Feedback control of heart rate during robotics-assisted tilt table exercise in patients after stroke: a clinical feasibility study

IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Journal of NeuroEngineering and Rehabilitation Pub Date : 2024-08-12 DOI:10.1186/s12984-024-01440-8
Lars Brockmann, Jittima Saengsuwan, Corina Schuster-Amft, Kenneth J. Hunt
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Abstract

Patients with neurological disorders including stroke use rehabilitation to improve cognitive abilities, to regain motor function and to reduce the risk of further complications. Robotics-assisted tilt table technology has been developed to provide early mobilisation and to automate therapy involving the lower limbs. The aim of this study was to evaluate the feasibility of employing a feedback control system for heart rate (HR) during robotics-assisted tilt table exercise in patients after a stroke. This feasibility study was designed as a case series with 12 patients ( $$n = 12$$ ) with no restriction on the time post-stroke or on the degree of post-stroke impairment severity. A robotics-assisted tilt table was augmented with force sensors, a work rate estimation algorithm, and a biofeedback screen that facilitated volitional control of a target work rate. Dynamic models of HR response to changes in target work rate were estimated in system identification tests; nominal models were used to calculate the parameters of feedback controllers designed to give a specified closed-loop bandwidth; and the accuracy of HR control was assessed quantitatively in feedback control tests. Feedback control tests were successfully conducted in all 12 patients. Dynamic models of heart rate response to imposed work rate were estimated with a mean root-mean-square (RMS) model error of 2.16 beats per minute (bpm), while highly accurate feedback control of heart rate was achieved with a mean RMS tracking error (RMSE) of 2.00 bpm. Control accuracy, i.e. RMSE, was found to be strongly correlated with the magnitude of heart rate variability (HRV): patients with a low magnitude of HRV had low RMSE, i.e. more accurate HR control performance, and vice versa. Feedback control of heart rate during robotics-assisted tilt table exercise was found to be feasible. Future work should investigate robustness aspects of the feedback control system. Modifications to the exercise modality, or alternative modalities, should be explored that allow higher levels of work rate and heart rate intensity to be achieved.
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中风后患者在机器人辅助倾斜台运动中的心率反馈控制:一项临床可行性研究
包括中风在内的神经系统疾病患者通过康复治疗来提高认知能力、恢复运动功能并降低进一步并发症的风险。目前已开发出机器人辅助倾斜台技术,以提供早期移动和涉及下肢的自动化治疗。本研究旨在评估中风后患者在机器人辅助倾斜台运动期间采用心率(HR)反馈控制系统的可行性。这项可行性研究以病例系列的形式进行,共有 12 名患者参与($$n = 12$$),对中风后的时间或中风后功能障碍的严重程度没有限制。在机器人辅助倾斜台上安装了力传感器、工作率估算算法和生物反馈屏幕,以方便患者自愿控制目标工作率。在系统识别测试中估算了心率对目标工作率变化的动态响应模型;使用标称模型计算了反馈控制器的参数,该控制器旨在提供指定的闭环带宽;在反馈控制测试中对心率控制的准确性进行了定量评估。所有 12 名患者都成功进行了反馈控制测试。估算出的心率对施加的工作率的动态响应模型的平均均方根(RMS)误差为 2.16 次/分(bpm),而实现的高精度心率反馈控制的平均均方根跟踪误差(RMSE)为 2.00 次/分(bpm)。研究发现,控制精度(即 RMSE)与心率变异幅度(HRV)密切相关:心率变异幅度低的患者 RMSE 低,即心率控制性能更准确,反之亦然。研究发现,在机器人辅助的倾斜台运动中对心率进行反馈控制是可行的。未来的工作应研究反馈控制系统的稳健性。此外,还应该对运动方式或替代方式进行改进,以实现更高水平的工作率和心率强度。
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来源期刊
Journal of NeuroEngineering and Rehabilitation
Journal of NeuroEngineering and Rehabilitation 工程技术-工程:生物医学
CiteScore
9.60
自引率
3.90%
发文量
122
审稿时长
24 months
期刊介绍: Journal of NeuroEngineering and Rehabilitation considers manuscripts on all aspects of research that result from cross-fertilization of the fields of neuroscience, biomedical engineering, and physical medicine & rehabilitation.
期刊最新文献
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