Mechanomyography and Torque during FES-Evoked Muscle Contractions to Fatigue in Individuals with Spinal Cord Injury.
ABSTRACT: A mechanomyography muscle contraction (MC) sensor, affixed to the skin surface, was used to quantify muscle tension during repetitive functional electrical stimulation (FES)-evoked isometric rectus femoris contractions to fatigue in individuals with spinal cord injury (SCI). Nine persons with motor complete SCI were seated on a commercial muscle dynamometer that quantified peak torque and average torque outputs, while measurements from the MC sensor were simultaneously recorded. MC-sensor-predicted measures of dynamometer torques, including the signal peak (SP) and signal average (SA), were highly associated with isometric knee extension peak torque (SP: r = 0.91, p < 0.0001), and average torque (SA: r = 0.89, p < 0.0001), respectively. Bland-Altman (BA) analyses with Lin's concordance (ρC) revealed good association between MC-sensor-predicted peak muscle torques (SP; ρC = 0.91) and average muscle torques (SA; ρC = 0.89) with the equivalent dynamometer measures, over a range of FES current amplitudes. The relationship of dynamometer torques and predicted MC torques during repetitive FES-evoked muscle contraction to fatigue were moderately associated (SP: r = 0.80, p < 0.0001; SA: r = 0.77; p < 0.0001), with BA associations between the two devices fair-moderate (SP; ρC = 0.70: SA; ρC = 0.30). These findings demonstrated that a skin-surface muscle mechanomyography sensor was an accurate proxy for electrically-evoked muscle contraction torques when directly measured during isometric dynamometry in individuals with SCI. The novel application of the MC sensor during FES-evoked muscle contractions suggested its possible application for real-world tasks (e.g., prolonged sit-to-stand, stepping,) where muscle forces during fatiguing activities cannot be directly measured.
Project description:Wrist movements become impaired with disease progression in various neuromuscular disorders. With the development of new therapies, thorough measurement of muscle strength is crucial to document natural disease progression and to assess treatment efficacy. We developed a new dynamometer enabling wrist flexion and extension torque measurement with high sensitivity. The aims of the present study were to collect norms for healthy children and adults, to compute predictive equations, to assess the reliability of the measurements and to test the feasibility of using the device in patients with a neuromuscular disease.The peak isometric torque of wrist flexion and extension was measured with the MyoWrist dynamometer in 345 healthy subjects aged between 5 and 80 years old and in 9 patients with limb girdle muscle dystrophy type 2 C (LGMD2C) aged between 16 and 38 years old.Predictive equations are proposed for the wrist flexion and extension strength in children and adults. Intra-rater and inter-rater reliability was good with ICCs higher than 0.9 for both wrist flexion and extension. However, retest values were significantly higher by 4% than test results. The dynamometer was applied with no difficulty to patients with LGMD2C and was sensitive enough to detect strength as weak as 0.82 N.m. From our models, we quantified the mean strength of wrist extension in LGMD2C patients to 39?±?17% of their predicted values.The MyoWrist dynamometer provides reliable and sensitive measurement of both wrist flexion and extension torques. However, a training session is recommended before starting a study as a small but significant learning effect was observed. Strength deficit can be quantified from predictive equations that were computed from norms of healthy children and adults.
Project description:Demand for wheelchairs is increasing with growing numbers of aged and disabled persons. Manual wheelchairs are the most commonly used assistive device for mobility because they are convenient to transport. Manual wheelchairs have several advantages but are not easy to use for the elderly or those who lack muscular strength. Therefore, handrim-activated power-assist wheelchairs (HAPAW) that can aid driving power with a motor by detecting user driving intentions through the handrim are being researched. This research will be on HAPAW that judge user driving intentions by using non-contact torque sensors. To deliver the desired motion, which is sensed from handrim rotation relative to a fixed controller, a new driving wheel mechanism is designed by applying a non-contact torque sensor, and corresponding torques are simulated. Torques are measured by a driving wheel prototype and compared with simulation results. The HAPAW prototype was developed using the wheels and a driving control algorithm that uses left and right input torques and time differences are used to check if the non-contact torque sensor can distinguish users' driving intentions. Through this procedure, it was confirmed that the proposed sensor can be used effectively in HAPAW.
Project description:Background:The steady-state increase in muscle force generating potential following a lengthening contraction is called residual force enhancement (RFE). In this study, we aimed to test for differences in torque, electromyographic activity (EMG), and the associated neuromuscular efficiency (NME) between isometric voluntary contractions of elbow flexors preceded and not preceded by a lengthening contraction. The dependence of such differences on (i) stretch amplitude, (ii) the region of the force-length (FxL) relationship where contraction occurs, and (iii) the individual's ability to produce (negative) work during the stretch was investigated. Methods:Sixteen healthy adults participated in the study. Elbow flexor torque, angle, and biceps brachii EMG for purely isometric contractions (reference contractions) and for isometric contractions preceded by active stretches of 20° and 40° were measured at the ascending, plateau, and descending regions of subject-specific FxL curves. All contractions were performed in an isokinetic dynamometer. Two-factor (stretch × FxL region) repeated measures analysis of variance ANOVAs was used to analyze the effect of active stretch on EMG, torque, and NME across conditions. The relationships between mechanical work during stretch-calculated as the torque-angular displacement integral-and the changes in EMG, torque, and NME were analyzed using Pearson correlation. Results:In general, torque, EMG, and NME following active stretches differed from the values observed for the purely isometric reference contractions. While although the detailed effects of active stretch on torque and EMG differed between regions of the FxL relationship, NME increased by about 19% for all muscle lengths. Up to 30% of the interindividual variability in torque generating potential change in response to active stretching was accounted for by differences in (negative) work capacity between subjects. Conclusion:Our results suggest that (i) RFE contributes to "flatten" the elbow flexor torque-angle relationship, favoring torque production at lengths where the purely isometric torques are reduced substantially, and (ii) RFE contributes to a reduction in energy cost of torque production during isometric contractions for the entire operating range.
Project description:A hybrid neuroprosthesis that combines human muscle power, elicited through functional electrical stimulation (FES), with a powered orthosis may be advantageous over a sole FES or a powered exoskeleton-based rehabilitation system. The hybrid system can conceivably overcome torque reduction due to FES-induced muscle fatigue by complementarily using torque from the powered exoskeleton. The second advantage of the hybrid system is that the use of human muscle power can supplement the powered exoskeleton's power (motor torque) requirements; thus, potentially reducing the size and weight of a walking restoration system. To realize these advantages, however, it is unknown how to concurrently optimize desired control performance and allocation of control inputs between FES and electric motor. In this paper, a model predictive control-based dynamic control allocation (DCA) is used to allocate control between FES and the electric motor that simultaneously maintain a desired knee angle. The experimental results, depicting the performance of the DCA method while the muscle fatigues, are presented for an able-bodied participant and a participant with spinal cord injury. The experimental results showed that the motor torque recruited by the hybrid system was less than that recruited by the motor-only system, the algorithm can be easily used to allocate more control input to the electric motor as the muscle fatigues, and the muscle fatigue induced by the hybrid system was found to be less than the fatigue induced by sole FES. These results validate the aforementioned advantages of the hybrid system; thus implying the hybrid technology's potential use in walking rehabilitation.
Project description:The neural constraints underlying hemiparetic gait dysfunction are associated with abnormal kinetic outflow and altered muscle synergy structure. Recent evidence from our lab implicates the lesioned hemisphere in mediating the expression of abnormally coupled hip adduction and knee extension synergy, suggesting a role of cortical networks in the regulation of lower limb motor outflow poststroke. The potential contribution of contralesional hemisphere (CON-H) in regulating paretic leg kinetics is unknown. The purpose of this study is to characterize the effect of CON-H activation on aberrant across-joint kinetic coupling of the ipsilateral lower-extremity muscles poststroke.Amplitude-matched adductor longus motor-evoked potentials were elicited using single pulse transcranial magnetic stimulation (TMS) of the lesioned (L-H) and CON-Hs during an isometric adductor torque matching task from 11 stroke participants. For 10 control participants, TMS of the contralateral and ipsilateral hemisphere were given during the same task. TMS-induced torques were characterized at the hip and knee joints to determine the differential regulation of abnormal kinetic synergies by each motor cortices. The TMS-induced ratio of knee extension/hip adduction torques was quantified during 40 and 20% of maximum adduction torque.For both the 40 and 20% target adduction tasks, we find that contralesional stimulation significantly reduced but did not eliminate the TMS-induced ratio of knee extension/hip adduction torques for the stroke group (p = 0.0468, p = 0.0396). In contrast, the controls did not present a significantly different TMS-evoked torque following stimulation (p = 0.923) of the hemisphere ipsilateral to the test leg.The reduced expression of abnormal across-joint kinetic coupling suggests that the CON-H may contribute an adaptive role in lower limb control poststroke. Future study of neuromodulation paradigms that leverage adaptive CON-H activation may yield clinically relevant gains in lower limb motor function poststroke.
Project description:Muscle weakness is a frequent complaint amongst Parkinson's disease (PD) patients. However, evidence-based therapeutic options for this symptom are limited. We objectively measure the efficacy of therapeutic Thai massage (TTM) on upper limb muscle strength, using an isokinetic dynamometer. A total of 60 PD patients with muscle weakness that is not related to their 'off' periods or other neurological causes were equally randomized to TTM intervention (n?=?30), consisting of six TTM sessions over a 3-week period, or standard medical care (no intervention, n?=?30). Primary outcomes included peak extension and flexion torques. Scale-based outcomes, including Unified Parkinson's Disease Rating Scale (UPDRS) and visual analogue scale for pain (VAS) were also performed. From baseline to end of treatment, patients in the intervention group showed significant improvement on primary objective outcomes, including peak flexion torque (F?=?30.613, p?<?.001) and peak extension torque (F?=?35.569, p?<?.001) and time to maximal flexion speed (F?=?14.216, p?=?.001). Scale-based assessments mirrored improvements in the objective outcomes with a significant improvement from baseline to end of treatment of the UPDRS-bradykinesia of a more affected upper limb (F?=?9.239, p?=?.005), and VAS (F?=?69.864, p?<?.001) following the TTM intervention, compared to the control group. No patients reported adverse events in association with TTM. Our findings provide objective evidence that TTM used in combination with standard medical therapies is effective in improving upper limb muscle strength in patients with PD. Further studies are needed to determine the efficacy of TTM on other motor and non-motor symptoms in PD.
Project description:OBJECTIVE:To compare the effects of conventional (constant load) eccentric training and isokinetic eccentric training on quadriceps muscle mass, strength and functional performance in recreational athletes following anterior cruciate ligament (ACL) reconstruction. METHODS:Thirty recreational male athletes (25 years old) undergoing ACL reconstruction received a standard rehabilitation program. Volunteers were randomized to conventional group (CG; n?=?15) or isokinetic group (IG; n?=?15) to be engaged in a 6-week (2 sessions/week) quadriceps eccentric training program at the extensor chair or at the isokinetic dynamometer, respectively. Assessments of quadriceps muscle mass (through magnetic resonance imaging), strength (through isokinetic dynamometry) and self-aware functionality (through questionnaire) were performed before and after the training programs. Single leg hop test performance was assessed only at post-training evaluation. RESULTS:IG had significantly higher improvements than CG (p?<?0.05) for all muscle mass outcomes (+17-23% vs. +5-9%), as well as for isometric (+34% vs. +20%) and eccentric (+85% vs. +23%) peak torques. There was no between-group difference (p?>?0.05) for concentric peak torque, Lysholm score, and single leg hop test. CONCLUSION:Isokinetic eccentric training promotes greater responses than conventional eccentric training on quadriceps muscle mass and strength of recreational athletes following ACL reconstruction.
Project description:Human reaching movements require complex muscle activations to produce the forces necessary to move the limb in a controlled manner. How gravity and the complex kinetic properties of the limb contribute to the generation of the muscle activation pattern by the central nervous system (CNS) is a long-standing and controversial question in neuroscience. To tackle this issue, muscle activity is often subdivided into static and phasic components. The former corresponds to posture maintenance and transitions between postures. The latter corresponds to active movement production and the compensation for the kinetic properties of the limb. In the present study, we improved the methodology for this subdivision of muscle activity into static and phasic components by relating them to joint torques. Ten healthy subjects pointed in virtual reality to visual targets arranged to create a standard center-out reaching task in three dimensions. Muscle activity and motion capture data were synchronously collected during the movements. The motion capture data were used to calculate postural and dynamic components of active muscle torques using a dynamic model of the arm with 5 degrees of freedom. Principal Component Analysis (PCA) was then applied to muscle activity and the torque components, separately, to reduce the dimensionality of the data. Muscle activity was also reconstructed from gravitational and dynamic torque components. Results show that the postural and dynamic components of muscle torque represent a significant amount of variance in muscle activity. This method could be used to define static and phasic components of muscle activity using muscle torques.
Project description:BACKGROUND: How the central nervous system (CNS) organizes the joint dynamics for multi-joint movement is a complex problem, because of the passive interaction among segmental movements. Previous studies have demonstrated that the CNS predictively compensates for interaction torque (INT) which is arising from the movement of the adjacent joints. However, most of these studies have mainly examined quick movements, presumably because the current belief is that the effects of INT are not significant at slow speeds. The functional contribution of INT for multijoint movements performed in various speeds is still unclear. The purpose of this study was to examine the contribution of INT to a planer reaching in a wide range of motion speeds for healthy subjects. METHODS: Subjects performed reaching movements toward five targets under three different speed conditions. Joint position data were recorded using a 3-D motion analysis device (50 Hz). Torque components, muscle torque (MUS), interaction torque (INT), gravity torque (G), and net torque (NET) were calculated by solving the dynamic equations for the shoulder and elbow. NET at a joint which produces the joint kinematics will be an algebraic sum of torque components; NET = MUS - G - INT. Dynamic muscle torque (DMUS = MUS-G) was also calculated. Contributions of INT impulse and DMUS impulse to NET impulse were examined. RESULTS: The relative contribution of INT to NET was not dependent on speed for both joints at every target. INT was additive (same direction) to DMUS at the shoulder joint, while in the elbow DMUS counteracted (opposed to) INT. The trajectory of reach was linear and two-joint movements were coordinated with a specific combination at each target, regardless of motion speed. However, DMUS at the elbow was opposed to the direction of elbow movement, and its magnitude varied from trial to trial in order to compensate for the variability of INT. CONCLUSION: Interaction torque was important at slow speeds. Muscle torques at the two joints were not directly related to each other to produce coordinated joint movement during a reach. These results support Bernstein's idea that coordinated movement is not completely determined by motor command in multi-joint motion. Based on the data presented in this study and the work of others, a model for the connection between joint torques (muscle and passive torques including interaction torque) and joint coordination is proposed.
Project description:<h4>Purpose</h4>We present a feasibility study for the visuo-haptic simulation of pedicle screw tract palpation in virtual reality, using an approach that requires no manual processing or segmentation of the volumetric medical data set.<h4>Methods</h4>In a first experiment, we quantified the forces and torques present during the palpation of a pedicle screw tract in a real boar vertebra. We equipped a ball-tipped pedicle probe with a 6-axis force/torque sensor and a motion capture marker cluster. We simultaneously recorded the pose of the probe relative to the vertebra and measured the generated forces and torques during palpation. This allowed us replaying the recorded palpation movements in our simulator and to fine-tune the haptic rendering to approximate the measured forces and torques. In a second experiment, we asked two neurosurgeons to palpate a virtual version of the same vertebra in our simulator, while we logged the forces and torques sent to the haptic device.<h4>Results</h4>In the experiments with the real vertebra, the maximum measured force along the longitudinal axis of the probe was 7.78 N and the maximum measured bending torque was 0.13 Nm. In an offline simulation of the motion of the pedicle probe recorded during the palpation of a real pedicle screw tract, our approach generated forces and torques that were similar in magnitude and progression to the measured ones. When surgeons tested our simulator, the distributions of the computed forces and torques were similar to the measured ones; however, higher forces and torques occurred more frequently.<h4>Conclusions</h4>We demonstrated the suitability of direct visual and haptic volume rendering to simulate a specific surgical procedure. Our approach of fine-tuning the simulation by measuring the forces and torques that are prevalent while palpating a real vertebra produced promising results.