Feasibility of combining gait robot and multichannel functional electrical stimulation with intramuscular electrodes

Abstract

Abstract-After stroke rehabilitation, many survivors of stroke exhibit persistent gait deficits. In previous work, we demonstrated significant gains in gait kinematics for survivors of chronic stroke using multichannel functional electrical stimulation with intramuscular electrodes (FES-IM). For this study, we tested the feasibility of combining FES-IM and gait robot technologies for treating persistent gait deficits after stroke. Six subjects, >/= 6 months after stroke, received 30-minute intervention sessions of combined FES-IM and gait robotics 4 days a week for 12 weeks. Feasibility was assessed according to three factors: (1) performance of the interface of the two technologies during intervention sessions, (2) clinicians' success in using two technologies simultaneously, and (3) subject satisfaction. FES-IM system hardware and software design features combined with the gait robot technology proved feasible to use. Each technology alone provided unique advantages and disadvantages of gait practice characteristics. Because of the unique advantages and disadvantages of each technology, gait deficits need to be accurately identified and a judicious treatment plan properly targeted before FES-IM, a gait robot, or both combined are selected. Clinical Trial Registration:Feasibility and Practice Characteristics of FNS and Gait Robot; NCT00508755; Study ID: B4036I, <www.clinicaltrials.gov>.

Hybrid FES–robotic gait rehabilitation technologies: a review on mechanical design, actuation, and control strategies

“…Two attempts to synchronize the Lokomat gait robot system with a multichannel functional electrical stimulator were also found. Firstly, McCabe et al (2008) combined the Lokomat gait robot system (Hocoma Inc.) with a multichannel functional electrical simulator using intramuscular electrodes (FES-IM) to provide a more coordinated gait training (Fig. 10).…”

“…Exoskeletal robots are worn by the patients to enhance the motor function of a limb or to fully substitute it while the FES targets the person's paralyzed muscles to evoke actions that would not be possible otherwise. Different approaches were proposed to combine FES and lower limb exoskeletons, where the FES system reviewed were as complex as intramuscular systems with up to 8 stimulated muscles (McCabe et al 2008), and as simple as systems incorporating surface stimulation of a single muscle (Kangude et al 2009). …”

“…The treadmill based exoskeletons widely employ the BWS system that provides uplifting force to maintain balance and suspension to the subject walking on the treadmill. Lokomat (McCabe et al 2008) is a notable system reviewed in this paper that uses the BWS system with the treadmill. Moreover, WalkTrainer (Stauffer et al 2009) also employs BWS with motorized wheels for over ground movement and the Electromechanical Gait Trainer (Hesse 2004) employs BWS with movable footplates.…”

“…Following the principle in which the active exoskeleton can provides torque to the joints and where the FES intensity and duration can be adjusted with the proper control to allow time for muscle relaxation, various approaches have been proposed. Comparable to the joint brakes based exoskeletons, fully powered exoskeleton have been developed with open-loop control (Hesse 2004;Obinata et al 2007;McCabe et al 2008;Poboroniuc et al 2009;Kurokawa et al 2012;Kirsch et al 2014;Bulea et al 2011) and closed-loop control (Vallery et al 2005;Stauffer et al 2009;Chen et al 2013;Tu et al 2016;delAma et al 2015;Quintero et al 2012) of the FES parameters. However, pre-programmed FES systems result in delivering of excessive electrical stimulation to the muscles causing either early fatigue or exaggerated gait pattern.…”

The effect of timing electrical stimulation to robotic-assisted stepping on neuromuscular activity and associated kinematics

“…Another group has also combined FES specifically with RTT and has even integrated the control of the stimulator with the gait-training robot, as in our system, so as to provide the capability for automated and precise coordinated control [54]. However, the details of how the stimulation is programmed to the gait cycle is lacking, and while the feasibility of using this system has been demonstrated [55], to our knowledge, results showing the effect on gait kinematics or underlying EMG activity have not been published.…”