatory motion recording can be realised.

Acceleration↗
PubMed2003

Surface electromyography analysis for variable gait.

The surface electromyographic (SEMG) signal obtained during gait is often presented as the SEMG profile, the average SEMG activation pattern during one gait cycle. A disadvantage of this method is that it omits the step-to-step variability of the timing of the muscle activation patterns that might be relevant information as a performance measure of motor control and balance. In this paper, a method was used in which every step in the gait cycle could be analysed with respect to the timing of the muscle activation. For this purpose, the approximated generalised likelihood (AGLR) algorithm was implemented and tested. Results of the simulations show that the AGLR was much more accurate than a standard threshold criterion. Timing parameters could be calculated from a SEMG recording during gait and a measure for symmetry and coordination could be extracted. The amplitude distribution within and outside defined bursts is also presented to avoid the less precise classification into on and off patterns.

Algorithms↗
PubMed2003

Three dimensional inertial sensing of foot movements for automatic tuning of a two-channel implantable drop-foot stimulator.

A three dimensional inertial sensing system for measuring foot movements during gait is proposed and tested. It can form the basis for an automated tuning system for a two-channel implantable drop-foot stimulator. The foot orientation and position during the swing phase of gait can be reconstructed on the basis of three-dimensional measurement of acceleration and angular velocity, using initial and final conditions during mid-stance. The foot movements during gait of one stroke person using the implanted two-channel stimulator were evaluated for several combinations of stimulation parameters for both channels. The reconstructed foot movements during gait in this person indicated that the channel stimulating the deep peroneal nerve contributes mainly to dorsiflexion and provides some reduction of inversion seen without stimulation, while the channel activating the superficial peroneal nerve mainly provides additional reduction of inversion. This agrees with anatomical knowledge about the function of the muscles activated by both branches of the peroneal nerve. The inertial sensor method is expected to be useful for the clinical evaluation of foot movements during gait supported by the two-channel drop-foot stimulator. Furthermore, it is expected to be applicable for the automated balancing of the two stimulation channels to ensure optimal support of gait.

Acceleration↗
PubMed2001

The influence of stimulation frequency and ankle joint angle on the moment exerted by human dorsiflexor muscles.

The purpose of this study was to investigate the force-frequency relationships and the post-tetanic twitch potentiation as a function of joint angle (i.e. muscle length) in human skeletal muscles under isometric conditions. The dorsiflexor muscles of healthy subjects were stimulated at different ankle joint angles by means of constant frequency bursts at seven submaximal frequencies (50, 33, 25, 20, 16, 12, 8 Hz) with a duration of two seconds. Particular attention has been focused on the stability of recruitment in the range of joint angles examined. The results show that moment-frequency curves of human dorsiflexors change as a function of ankle angle: especially for the lower stimulation frequency range (8, 12, 16, 20 Hz), the normalized moment increases from dorsiflexion to plantar flexion (i.e. with increasing muscle length) resulting in a leftward shift of the normalized moment-frequency curves. Post-tetanic twitch potentiation is shown to be ankle joint dependent as well.

Adult↗
PubMed2001

Biomechatronics--assisting the impaired motor system.

Biomechatronics concerns the interdisciplinary field of interaction with the human neuromuscular-skeletal system with the objective to assist impaired human motor control. In this field technology is developed that integrates neuroscience, robotics, interface and sensor technology, dynamic systems and control theory. The primary issue in this field concerns the concepts of assisting impaired human motor function. The secondary, derived, issue concerns possible methods of interfacing with the human body at all hierarchical levels of the human motor system. The application of motor assist systems may serve several goals: it can take over part of the affected motor control, enable the physiological motor system to perform the desired function or aid in training the impaired physiological system. The progress in these issues are reviewed and their potential implications for assistance of the impaired human motor system are discussed.

Bone and Bones↗
PubMed2001

Excessive reflexes in spinal cord injury triggered by electrical stimulation.

Interaction of electrocutaneous stimulation with an impaired human motor control system may result in unstable reflex loops causing excessive spastic reactions. These contractions are usually excluded from analysis since the presence of spasm is one of the criteria commonly applied for discarding a contraction. They may, however, provide interesting information on the nature of spasticity. The dorsiflexor muscles of four SCI subjects were activated by means of surface electrical stimulation and the isometric ankle moment was measured. Short bursts of constant stimulation frequency at seven different frequencies (8, 12, 16, 20, 25, 33, 50 Hz) triggered spastic reactions in all subjects. The onset times of spastic activity during an electrically elicited contraction shortened with increased stimulation frequency. A stimulation burst may also have a spasticity reduction effect on a subsequent burst, indicating potential short term therapeutic effects of stimulation on spasticity in isometric conditions.

Adult↗
PubMed2000

Finite state control of functional electrical stimulation for the rehabilitation of gait.

Finite state control is an established technique for the implementation of intention detection and activity co-ordination levels of hierarchical control in neural prostheses, and has been used for these purposes over the last thirty years. The first finite state controllers (FSC) in the functional electrical stimulation of gait were manually crafted systems, based on observations of the events occurring during the gait cycle. Subsequent systems used machine learning to automatically learn finite state control behaviour directly from human experts. Recently, fuzzy control has been utilised as an extension of finite state control, resulting in improved state detection over standard finite state control systems in some instances. Clinical experience over the last thirty years has been positive, and has shown finite state control to be an effective and intuitive method for the control of functional electrical stimulation (FES) in neural prostheses. However, while finite state controlled neural prostheses are of interest in the research community, they are not widely used outside of this setting. This is largely due to the cumbersome nature of many neural prostheses which utilise externally mounted gait sensors and FES electrodes. FES-based control of movement has been subject to the constraints of artificial sensor and FES actuator technologies. However, continued advances in natural sensors and implanted multi-channel stimulators are broadening the boundaries of artificial control of movement, driving an evolutionary process towards increasingly human-like control of FES-based gait rehabilitation systems.

Electric Stimulation Therapy↗
PubMed2000

Inhibition of the triceps surae stretch reflex by stimulation of the deep peroneal nerve in persons with spastic stroke.

OBJECTIVE: To reduce the triceps surae stretch reflex by electrical stimulation of the deep peroneal nerve. DESIGN: Intervention study. SETTING: Research institution. PARTICIPANTS: Sample of convenience of 10 spastic stroke individuals. INTERVENTION: After the deep peroneal nerve was stimulated between 0.9 and 4 times tibialis anterior motor threshold, the triceps surae was stretched to elicit a reflex. MAIN OUTCOME MEASURE: The triceps surae stretch reflex was quantified by the amplitude of the reflex electromyography (EMG) in soleus and medial gastrocnemius muscles and mean ankle moment. Paired t test and the Wilcoxon signed rank test (p < .05) were used to evaluate the effect of conditioning stimulation. RESULTS: The soleus stretch reflex EMG was reduced significantly (p < .001) by stimulating the deep peroneal nerve to 25%+/-6% (standard error) of the unconditioned value (relaxed triceps surae). The optimal interval between stimulation and stretch was 141+/-15 msec. The velocity threshold increased significantly (p = .006) from a median value of 8 degrees per second to 33 degrees per second and the area under the stretch velocity/stretch reflex relation decreased significantly (p < .001) (soleus EMG). CONCLUSIONS: The stretch reflex of relaxed triceps surae in persons with spastic stroke can be extensively reduced by stimulating the deep peroneal nerve at several times motor threshold of the tibialis anterior.

Aged↗
PubMed1999

Validity and reproducibility of crutch force and heart rate measurements to assess energy expenditure of paraplegic gait.

OBJECTIVE: To determine the validity and reproducibility of heart rate (HR) and crutch force measurements to estimate energy expenditure during paraplegic walking. Usefulness of these outcome measures in comparative trials was assessed in terms of responsiveness. DESIGN: Cross-sectional validity was determined using one single (first) measurement. Longitudinal validity as well as reproducibility were calculated using repeated measurements. SETTING: Oxygen uptake and HR during steady state as well as axial crutch load were measured at subjects' self-selected walking speeds. PATIENTS: Ten subjects with thoracic-level spinal cord injury were included in the study. All subjects had considerable experience with ambulation in the advanced reciprocating gait orthosis (ARGO). MAIN OUTCOME MEASURES: Oxygen uptake (VO2, mL/min) and oxygen cost (EO2, mL/m) were used as criterion standards. Crutch peak force (CPF), crutch force time integral (CFTI), HR, and physiological cost index (PCI) were used to estimate energy expenditure. RESULTS: The PCI was found to be sensitive to detect differences between sessions in criterion standard (r = .86). Smallest detectable difference (ie, point where difference exceeds measurement error) ranged from approximately 15% for CPF to 33.7% and 41.8% for EO2 and PCI, respectively. CONCLUSIONS: Although PCI is expected to be a valid measure for within-patient differences in VO2, responsiveness was lower compared to EO2 and CPF. The limited number of patients who can be included in studies on paraplegic locomotion requires reproducible outcome measures. Therefore, CPF and EO2 are advocated in favor of PCI.

Adult↗
PubMed1999

Comparative trials on hybrid walking systems for people with paraplegia: an analysis of study methodology.

A new orthosis (SEPRIX) which combines user friendliness with low energy cost of walking has been developed and will be subject to a clinical comparison with conventional hip-knee-ankle-foot orthoses. In designing such comparative trials it was considered it may be worthwhile to use previous clinical studies as practical examples. A literature search was conducted in order to select all comparative trials which have studied two walking systems (hip-knee-ankle-foot orthoses) for patients with a complete thoracic lesion. Study population, intervention, study design, outcome measurement and statistical analyses were examined. Statistical power was calculated where possible. Of 12 selected studies, 7 were simple A-B comparisons, 2 A-B comparisons with a replication, 2 cross-over trials and 1 nonrandomised parallel group design, the last of which was considered internally invalid due to severe confounding by indication. All A-B comparisons were considered internally invalid as well, since they have not taken into account that a comparison of two orthoses requires a control for aspecific effects (like test effects) which may cause a difference. Statistical power could only be examined in 4 studies and the highest statistical power achieved in one study was 47%. It is concluded that statistical power was too low to be able to detect differences. Even analysis through interval estimation showed that the estimation of the difference was too imprecise to be useful. Since the majority of the surveyed papers have reported small studies (of only 4-6 patients), it is assumed that lack of statistical power is a more general problem. Three possibilities are discussed in order to enhance statistical power in comparative trials, i.e. multicentre studies, statistical pooling of results and improving the efficiency of study design by means of interrupted time series designs.

Equipment Design↗
PubMed1999

Sensory feedback in artificial control of human mobility.

Artificial motor control systems may reduce the handicap of motor impaired individuals. Sensors are essential components in feedback control of these systems and in the information exchange with the user. The objective of this paper is to give an overview of the applications of sensors in the artificial control of human mobility. These applications may either require an accurate estimate of the measured physical quantities or can be based on learning the relation between sensory information and control actions by example. Actual use of sensors in artificial motor control systems requires that the user experienced complexity of the system is not increased, while improving the repeatable and flexible functioning of the system. Therefore, the sensors need to be integrated with the mechanical part of the artificial support system or implanted, the information exchange between sensor and controller should be wireless and automatic in-use calibration is a desired feature.

Artificial Intelligence↗
PubMed1998

Speed dependence of crutch force and oxygen uptake: implications for design of comparative trials on orthoses for people with paraplegia.

OBJECTIVE: To determine speed dependence of crutch force and oxygen uptake, and to discuss the implications of differences in self-selected walking speed between orthoses in a comparative trial. DESIGN: Cross-sectional comparison. SETTING: Treadmill experiments and gait laboratory experiments were performed at five and three different imposed walking speeds, respectively. PATIENTS: Five paraplegic subjects with lesions between T9 and T12 were included. All subjects had experience with ambulation using the advanced reciprocating gait orthosis (ARGO) as well as walking on a treadmill. MAIN OUTCOME MEASURES: Crutch force time integral (CFTI), crutch peak force on stance and swing side (CPFstance and CPFswing), oxygen uptake (VO2), oxygen cost (EO2). RESULTS: VO2, EO2, and CFTI were strongly dependent on walking speed. CPFstance and CPFswing were less dependent. However, depending on the clinically relevant difference that should be detected in a comparative trial, the peak forces can still be confounded by walking speed. CONCLUSION: CFTI, CPFswing, VO2, and EO2 should be adjusted for walking speed if differences in walking speed between orthoses are found, but this correction is relevant only if there is no effect modification. Such modification (different slopes between orthoses) cannot be excluded for the studied outcome measures. In addition, because determination of effect modification is difficult in small studies, standardization of walking speed, by means of a three-point design, is recommended.

Adult↗
PubMed1998

Validity and reliability of measurements obtained with an "activity monitor" in people with and without a transtibial amputation.

BACKGROUND AND PURPOSE: In this study, the validity and reliability of measurements obtained with an "Activity Monitor" (AM) were examined. The instrument is designed to monitor ambulatory activity by use of accelerometer signals, and it detects several activities associated with mobility (standing, sitting, lying, transitions, movement-related activities). SUBJECTS: Four men with a transtibial amputation and 4 men without a transtibial amputation participated. METHODS: The subjects performed normal daily activities, during which accelerations were measured and videotape recording were made (reference method). Validity was assessed by calculating agreement scores between the AM output and the videotape recordings and by comparing the number of transitions and the duration of activities determined by both methods. RESULTS: The overall agreement between the AM output and the videotape recordings was 90%. Other agreement scores, in addition to the determination of the number of transitions and the duration of activities, were generally within a range of error of 0% to 10%. CONCLUSION AND DISCUSSION: The reliability and validity of the AM measurements appeared to be good, which supports its potential use in rehabilitation and physical therapy. [Bussmann HBJ, Reuvekamp PJ, Veltink PH, et al. Validity and reliability of measurements obtained with an "Activity Monitor" in people with and without a transtibial amputation.

Activities of Daily Living↗
PubMed1998

Switching curve controller for FES-assisted standing up and sitting down.

A low-level, closed-loop controller for FES-assisted standing up and sitting down is described. If, for able-bodied individuals, when standing up and sitting down, the knee angular velocity is plotted against knee angle, consistent phase-plane trajectories are produced. The bang-bang controller uses a model of this trajectory as a switching curve. The design rationale for the controller was the desire to avoid injuries that might occur if knee-locking on standing up and seat-contact on sitting down are not adequately controlled. This switching curve controller (SCC) was incorporated within a hierarchical, finite state control scheme, with electrical stimulation applied bilaterally to the knee extensors. The SCC was tested in a pilot study on a female volunteer with paraplegia (T5/6 ASIA A) and evaluated against an unramped, open-loop controller (OLC). The vertical hand forces and knee angles were measured. The subject was able to achieve standing up and sitting down safely using both controllers. For standing up, the SCC was not found to offer any quantifiable advantages over the OLC and was found to increase the hand force by 8.4%. In contrast, for sitting down the SCC was found to reduce the knee angular velocities as the subject approached the seat by 27%, demonstrating a safer, softer landing.

Adult↗
PubMed1998

A perspective on the control of FES-supported standing.

This special section is about the control of electrical stimulators to restore standing functions to paraplegics. It addresses several important topics regarding the interactions of the intact central nervous systems (CNS) with the artificial control system. The topics are as follows: how paraplegics use their arms to help themselves stand up with functional electrical stimulation (FES); the user-driven artificial control of FES-supported standing up; a controller which is promising for the control of sitting down; the application of reinforcement machine learning for the controllers of standing up; arms-free standing with voluntary upper body balancing and artificially controlled ankle stiffness; and cognitive feedback in balancing. This Commentary introduces the papers in this section and relates them to earlier research.

Electric Stimulation Therapy↗
PubMed1997

Influence of synchronous and sequential stimulation on muscle fatigue.

In acute experiments the sciatic nerve of the rat is electrically stimulated to induce fatigue in the medial Gastrocnemius muscle. Fatigue tests are carried out using intermittent stimulation of different compartments (sequential) or a single compartment (synchronous) of the sciatic nerve. The activation of different compartments is achieved by dividing nerve fibres into subbundles and placing them in separate grooves in a multigroove electrode. The aim of the investigation is to quantify the effect of sequential contra synchronised stimulation in reducing muscle fatigue, with no overlap between compartments. Overlap between two compartments is calculated using the combined and individual forces from both compartments. Sequential stimulation of two and three compartments is investigated. There is a significant decrease of fatigue in sequential stimulation compared to synchronous. After 2 min of intermittent stimulation the force time level is significantly increased in sequential stimulation, than in synchronous stimulation. The rate of force time decrease is significantly slower in sequential stimulation than in synchronous stimulation. With sequential stimulation it takes significantly longer before the maximal force time is reached than with synchronous stimulation.

Animals↗