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Biomedical subjects

T Bajd

Publications and source records attributed to T Bajd.

At least 19 recordsLinked to original sources

Predicting the voluntary arm forces in FES-assisted standing up using neural networks.

For individuals with paraplegia, standing up requires activation of paralyzed leg muscles by an artificial functional electrical stimulation (FES) controller and voluntary control of arm forces by the individual. Any knowledge of such voluntary control, particularly its prediction, could be used to design more effective FES controllers. Therefore, artificial neural network models were developed to predict voluntary arm forces from measured angular positions of the ankle, knee, and hip joints during FES-assisted standing up in paraplegia. The training data were collected from eight paraplegic subjects in repeated standing-up trials, and divided into two categories for training and validation. The predictions of the models closely followed both the training and validation data, showing good accuracy and generalization. The comparison of the models showed that, although there are striking similarities among the voluntary controls adopted by different subjects, each subject develops his/her own 'personal strategy' to control the arm forces, which is consistent from trial to trial. The level of consistency was dependent on the experience in using FES, injury level, body weight, and other subject-specific parameters.

Adult↗

Stability analysis of four-point walking.

The aim of the experiment reported here was to determine the static and dynamic stability of two-point stance phases when walking on hands and knees at different speeds. In addition, we defined the methods and predicted the consequences of including two-point stance phases into crutch assisted functional electrical stimulation (FES) walking. Crawling on hands and knees was performed at three speeds by five healthy male persons. With twelve joint-position markers placed on the subject, we determined two stability indices for every instant of gait. We analysed the peak values of these two indices during the two-point stance phases. The results indicate that we have to ensure the proper position of the centre of gravity to increase the speed of walking. To reach speeds, lower than 0.6 m/s, it is not necessary to include statically unstable phases. The shift of the centre of gravity towards and across the leading stability edge can result in getting into the dynamically unstable state. Considering the results we can effectively introduce two-point stance phases into crutch assisted FES walking and therefore increase the speed and energy effectiveness of walking

Biomechanical Phenomena↗

Postural activity of constrained subject in response to disturbance in sagittal plane.

This study examines the postural activity of partially constrained subjects for three different initial standing postures in response to disturbances in the sagittal plane. When the ankle strategy suffices for disturbance rejection in response to anterior disturbances, a mostly linear relationship between the ankle torque and ankle angle was observed, resulting in a constant stiffness at the ankles. However, when the ankle torque saturation was reached, a combined ankle-trunk postural strategy was utilized mainly in response to posterior perturbations due to the properties of the base-of-support. This caused a nonlinear scaling of ankle responses, thereby increasing variability of ankle stiffness. Distinctions in the ankle responses were also observed for different initial standing postures. The anterior initial stance generally increases the overall postural stability and renders the utilization of ankle strategy feasible, even for the rejection of posterior disturbances. Therefore, a linear torque-angle relationship at the ankles was observed for the anterior initial stance, regardless of the perturbation parameters.

Adult↗

Problems associated with FES-standing in paraplegia.

Prolonged immobilization, such as occurs after the spinal cord injury (SCI), results in several physiological problems. It has been demonstrated that the standing posture can ameliorate many of these problems. Standing exercise can be efficiently performed by the help of functional electrical stimulation (FES). The first application of FES to a paraplegic patient was reported by Kantrowitz in 1963. It was later shown by our group that standing for therapeutic purposes can be achieved by a minimum of two channels of FES delivered to both knee extensors. The properties of the stimulated knee extensors (maximal isometric joint torque, fatiguing, and spasticity) were not found as sufficient conditions for efficient standing exercise. According to our studies, the ankle joint torque during standing is the only parameter which is well correlated to the duration of FES assisted standing. For good standing low values of the ankle joint torque are required. To minimize the ankle joint torque the lever belonging to the vertical reaction force must be decreased. Adequate alignment of the posture appears to be the prerequisite for efficient FES assisted and arm supported standing exercise. Some patients are able to assume such posture by themselves, while many must be aided by additional measures. At present, surface stimulation of knee extensors combined with some appropriately "compliant shoes" looks to be adequate choice.

Ankle Joint↗

Use of functional electrical stimulation in the lower extremities of incomplete spinal cord injured patients.

After a program of therapeutic electrical stimulation, 3 groups of incomplete spinal cord injured (SCI) patients were identified, those in whom an improvement of both voluntary and stimulated muscle force was observed, those with an increase in stimulation response only, and patients in whom no effect of electrical stimulation training could be recorded. As it is difficult to predict the outcome of the electrical stimulation rehabilitation process, a diagnostic procedure was developed to predict soon after accidents which incomplete SCI patients are candidates for permanent use of a functional electrical stimulation (FES) orthotic aid. The candidates for chronic use of FES are patients with weak ankle dorsiflexors and sufficiently strong knee extensors. These patients are equipped with a single channel peroneal stimulator augmenting dorsiflexion and knee and hip flexion in a total lower limb flexion response. By applying FES to the ankle plantar flexors, the swing phase of walking can be significantly shortened and faster walking obtained.

Ankle Joint↗

Functional electrical stimulation and arm supported sit-to-stand transfer after paraplegia: a study of kinetic parameters.

The sit-to-stand transfer of paraplegic patients using functional electrical stimulation (FES) of the knee extensors and arm support was analyzed in the study. In a group of 8 completely paralyzed subjects who were trained FES users, kinematic and dynamic parameters were recorded during standing up trials. A contactless optical system was used to assess the human body motion. The forces acting on the human body were measured by multi-axis force transducers. On the basis of recursive Newton-Euler inverse dynamic analysis, the forces and torques acting on the body joints were calculated. The joint moments in the lower and upper extremities during the sit-to stand task are presented in this paper. The influences of the patient's strength, FES training duration, and rising strategy on the joint loading are discussed.

Adult↗

Postural activity of constrained subject in response to disturbance in sagittal plane.

The study examines postural activity of a constrained subject in response to various disturbances in the sagittal plane. Three different initial standing postures were examined. Each response to a perturbation was divided into three consecutive phases according to the intensity of the muscular activity. The relation of the ankle joint torque versus the ankle joint angle was studied. A linear relationship, resulting in constant ankle stiffness, was observed in each phase of the response. Only negligible differences in the stiffness values were observed among different phases. The results indicate an ankle stiffness value of 10 N m/o for the majority of initial stance postures and perturbation intensities.

Adult↗

Comparison of position repeatability of a human operator and an industrial manipulating robot.

Robot performance criteria of position repeatability are studied. Weight-to-payload ratio is in manipulating robots significantly higher than in human operators. Bracing strategy improving the robot performances is introduced in the paper. The strategy copies human behavior during fine motion operations. A comparison is made between the robot and the human operator performing approximately the same manipulating task. Contactless measurements of position repeatability were accomplished with the OPTOTRAK motion analysis system. The results of tests demonstrate considerable improvement of robot and human operator's position repeatability when using bracing.

Braces↗

Arm-free paraplegic standing--Part I: Control model synthesis and simulation.

The following paper is the first part of our investigation into the feasibility of arm-free paraplegic standing. A novel control strategy for unsupported paraplegic standing which utilizes the residual sensory and motor abilities of the thoracic spinal cord injured subjects is proposed. The strategy is based on voluntary and reflex activity of the paraplegic person's upper body and artificially controlled stiffness in the ankles. The knees and hips are maintained in an extended position by functional electrical stimulation (FES). The analysis of a linearized double inverted pendulum model revealed that with properly selected ankle stiffness the system can be easily stabilized. We developed a closed-loop double inverted pendulum model including a neural system delay, trunk muscles dynamics, body segmental dynamics and linear quadratic regulator (LQR) optimal controller. Through simulations of the closed-loop model two different strategies for disturbance rejection were explained. We investigated the capability of the closed-loop model to reject disturbances, imposed at the ankle joint (in anterior and posterior directions) for various stiffness levels and neural system delays in the presence of biomechanical constraints. By limiting permissible excursions of the center of pressure, we found out that the length of the foot is the most important constraint, while the strength of the trunk muscles is not of major importance for successful balancing. An ankle stiffness of approximately 10 Nm/degree suffices for arm-free standing of paraplegic subjects.

Ankle Joint↗

Arm-free paraplegic standing--Part II: Experimental results.

In Part I, we proposed an approach for restoring unsupported standing to thoracic-level paraplegics. The theoretical analysis and simulation of an underactuated double inverted pendulum, representing the standing subject, showed that arm-free standing might be achieved. Here in Part II, we present the mechanical apparatus which we used in our experiments and experimental results from tests of the balance-control strategy. We demonstrate that an intact and a paraplegic subject could perform quiet standing with the ankle stiffness set to 8 Nm/degree or even less (the intact subject). Both were also able to recover from disturbances, imposed by the artificial ankle joint of the apparatus. Introducing cognitive auditory feedback greatly improved the standing abilities of both subjects.

Adult↗

Control of FES in paraplegia: modeling voluntary arm forces.

Skilled behavior is difficult or impossible to articulate explicitly by the performers. Likewise biomechanical models of skilled motor actions are often limited by the lack of knowledge of the underlying mechanisms. A 'behavioral cloning' technique is described, based on a trained artificial neural network (ANN), that precisely mimics an individual's learned skill. In this paper the motor skill considered is that of paraplegics using their upper limbs whilst standing-up with FES. In a group of eight paraplegics with complete spinal injuries, it was possible to develop clones that followed closely the observed behavior of the subjects. Each subject used a unique and consistent voluntary control strategy. Subjects with more experience in using FES were more consistent in the use of their arms from trial to trial. Comparison of the clones revealed features suggestive of some common underlying voluntary control strategies.

Adolescent↗

Improvement in step clearance via calf muscle stimulation.

The aim is to study the influence of electrically stimulated calf muscles on the effectiveness of the swinging leg movement. The study is carried out with a group of patients with incomplete spinal cord injuries both under stationary conditions and during crutch-assisted walking. Before stimulation is applied to the ankle plantar flexors, the knee extensors are inactivated. In each cycle, after ankle plantar flexor stimulation, peroneal stimulation is started, triggering the flexion reflex. From a biomechanical point of view, functional electrical stimulation (FES) of the ankle plantar flexors results in increased ground clearance of the lower extremity. Additionally, the FES-assisted lifting of the heel results in the elimination of extensor tone and thus shortens the swing time.

Adolescent↗

Influence of electrically stimulated ankle plantar flexors on the swinging leg.

The influence of functional electrically stimulated ankle plantar flexors on the swinging lower extremity was studied in incomplete spinal cord injured persons. Stimulation sequences with different time and frequency parameters were delivered to ankle plantar flexors and knee extensors and to the peroneal nerve. The results of kinematic assessment showed that stimulated calf muscles provide noticeable forward and upward propulsion to the swinging leg.

Adolescent↗

Wireless control of functional electrical stimulation systems.

With the assistance of crutches and functional electrical stimulation (FES), we are able to restore standing and simple gait in some spinal cord injured (SCI) patients. In present rehabilitative systems, the patient divides the gait cycle into stance and swing phases via pushbuttons mounted on the handles of the crutches, which are hardwired to the functional electrical stimulator. The surface-mount technology based telemetry system, which makes use of the radiofrequency medium at 40 MHz, was developed to provide wireless control of the FES system. Signals from crutch pushbuttons were coded and transferred from the transmitter to the receiver. The receiver was firmly attached to the patient's waist and was connected to the stimulator.

Crutches↗

Unstable states in four-point walking.

The presently utilized walking patterns in paraplegic subjects with complete spinal cord injury (SCI) are compared by the help of graphic representations. Improved four-point gait assisted by functional electrical stimulation (FES) and crutches is proposed by introducing unstable states into the walking sequence. The unstable states are defined as passive phases of walking where the centre of mass (COM) is gravity driven in the direction of progression. The unstable state is described by a simple inverted pendulum model. Kinematic measurements of the unstable state were performed in normal and paraplegic subjects.

Biomechanical Phenomena↗

FES gait restoration and balance control in spinal cord-injured patients.

The status of gait restoration in spinal cord-injured patients by means of FES is reviewed and the main aspects are discussed. This introduction highlights the issues of balance control, stimulation sequence synthesis, and control of enhanced gait modes containing unbalancing. The use of statically unstable dynamic weight-transfer phases is important for enhanced gait modes. To show how this phase can be employed the mode of static balance currently used for FES-assisted four-point gait in paraplegic patients is discussed, and how this mode of gait can be converted to a semi-dynamic gait mode is described. The possibilities and consequences of such an approach are briefly discussed.

Biomechanical Phenomena↗

Bending moments in lower extremity bones for two standing postures.

The goal of this paper is to study how external gravitational forces stress the lower extremity bones and to ascertain and study how muscle activation compensates for the external load. For these purposes relatively accurate anatomical and biomechanical modelling is necessary. For a comparison of the calculated results to the naturally occurring muscular activity, seven-channel surface EMG activity was recorded. For simplicity a two-dimensional model was developed for the sagittal plane including 19 lower extremity muscles relevant to human standing and walking. In the calculation procedure of muscle forces an optimization procedure is also included. The results give rise to the expected assumption that muscle action is covered by two main requirements: first, to stabilize the joint actively (moment equilibrium) and, second, to compensate efficiently for bending moments produced by gravitational and external forces.

Biomechanical Phenomena↗