Electromechanical delay during functional electrical stimulation induced cycling is a function of lower limb position.

INTRODUCTION: Functional electrical stimulation (FES) induced cycling has been shown to be an effective rehabilitation for those with lower limb movement disorders. However, a consequence of FES is an electromechanical delay (EMD) existing between the stimulation input and the onset of muscle force. The objective of this study is to determine if the cycle crank angle has an effect on the EMD. METHODS: Experiments were performed on 10 participants, five healthy and five with neurological conditions resulting in movement disorders. A motor fixed the crank arm of a FES-cycle in 10° increments and at each angle stimulation was applied in a random sequence to a combination of the quadriceps femoris and gluteal muscle groups. The EMD was examined by considering the contraction delay (CD) and the residual delay (RD), where the CD (RD) is the time latency between the start (end) of stimulation and the onset (cessation) of torque. Two different measurements were used to examine the CD and RD. Further, two multiple linear regressions were performed on each measurement, one for the left and one for the right muscle groups. RESULTS: The crank angle was determined to be statistically relevant for both the CD and RD. CONCLUSIONS: Since the crank angle has a significant effect on both the CD and RD, the angle has a significant effect on the EMD. Therefore, future efforts should consider the importance of the crank angle when modelling or estimating the EMD to improve control designs and ultimately improve rehabilitative treatments.Implications for rehabilitationNew model predicts the delayed response of muscle torque production to electrical stimulation as a function of limb position during FES cycling.The model can inform closed-loop electrical stimulation induced rehabilitative cycling.

Data-Based and Opportunistic Integral Concurrent Learning for Adaptive Trajectory Tracking During Switched FES-Induced Biceps Curls.

Hybrid exoskeletons, which combine functional electrical stimulation (FES) with a motorized testbed, can potentially improve the rehabilitation of people with movement disorders. However, hybrid exoskeletons have inherently nonlinear and uncertain dynamics, including combinations of discrete modes that switch between different continuous dynamic subsystems, which complicate closed-loop control. A particular complication is the uncertain muscle control effectiveness associated with FES. In this work, adaptive integral concurrent learning (ICL) motor and FES controllers are developed for a hybrid biceps curl exoskeleton, which are designed to achieve opportunistic and data-based learning of the uncertain human and electromechanical testbed parameters. Global exponential trajectory tracking and parameter estimation errors are proven through a Lyapunov-based stability analysis. The motor effectiveness is assumed to be unknown, and, to help with fatigue reduction, FES is enabled to switch between multiple electrodes on the biceps brachii, further complicating the analysis. A consequence of switching between the different uncertain subsystems is that the parameters must be opportunistically learned for each subsystem (i.e. each electrode and the motor), while that subsystem is active. Experiments were performed to validate the developed ICL controllers on twelve healthy participants. The average (± standard deviation) position tracking errors across each participant were 1.44 ± 5.32 deg, -0.25 ± 2.85 deg, and -0.17 ± 2.66 deg across biceps Curls 1-3, 4-7, and 8-10, respectively, where the average across the entire experiment was 0.28 ± 3.53 deg.

Characterization of the Time-Varying Nature of Electromechanical Delay During FES-Cycling.

Functional electrical stimulation (FES) induced cycling is a common rehabilitative technique for people with neuromuscular disorders. A challenge for closed-loop FES control is that there exists a potentially destabilizing time-varying input delay, termed electromechanical delay (EMD), between the application of the electric field and the corresponding muscle contraction. In this article, the FES-induced torque production and EMD are quantified on an FES-cycle for the quadriceps femoris and gluteal muscle groups. Experiments were performed on five able-bodied individuals and five individuals with neurological conditions. Closed-loop FES-cycling was applied to induce fatigue and torque and EMD measurements were made during isometric conditions before and after each minute of cycling to quantify the effect of fatigue on EMD and torque production. A multiple linear regression and other descriptive statistics were performed to establish a range of expected EMD values and bounds on the rate of change of the EMD across a diverse population. The results from these experiments can be used to assist in the development of closed-loop controllers for FES-cycling that are robust to time-varying EMD and changes in torque production.

Addiction Disorder Considerations for Patients Seeking Psychotherapy.

Substance use disorders are widespread and cause significant dysfunction. Substance use disorders often co-occur with other psychiatric disorders. Because of this overlap, clinicians commonly encounter patients at risk for substance abuse disorders. This article reviews strategies to aid the practicing clinician in the screening, assessment, intervention, and referral of their parents at risk for substance use disorders.