Surface‐distributed low‐frequency asynchronous stimulation delays fatigue of stimulated muscles

Maneski, Lana Z Popović; Malešević, Nebojša; Savić, Andrej M.; Keller, Thierry; Popović, Dejan B.

doi:10.1002/mus.23840

Cited by 62 publications

(54 citation statements)

References 19 publications

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“…However, in our previous studies, we examined certain effects related to an asynchronous multi-pad FES [12, 32]. The important factor that affects the summation effect was the choice of stimulation parameters.…”

Section: Discussionmentioning

confidence: 99%

“…The Fesia Walk stimulator delivered a train of biphasic pulses of various widths and amplitudes to a demultiplexer, which routed them to different conductive pads of the electrode in an asynchronous manner. This operating principle (i.e., the surface-distributed low-frequency asynchronous stimulation - sDLFAS) has been investigated in our previous studies [30–32]. The integrated stimulator unit could be controlled with a PC, a tablet or a mobile phone via a user-friendly graphical interface.…”

Section: Methodsmentioning

confidence: 99%

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A decision support system for electrode shaping in multi-pad FES foot drop correction

Malešević

Dujović

Savić

et al. 2017

J NeuroEngineering Rehabil

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BackgroundFunctional electrical stimulation (FES) can be applied as an assistive and therapeutic aid in the rehabilitation of foot drop. Transcutaneous multi-pad electrodes can increase the selectivity of stimulation; however, shaping the stimulation electrode becomes increasingly complex with an increasing number of possible stimulation sites. We described and tested a novel decision support system (DSS) to facilitate the process of multi-pad stimulation electrode shaping. The DSS is part of a system for drop foot treatment that comprises a custom-designed multi-pad electrode, an electrical stimulator, and an inertial measurement unit.MethodsThe system was tested in ten stroke survivors (3–96 months post stroke) with foot drop over 20 daily sessions. The DSS output suggested stimulation pads and parameters based on muscle twitch responses to short stimulus trains. The DSS ranked combinations of pads and current amplitudes based on a novel measurement of the quality of the induced movement and classified them based on the movement direction (dorsiflexion, plantar flexion, eversion and inversion) of the paretic foot. The efficacy of the DSS in providing satisfactory pad-current amplitude choices for shaping the stimulation electrode was evaluated by trained clinicians. The range of paretic foot motion was used as a quality indicator for the chosen patterns.ResultsThe results suggest that the DSS output was highly effective in creating optimized FES patterns. The position and number of pads included showed pronounced inter-patient and inter-session variability; however, zones for inducing dorsiflexion and plantar flexion within the multi-pad electrode were clearly separated. The range of motion achieved with FES was significantly greater than the corresponding active range of motion (p < 0.05) during the first three weeks of therapy.ConclusionsThe proposed DSS in combination with a custom multi-pad electrode design covering the branches of peroneal and tibial nerves proved to be an effective tool for producing both the dorsiflexion and plantar flexion of a paretic foot. The results support the use of multi-pad electrode technology in combination with automatic electrode shaping algorithms for the rehabilitation of foot drop.Trial registrationThis study was registered at the Current Controlled Trials website with ClinicalTrials.gov ID NCT02729636 on March 29, 2016.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A decision support system for electrode shaping in multi-pad FES foot drop correction

Malešević

Dujović

Savić

et al. 2017

J NeuroEngineering Rehabil

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“…These advancements provide novel and effective means by which to not only augment recruitment, but also provide options such as systematic cycling between stimulation channels to switch postural support strategies and continually adapt and compensate against muscle fatigue [Krajl, Bajd et al 55]. In deed, stimulation cycling with a spatially-distributed stimulation interface can delay fatigue in the quadriceps [Maneski, Malesevic et al 93]. …”

Section: - Necessary Advancementsmentioning

confidence: 99%

Restoring standing capabilities with feedback control of functional neuromuscular stimulation following spinal cord injury

Nataraj

Audu

Triolo

2017

Medical Engineering & Physics

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This paper reviews the field of feedback control for neuroprosthesis systems that restore advanced standing function to individuals with spinal cord injury. Investigations into closed-loop control of standing by functional neuromuscular stimulation (FNS) have spanned three decades. The ultimate goal for FNS standing control systems is to facilitate hands free standing and enabling the user to perform manual functions at self-selected leaning positions. However, most clinical systems for home usage currently only provide basic upright standing using preprogrammed stimulation patterns. To date, online modulation of stimulation to produce advanced standing functions such as balance against postural disturbances or the ability to assume leaning postures have been limited to simulation and laboratory investigations. While great technological advances have been made in biomechanical sensing and interfaces for neuromuscular stimulation, further progress is still required for finer motor control by FNS. Another major challenge is the development of sophisticated control schemes that produce the necessary postural adjustments, adapt against accelerating muscle fatigue, and consider volitional actions of the intact upper-body of the user. Model-based development for novel control schemes are proven and sensible approaches to prototype and test the basic operating efficacy of potentially complex and multi-faceted control systems. The major considerations for further innovation of such systems are summarized in this paper prior to describing the evolution of closed-loop FNS control of standing from previous works. Finally, necessary emerging technologies to for implementing FNS feedback control systems for standing are identified. These technological advancements include novel electrodes that more completely and selectively activate paralyzed musculature and implantable sensors and stimulation modules for flexible neuroprosthesis system deployment.

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“…Ideally, electrical stimulation is applied over the motor system nerves which activate the desired forearm muscles, but in practical usage scenarios this is difficult to achieve. Multipad electrodes and asynchronous stimulation protocols [9, 10] are recent developments that improve the selectivity of the activated muscles and also contribute to the postponing of muscle fatigue [11, 12]. …”

Section: Introductionmentioning

confidence: 99%

Microsoft Kinect-Based Artificial Perception System for Control of Functional Electrical Stimulation Assisted Grasping

Štrbac

Kočović

Marković

et al. 2014

BioMed Research International

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We present a computer vision algorithm that incorporates a heuristic model which mimics a biological control system for the estimation of control signals used in functional electrical stimulation (FES) assisted grasping. The developed processing software acquires the data from Microsoft Kinect camera and implements real-time hand tracking and object analysis. This information can be used to identify temporal synchrony and spatial synergies modalities for FES control. Therefore, the algorithm acts as artificial perception which mimics human visual perception by identifying the position and shape of the object with respect to the position of the hand in real time during the planning phase of the grasp. This artificial perception used within the heuristically developed model allows selection of the appropriate grasp and prehension. The experiments demonstrate that correct grasp modality was selected in more than 90% of tested scenarios/objects. The system is portable, and the components are low in cost and robust; hence, it can be used for the FES in clinical or even home environment. The main application of the system is envisioned for functional electrical therapy, that is, intensive exercise assisted with FES.

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Surface‐distributed low‐frequency asynchronous stimulation delays fatigue of stimulated muscles

Abstract: Combining the performance of multipad electrodes (increased selectivity and facilitated positioning) with sDLFAS (decreased fatigue) can improve many FES applications in both the lower and upper extremities.

Cited by 62 publications

References 19 publications

A decision support system for electrode shaping in multi-pad FES foot drop correction

A decision support system for electrode shaping in multi-pad FES foot drop correction

Restoring standing capabilities with feedback control of functional neuromuscular stimulation following spinal cord injury

Microsoft Kinect-Based Artificial Perception System for Control of Functional Electrical Stimulation Assisted Grasping

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