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Impedance control and internal model formation when reaching in a randomly varying dynamical environment.

We investigated the effects of trial-to-trial, random variation in environmental forces on the motor adaptation of human subjects during reaching. Novel sequences of dynamic environments were applied to subjects' hands by a robot. Subjects reached first in a "mean field" having a constant gain relating force and velocity, then in a "noise field," having a gain that varied randomly between reaches according to a normal distribution with a mean identical to that of the mean field. The unpredictable nature of the noise field did not degrade adaptation as quantified by final kinematic error and rate of adaptation. To achieve this performance, the nervous system used a dual strategy. It increased the impedance of the arm as evidenced by a significant reduction in aftereffect size following removal of the noise field. Simultaneously, it formed an internal model of the mean of the random environment, as evidenced by a minimization of trajectory error on trials for which the noise field gain was close to the mean field gain. We conclude that the human motor system is capable of predicting and compensating for the dynamics of an environment that varies substantially and randomly from trial to trial, while simultaneously increasing the arm's impedance to minimize the consequence of errors in the prediction.

Adult↗

NovaSure impedance controlled system for endometrial ablation: three-year follow-up on 107 patients.

OBJECTIVE: This study was undertaken to assess the safety, efficacy, and data durability of the NovaSure ablation at 3 years after the procedure in women with menorrhagia secondary to dysfunctional uterine bleeding (DUB). STUDY DESIGN: A prospective, single-arm, observational pilot study (Canadian Task Force classification II-1) was carried out at a specialized center for gynecologic endoscopy with 107 premenopausal women with menorrhagia secondary to DUB. NovaSure ablation was performed in 107 patients. Pictorial Blood loss Assessment Chart diary sampling was used to assess menstrual blood loss. Ablation was performed without any type of endometrial pretreatment. RESULTS: No intraoperative or postoperative complications were observed. Treatment time averaged 94 seconds; 65% of the patients reported amenorrhea. Hysterectomy was avoided in 97.2% of patients at 3-year follow-up. CONCLUSION: Long-term clinical results demonstrate that the NovaSure system is a safe and effective method for treatment of women with menorrhagia secondary to DUB, yielding high amenorrhea and success rates, with low re-treatment rates.

Adult↗

NovaSure impedance controlled endometrial ablation: long-term follow-up results.

STUDY OBJECTIVE: A 7-year follow-up evaluation of the safety, efficacy, and long-term outcome of endometrial ablation when using the NovaSure system in patients with menorrhagia secondary to abnormal uterine bleeding (AUB). DESIGN: Prospective, single-arm study (Canadian Task Force classification II-1). SETTING: St. Imre Teaching Hospital, Budapest, Hungary. PATIENTS: Seventy-five premenopausal women with menorrhagia secondary to AUB. INTERVENTIONS: Endometrial ablation using the NovaSure System without the use of endometrial pretreatment. MEASUREMENTS AND MAIN RESULTS: Loss of menstrual blood was measured using pictorial blood loss assessment chart diaries. Treatment times, complications, and rate of surgical re-interventions were recorded. No intra or postoperative complications were noted. Median follow-up period at the time was 7.8 years (range 6-8.6 years). The proportion of patients with fewer than 7 and 7 or more years of follow-up was 28.8% and 71.2%, respectively. The median treatment time was 92 seconds (range 40-120 seconds). At 7-year follow-up, 97.1% of evaluable patients reported amenorrhea. However, all patients (100%, actuarial rate: 97% with 95% CI [83%-100%]) experienced a successful reduction in bleeding to normal levels or less. Six of 75 patients underwent hysterectomy, and one of 75 had a repeat ablation representing a total of 92% (95% CI: 83%-96%) avoidance of additional surgery during the follow-up period. CONCLUSIONS: Clinical results demonstrate that the use of NovaSure System is safe and effective, with a low rate of surgical re-intervention at 7-year follow-up.

Adult↗

NovaSure impedance-controlled system for endometrial ablation.

STUDY OBJECTIVE: To assess the efficacy and safety of the NovaSure endometrial ablation system in women with severe dysfunctional uterine bleeding (DUB). STUDY DESIGN: Prospective, single-arm, controlled, observational pilot study (Canadian Task Force classification II-1). SETTING: Free-standing center for gynecologic endoscopy. PATIENTS: One hundred seven premenopausal women whose menorrhagia was unresponsive to medical therapy, who had completed childbearing, and who had undistorted uterine cavities. INTERVENTION: Endometrial ablation with the NovaSure system. MEASUREMENTS AND MAIN RESULTS: Diaries were used to qualify patients for the study, as well as for posttreatment evaluation of menstrual blood loss and bleeding pattern (amenorrhea, spotting, hypomenorrhea, eumenorrhea, menorrhagia). No drug or mechanical endometrial pretreatment was administered. Position of the uterus was not a factor in patient selection. No intraoperative or postoperative complications occurred. Treatment time averaged 94 seconds. Of 107 women, 106 completed 6 months of follow-up and 105 had 12 months. Amenorrhea was 46% and 58%, respectively. CONCLUSION: The NovaSure System is safe and is effective in treating women with DUB. Endometrial pretreatment is not necessary, and presence of blood in the uterine cavity during treatment is not a limiting factor.

Adult↗

Modeling biological motor control for human locomotion with functional electrical stimulation.

This paper develops a novel control system for functional electrical stimulation (FES) locomotion, which aims to generate normal locomotion for paraplegics via FES. It explores the possibility of applying ideas from biology to engineering. The neural control mechanism of the biological motor system, the central pattern generator, has been adopted in the control system design. Some artificial control techniques such as neural network control, fuzzy logic, control and impedance control are incorporated to refine the control performance. Several types of sensory feedback are integrated to endow this control system with an adaptive ability. A musculoskeletal model with 7 segments and 18 muscles is constructed for the simulation study. Satisfactory simulation results are achieved under this FES control system, which indicates a promising technique for the potential application of FES locomotion in future.

Electric Stimulation Therapy↗

Development of anthropomorphic multi-D.O.F. master-slave arm for mutual telexistence.

We developed a robotic arm for a master-slave system to support "mutual telexistence," which realizes remote dexterous manipulation tasks and close physical communication with other people using gestures. In this paper, we describe the specifications of the experimental setup of the master-slave arm to demonstrate the feasibility of the mutual telexistence concept. We developed the master arm of a telexistence robot for interpersonal communication. The last degree of the 7-degree-of-freedom slave arm is resolved by placing a small orientation sensor on the operators arm. This master arm is made light and impedance control is applied in order to grant the operator as much freedom of movement as possible. For this development stage, we compared three control methods and confirmed that the impedance control method is the most appropriate to this system.

Arm↗

Improvement in blood pressure control with impedance cardiography-guided pharmacologic decision making.

Previous reports have demonstrated improvement in blood pressure (BP) control utilizing noninvasive hemodynamic measurements with impedance cardiography (ICG). The purpose of this article is to report the effect of utilizing ICG-guided decision making to treat uncontrolled hypertension in a community generalist setting. Patient medical records were retrospectively reviewed for subjects on two antihypertensive agents with systolic blood pressure > or =140 mm Hg or diastolic blood pressure > or =90 mm Hg. All subjects were treated utilizing a previously published ICG-guided treatment algorithm. Twenty-one subjects met the BP and medication criteria. BP at entry was 157.2+/-13.9/78.7+/-9.9 mm Hg. Subjects were treated for 215+/-85 days (5.0+/-2.0 visits). After ICG-guided treatment, 12/21 (57.1%) achieved sustained BP control (p<0.001). BP was lowered to 141.6+/-22.0 (p<0.001)/77.1+/-10.7 (p>0.05) mm Hg. Antihypertensive agents increased from 2.0+/-0.0 to 2.5+/-0.7 (p<0.05). In this series of subjects with uncontrolled BP taking two antihypertensive agents, ICG-guided pharmacologic decision making resulted in significant reduction in BP and improvement in BP control.

Aged↗

Impedance feedback control for scanning electrochemical microscopy.

A new constant-distance imaging method based on the relationship between tip impedance and tip-substrate separation has been developed for the scanning electrochemical microscope. The tip impedance is monitored by application of a high-frequency ac voltage bias between the tip and auxiliary electrode. The high-frequency ac current is easily separated from the dc-level faradaic electrochemistry with a simple RC filter, which allows impedance measurements during feedback or generation/collection experiments. By employing a piezo-based feedback controller, we are able to maintain the impedance at a constant value and, thus, maintain a constant tip-substrate separation. Application of the method to feedback and generation/collection experiments with tip electrodes as small as 2 microm is presented.

Journal Article↗

Randomised controlled trial of bipolar radio-frequency endometrial ablation and balloon endometrial ablation.

OBJECTIVE: To compare the effectiveness of two second-generation ablation techniques, bipolar radio-frequency impedance-controlled endometrial ablation (NovaSure) and balloon ablation (ThermaChoice), in the treatment of menorrhagia. DESIGN: Double-blind, randomised, controlled trial. SETTING: A large teaching hospital with 500 beds in The Netherlands. POPULATION: Women suffering from menorrhagia referred by their general practitioner. METHODS: Women suffering from menorrhagia, without intracavitary abnormalities, were randomly allocated to bipolar radio-frequency ablation (bipolar group) and balloon ablation (balloon group) in a 2:1 ratio. At follow up, both women and observers were unaware of the type of treatment that had been performed. MAIN OUTCOME MEASURES: The main outcome measure was amenorrhea at 3, 6 and 12 months after randomisation. RESULTS: One hundred and twenty-six women were included in the study, of which 83 were allocated to the bipolar group, and 43 to the balloon group. No complications occurred in either of the treatment groups. At the one-year follow up stage, amenorrhea rates were 43% (34/83) in the bipolar group and 8% (3/43) in the balloon group (treatment effect in time P < 0.001). At this stage, 90% of the patients in the bipolar group were satisfied with the result of the treatment against 79% in the balloon group (treatment effect in time P= 0.003). CONCLUSION: The bipolar radio-frequency impedance-controlled endometrial ablation system is more effective than balloon ablation in the treatment of menorrhagia.

Adult↗

Issues in impedance selection and input devices for multijoint powered orthotics.

We investigated the applicability of impedance controllers to robotic orthoses for arm movements. We had tetraplegics turn a crank using their paralyzed arm propelled by a planar robot manipulandum. The robot was under impedance control, and chin motion served as command source. Stiffness varied between 50, 100, or 200 N/m and damping varied between 5 or 15 N/m/s. Results indicated that a low stiffness and high viscosity provided better directional control of the tangential force exerted on the crank.

Arm↗

Self-adjusting continuous positive airway pressure therapy based on the measurement of impedance. A comparison of free pressure variation and individually fixed higher minimum pressure.

BACKGROUND: Measurement of impedance using forced oscillation technique is a sensitive means of detecting airway obstructions, including the obstructive sleep apnea syndrome (OSAS). OBJECTIVE: The present study was conducted to determine whether treatment with an automated impedance-controlled continuous positive airway pressure (CPAP) device (APAP(FOT)) is possible in patients with OSAS, and which is the best range of pressure variation in automatical CPAP treatment. We investigated two modes of APAP(FOT) with different pressure ranges: (1) the widest technically possible pressure range and (2) a range with individually defined minimum pressure. METHODS: Ten patients [9 men, age 56.6+/-10.5 years, BMI 32.0+/-4.5 kg/m(2), apnea/hypopnea index (AHI) 18.2+/-13.3 /h] had a diagnostic polysomnography (baseline). After manual titration of positive airway pressure they were submitted, in randomized order, to two modes of the APAP(FOT) device, namely pressure range of 4.0- 15.5 mbar (mode 1 free range) and an individually fixed higher minimum pressure with a maximum pressure of 15.5 mbar (mode 2). RESULTS: While the manually titrated pressure was 8.0+/-1.3 mbar, in mode 1 it was 5.6+/-2.1 mbar (p<0.01); in mode 2 7.3+/-1.6 mbar (p< 0.05). Both of these modes suppressed abnormal respiratory events (baseline AHI 18.2+/-13.3/h; mode 1: 2.5+/-1.9; mode 2: 1.8 +/-0.7, p<0.01 in each case), and increased slow wave sleep (baseline: 10.6+/-8.0%, mode 1: 20.2+/-10.4%, p<0.05; mode 2: 22.3+/-9.3%, p<0.01). In mode 1, the pressure was lower than that titrated manually in 73.2% of total sleep time, in mode 2 in 48.6%, while pressures higher than those derived manually were observed in 13.0% in mode 1 and in 19.1% in mode 2. CONCLUSIONS: The data indicate that impedance-controlled CPAP (APAP(FOT)) allows adequate treatment of OSAS patients at significantly lower pressures as compared with manually titrated pressure. Differences between the two modes are only minor.

Adult↗

Percutaneous saline-enhanced radiofrequency ablation of unresectable hepatic tumors: initial experience in 26 patients.

OBJECTIVE: The purpose of our study was to evaluate the safety and efficacy of percutaneous saline-enhanced radiofrequency ablation for unresectable primary or metastatic hepatic tumors. SUBJECTS AND METHODS: Twenty-six patients with 15 hepatocellular carcinomas and 33 hepatic metastases (maximum diameter < or = 8.6 cm) were treated; of these, seven tumors in five patients were treated twice. Thus, 44 radiofrequency treatments were performed. Saline-enhanced and impedance-controlled radiofrequency ablation (0.5-1.1 mL/min of saline, 15-mm conductive portion of the electrode tip, 25-60 W, 5-43 min) was performed using MR imaging guidance. Coagulation necrosis, volume indexes, morbidity, and complications were assessed. RESULTS: The volume of coagulation necrosis 1-7 days after radiofrequency ablation was 1.6-126.6 cm(3) (median, 18.9 cm(3)), corresponding to coagulation diameters of 1.5-6.2 cm (median, 3.2 cm). The coagulation volume was significantly larger if there were more than four radiofrequency applications (p = 0.006). Tumors of 3 cm or less in diameter were eight times as likely to be successfully completely ablated (p = 0.01) and volume indexes of lesions treated with the patient under general anesthesia were significantly larger than those treated with the patient under conscious sedation (p < 0.001). Major complications occurred in four patients (15%). Incomplete ablation in 19 (35%) of 54 radiofrequency lesions was due to cooling by a large vessel nearby (n = 2) or to low power applied in painful (n = 11) or critical (n = 6) locations. Residual tumor was observed in 14 (58%) of 24 tumors evaluated 6-8 months after radiofrequency ablation. CONCLUSION: Percutaneous saline-enhanced and impedance-controlled radiofrequency ablation can be effective in the treatment of unresectable hepatic tumors and minimizes potential carbonization. A greater number of radiofrequency applications, general anesthesia, and increasing experience provide significantly better results.

Administration, Cutaneous↗

Computational principles of sensorimotor control that minimize uncertainty and variability.

Sensory and motor noise limits the precision with which we can sense the world and act upon it. Recent research has begun to reveal computational principles by which the central nervous system reduces the sensory uncertainty and movement variability arising from this internal noise. Here we review the role of optimal estimation and sensory filtering in extracting the sensory information required for motor planning, and the role of optimal control, motor adaptation and impedance control in the specification of the motor output signal.

Algorithms↗

A state feedback electro-acoustic transducer for active control of acoustic impedance.

In this paper, a new control system in which the acoustic impedance of an electro-acoustic transducer diaphragm can be actively varied by modifying design parameters is presented and its effectiveness is theoretically investigated. The proposed control system is based on a state-space description of the control system derived from an electrical equivalent circuit of an electro-acoustic transducer to which a differentiating circuit is connected, and is designed using modem control theory. The optimal quadratic regulator is used in the control system design, with its quadratic performance index formulated for producing desired acoustic impedance. Computer simulations indicate that the acoustic impedance of the diaphragm can be significantly varied over a wide frequency range that includes the range below the resonance frequency of the electro-acoustic transducer. A computer model of the proposed control system is used to illustrate its application to semi-active noise control in a duct. It is demonstrated that the proposed control system provides substantial reductions in the noise radiating from the outlet of the duct, both in the stiffness control range and in the mass control range.

Journal Article↗

Impedance loading servo pump system for excised canine ventricle.

To investigate ventricular-arterial system interaction, we have developed a hybrid-computer-controlled impedance loading servo pump system that enables us to impose a simulated arterial hydraulic impedance on an excised canine ventricle. An analog computer programmed to simulate a three-element Windkessel model of the arterial system computes instantaneous aortic flow from the instantaneous ventricular pressure. The time integral of this flow is used to command a volume servo pump system that controls the instantaneous ventricular volume. All parameter values in the loading system are controlled by a digital computer. The actual impedance spectrum generated by the system was reasonably close to that expected from the arterial model. The unique features of this system are the following. 1) The instantaneous volume of the ventricle, which is crucial information, can be measured. 2) If needed, the arterial impedance model can easily be reprogrammed to generate more complex impedance spectra. 3) The vascular parameters can be made nonlinear or time varying through the digital computer control.

Animals↗