Task-oriented repetitive movements can improve motor performance in patients with neurological or orthopaedic lesions. The application of robotics and automation technology can serve to assist, enhance, evaluate, and document neurological and orthopedic rehabilitation. This paper deals with the application of "patient-cooperative" techniques to robot-aided gait rehabilitation of neurological disorders. We define patient-cooperative to mean that, during movement, the technical system takes into account the patient's intention and voluntary efforts rather than imposing any predefined movements or inflexible strategies. It is hypothesized that such cooperative robotic approaches can improve the therapeutic outcome compared to classical rehabilitation strategies. New cooperative strategies are presented that detect the patient's voluntary efforts. First, this enables the patient increased freedom of movement by a certain amount of robot compliance. Second, the robot behavior adapts to the existing voluntary motor abilities. And third, the robotic system displays and improves the patient contribution by visual biofeedback. Initial experimental results are presented to evaluate the basic principle and technical function of proposed approaches. Further improvements of the technical design and additional clinical testing is required to prove whether the therapeutic outcome can be enhanced by such cooperative strategies.
Functional electrical stimulation (FES) enables restoration of movement in individuals with spinal cord injury. FES-based devices use electric current pulses to stimulate and excite the intact peripheral nerves. They produce muscle contractions, generate joint torques, and thus, joint movements. Since the underlying neuromuscular-skeletal system is highly nonlinear and time-varying, feedback control is necessary for accurate control of the generated movement. However, classical feedback/closed-loop control algorithms have so far failed to provide satisfactory performance and were not able to guarantee stability of the closed-loop system. Because of this, only open-loop controlled FES devices are in clinical use in spite of their limitations. The purpose of the reported research was to design a novel closed-loop FES controller that achieves good tracking performance and guarantees closed-loop stability. Such a controller was designed based on a mathematical neuromuscular-skeletal model and is founded on a sliding mode control theory. The controller was used to control shank movement and was tested in computer simulations as well as in actual experiments on healthy and spinal cord injured subjects. It demonstrated good robustness, stability, and tracking performance properties.
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