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Myoelectric motor execution and sensory training to treat chronic pain and paralysis in a replanted arm: a case study. 用肌电运动执行和感觉训练治疗再植手臂的慢性疼痛和瘫痪:一项案例研究。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-11-23 DOI: 10.1186/s12984-024-01508-5
Morten B Kristoffersen, Maria Munoz-Novoa, Mirka Buist, Mona Emadeldin, Carina Reinholdt, Max Ortiz-Catalan

Background: Following upper limb amputation, surgeries such as arm transplantation or replantation might be an option to restore function. After such surgeries, rehabilitation of the arm is needed. However, conventional rehabilitation is dependent on some volitional movement of the arm. If there is no or minimal movement of the arm, conventional rehabilitation might not be successful. The purpose of this study is to evaluate a novel combination of myoelectric motor execution (MME) and sensory training (ST) to reduce pain and improve upper limb function in a person with a highly impaired replanted arm.

Methods: The participant, a 72-year-old male, had his right arm replanted after a traumatic accident. No functional recovery was achieved following conventional rehabilitation and chronic neuropathic pain developed post-surgery. The participant then received 18 sessions of MME in which intended movements were decoded from the replanted arm's myoelectric signals using machine learning and real-time feedback was provided on a screen. Nine sessions included ST using tactile grids where the participant discriminated different sensations.

Results: The participant regained active extension of the thumb (4 degrees) and regained active wrist movement (flex: 6 degrees, extend: 10 degrees), both of which had no active movement prior the MME interventions. He also perceived an increase in sensation in the thumb and fingers. Pain levels fluctuated throughout the study and no consistent change could be concluded.

Conclusion: MME is a novel virtual rehabilitation treatment which provides feedback using virtual limbs and serious games. MME combined with ST is a potential rehabilitation treatment for individuals with highly impaired arms and hands which might ameliorate chronic neuropathic pain.

背景:上肢截肢后,手臂移植或再植等手术可能是恢复功能的一种选择。此类手术后,手臂需要进行康复训练。然而,传统的康复治疗依赖于手臂的一些自主运动。如果手臂没有运动或运动很少,传统的康复治疗可能不会成功。本研究的目的是评估肌电运动执行(MME)和感觉训练(ST)的新型组合,以减轻高度受损的再植手臂患者的疼痛并改善其上肢功能:受试者是一名 72 岁的男性,在一次外伤事故后接受了右臂再植手术。传统的康复治疗无法恢复其功能,术后出现了慢性神经性疼痛。随后,该受试者接受了 18 次 MME 治疗,在这些治疗中,利用机器学习从再植手臂的肌电信号中解码预期动作,并在屏幕上提供实时反馈。其中九个疗程包括使用触觉网格进行 ST,让受试者分辨不同的感觉:结果:受试者恢复了拇指的主动伸展(4 度)和手腕的主动运动(屈曲:6 度,伸展:10 度),这两项运动在接受 MME 干预之前都没有。他还感觉到拇指和手指的感觉有所增强。在整个研究过程中,疼痛程度有所波动,但无法得出一致的变化结论:MME 是一种新型的虚拟康复治疗方法,可利用虚拟肢体和严肃游戏提供反馈。结论:MME 是一种新型的虚拟康复治疗方法,它利用虚拟肢体和严肃游戏提供反馈。MME 与 ST 相结合,是一种针对手臂和手部高度受损者的潜在康复治疗方法,可改善慢性神经性疼痛。
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引用次数: 0
Selective nociceptive modulation using a novel prototype of transcutaneous kilohertz high-frequency alternating current stimulation: a crossover double-blind randomized sham-controlled trial. 使用新型经皮千赫兹高频交流电刺激的选择性痛觉调节:交叉双盲随机假对照试验。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-11-15 DOI: 10.1186/s12984-024-01503-w
Juan José Fernández-Pérez, Diego Serrano-Muñoz, Julio Gómez-Soriano, David Martín-Caro Álvarez, Juan Avendaño-Coy

Background: Kilohertz high-frequency alternating current (KHFAC) stimulation has demonstrated to induce rapid and reversible nerve blocks without causing nerve damage. Previous studies have explored frequency-dependent effects using a transcutaneous approach in humans from 5 to 20 kHz. Nevertheless, its application in humans is limited by the lack of stimulators approved for frequencies above 20 kHz. Therefore, this study aimed to assess the effects and safety of transcutaneous KHFAC stimulation using a novel prototype stimulator, comparing interventions at 30, 40, and 50 kHz to sham stimulation on experimental pain, sensory, motor, and neurophysiological outcomes.

Methods: A randomized, double-blind, sham-controlled crossover study involving 34 healthy participants was conducted. Four interventions (30, 40, 50 kHz, and sham) were administered, and stimulation was applied for 20 min to the median nerve of the non-dominant hand. A prototype stimulator capable of delivering frequencies between 1 and 50 kHz, with a maximum peak-to-peak output current intensity of 400 mA was designed. The intensity applied during the stimulation was below motor threshold, evoking a 'strong but comfortable' tingling sensation. Primary outcomes included heat pain threshold (HPT), pressure pain threshold (PPT), and adverse effects. The secondary outcomes included static two-point discrimination sensitivity, isometric pinch strength, and median sensory nerve action potential (SNAP).

Results: Compared with the sham stimulation, all the active interventions exhibited a significantly greater increase in the PPT during and immediately after the stimulation, while only a significant increase was observed at 40 kHz (4.1 N/cm2; 95%CI 0.3 to 7.9) at 15 min post-intervention. Compared to sham stimulation, the 40 kHz intervention had a significantly greater effect on the HPT at all time points, with the greatest difference (1.4 °C; 0.6 to 2.1) occurring immediately post-intervention. Adverse effects during active interventions included petechiae, erythema, and itching, which resolved at 24 h post-intervention. For secondary outcomes, only a significant reduction in the median SNAP velocity was observed in the sham stimulation group compared to the 50 kHz group.

Conclusions: Active KHFAC stimulation, particularly at 40 kHz, delivered through a novel stimulator, effectively increased the PPT and HPT without affecting tactile or motor outcomes, inducing mild skin-related adverse effects. These findings have potential implications for people with pain-related pathologies.

Trial registration: NCT05230836.

背景:千赫兹高频交流电(KHFAC)刺激已被证明可诱导快速、可逆的神经阻滞,且不会造成神经损伤。之前的研究采用 5 至 20 千赫的经皮方法在人体中探索了频率依赖性效应。然而,由于缺乏获准用于 20 kHz 以上频率的刺激器,其在人体中的应用受到了限制。因此,本研究旨在评估使用新型刺激器原型进行经皮 KHFAC 刺激的效果和安全性,比较 30、40 和 50 kHz 的干预与假刺激对实验性疼痛、感觉、运动和神经电生理结果的影响:方法: 对 34 名健康参与者进行了随机、双盲、假对照交叉研究。研究人员采取了四种干预措施(30、40、50 千赫和假干预),并对非惯用手的正中神经进行了 20 分钟的刺激。设计的原型刺激器能够提供 1 至 50 kHz 的频率,最大峰峰值输出电流强度为 400 mA。刺激时施加的强度低于运动阈值,唤起 "强烈但舒适 "的刺痛感。主要结果包括热痛阈值(HPT)、压痛阈值(PPT)和不良反应。次要结果包括静态两点辨别灵敏度、等长捏力和正中感觉神经动作电位(SNAP):结果:与假刺激相比,所有主动干预在刺激过程中和刺激后立即显示出 PPT 的显著增加,而在干预后 15 分钟,仅在 40 kHz 时观察到 PPT 的显著增加(4.1 N/cm2;95%CI 0.3 至 7.9)。与假刺激相比,40 千赫干预在所有时间点对 HPT 的影响都明显更大,最大的差异(1.4 °C;0.6 至 2.1)出现在干预后立即。主动干预期间的不良反应包括瘀斑、红斑和瘙痒,这些症状在干预后 24 小时内消失。在次要结果方面,与 50 kHz 组相比,仅观察到假刺激组的中位 SNAP 速度显著降低:结论:通过新型刺激器进行有源 KHFAC 刺激,尤其是 40 kHz 的刺激,可以有效提高 PPT 和 HPT,而不会影响触觉或运动效果,同时会引起轻微的皮肤相关不良反应。这些发现对疼痛相关病症患者具有潜在意义:试验注册:NCT05230836。
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引用次数: 0
Effects of different types of high-definition transcranial electrical stimulation on visual working memory and contralateral delayed activity. 不同类型的高清经颅电刺激对视觉工作记忆和对侧延迟活动的影响。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-11-08 DOI: 10.1186/s12984-024-01498-4
Yinan Ai, Mingyu Yin, Liying Zhang, Haojie Hu, Haiqing Zheng, Wuwei Feng, Yixuan Ku, Xiquan Hu

Background and purpose: Working memory is critical for individuals and has been found to be improved by electrical stimulation of the left dorsolateral prefrontal cortex (DLPFC). However, the effects of different types of transcranial electrical stimulation on working memory are controversial, and the underlying mechanism remains uncertain. In this study, high-definition transcranial direct current stimulation (HD-tDCS) and high-definition transcranial random noise stimulation (HD-tRNS) were applied to the DLPFC to observe the different effects on visual working memory (VWM). The aim was to explore the causal relationship between the electrical activity of the DLPFC and the posterior parietal cortex (PPC) electrical activity and the contralateral delayed activity (CDA).

Methods: Thirty-three healthy subjects received HD-tDCS, HD-tRNS and sham stimulation in a random order. Stimulation was applied to the left DLPFC for 20 min. The subjects underwent a color change-detection task as our VWM task and an auditory digit span test (DST) immediately after stimulation. Event-related potential (ERP) data were collected during the VWM task.

Results: The results revealed significant differences between the different types of HD-tES. There was a remarkable increase in VWM capacity following HD-tDCS compared with both HD-tRNS (pa = 0.038) and sham stimulation (pa = 0.038). Additionally, the CDA from the PPC differed after stimulation of the DLPFC. Both HD-tDCS and HD-tRNS expanded the maximum CDA amplitude from set size of 4 to 6, whereas after sham stimulation, the maximum CDA was maintained at a set size of 4. Compared with the sham condition, only HD-tDCS induced a noteworthy increase in CDA amplitude (pa = 0.012). Notably, a significant correlation emerged between the mean CDA amplitude and VWM capacity (p < 0.001, r = - 0.402).

Conclusion: These findings underscore the ability of HD-tDCS to target the DLPFC to augment working memory capacity while concurrently amplifying CDA amplitudes in the PPC through the frontoparietal network. Trial registration ChiCTR2300074898.

背景和目的:工作记忆对个人至关重要,研究发现电刺激左侧背外侧前额叶皮层(DLPFC)可改善工作记忆。然而,不同类型的经颅电刺激对工作记忆的影响存在争议,其潜在机制仍不确定。本研究将高清晰度经颅直流电刺激(HD-tDCS)和高清晰度经颅随机噪声刺激(HD-tRNS)应用于DLPFC,观察其对视觉工作记忆(VWM)的不同影响。目的是探讨DLPFC的电活动与后顶叶皮层(PPC)电活动和对侧延迟活动(CDA)之间的因果关系:方法:33 名健康受试者按照随机顺序接受了 HD-tDCS、HD-tRNS 和假刺激。刺激左侧 DLPFC 20 分钟。受试者在接受刺激后立即进行颜色变化检测任务(我们的 VWM 任务)和听觉数字跨度测试(DST)。在VWM任务期间收集了事件相关电位(ERP)数据:结果显示,不同类型的 HD-tES 之间存在明显差异。与HD-tRNS(pa = 0.038)和假刺激(pa = 0.038)相比,HD-tDCS刺激后的VWM容量明显增加。此外,刺激 DLPFC 后,来自 PPC 的 CDA 也有所不同。HD-tDCS 和 HD-tRNS 都将最大 CDA 振幅从设定值 4 扩大到 6,而假刺激后,最大 CDA 保持在设定值 4。值得注意的是,平均 CDA 振幅与 VWM 容量之间存在明显的相关性(p 结论):这些研究结果强调了 HD-tDCS 能够靶向 DLPFC 增强工作记忆能力,同时通过额顶网络放大 PPC 中的 CDA 振幅。试验注册号:ChiCTR2300074898。
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引用次数: 0
A fuzzy-logic approach for longitudinal assessment of patients' psychophysiological state: an application to upper-limb orthopedic robot-aided rehabilitation. 纵向评估患者心理生理状态的模糊逻辑方法:上肢矫形机器人辅助康复的应用。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-11-08 DOI: 10.1186/s12984-024-01501-y
Christian Tamantini, Francesca Cordella, Francesco Scotto di Luzio, Clemente Lauretti, Benedetta Campagnola, Fabio Santacaterina, Marco Bravi, Federica Bressi, Francesco Draicchio, Sandra Miccinilli, Loredana Zollo

Understanding the psychophysiological state during robot-aided rehabilitation is crucial for assessing the patient experience during treatments. This paper introduces a psychophysiological estimation approach using a Fuzzy Logic inference model to assess patients' perception of robots during upper-limb robot-aided rehabilitation sessions. The patients were asked to perform nine cycles of 3D point-to-point trajectories toward different targets at varying heights with the assistance of an anthropomorphic robotic arm (i.e. KUKA LWR 4+). Physiological parameters, including galvanic skin response, heart rate, and respiration rate, were monitored across ten out of forty daily sessions. This data enabled the construction of an inference model to estimate patients' perception states. Results expressed in terms of correlation coefficients between the patient state and the increasing number of sessions. Correlation coefficients showed statistically significant strong associations: a state of heightened engagement (formerly described as "Excited") had ρ = - 0.73 (p-value=0.01), and a more calm and resting state (namely "Relaxed" state) had ρ = 0.70 (p-value=0.02) with the number of sessions completed. All patients had positive interaction with the robot, initially expressing curiosity and interest that gradually shifted to a more "Relaxed" state over time.

了解机器人辅助康复过程中的心理生理状态对于评估患者在治疗过程中的体验至关重要。本文介绍了一种使用模糊逻辑推理模型的心理生理学评估方法,用于评估患者在上肢机器人辅助康复过程中对机器人的感知。在拟人机器人手臂(即 KUKA LWR 4+)的辅助下,患者被要求在不同高度对不同目标执行九个循环的三维点对点轨迹。在每天进行的 40 次训练中,有 10 次对生理参数进行了监测,包括皮肤电反应、心率和呼吸频率。利用这些数据构建了一个推理模型,以估计患者的感知状态。结果以患者状态与治疗次数增加之间的相关系数表示。相关系数显示出统计学意义上的显著关联:高度投入状态(以前称为 "兴奋 "状态)与完成疗程次数的相关系数ρ = - 0.73(p 值=0.01),而更平静和休息状态(即 "放松 "状态)与完成疗程次数的相关系数ρ = 0.70(p 值=0.02)。所有患者都与机器人进行了积极的互动,最初表现出好奇和兴趣,随着时间的推移,逐渐转变为更加 "放松 "的状态。
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引用次数: 0
A multi-objective optimal control approach to motor strategy changes in older people with mild cognitive impairment during obstacle crossing. 针对患有轻度认知障碍的老年人在穿越障碍时的运动策略变化的多目标优化控制方法。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-11-06 DOI: 10.1186/s12984-024-01483-x
Tung-Wu Lu, Shiuan-Huei Lu, Cheng-Hao Yu, Kuan-Wen Wu, Yi-Chun Kuan

Background: Mild cognitive impairment (MCI) may lead to difficulty maintaining postural stability and balance during locomotion. This heightened susceptibility to falls is particularly evident during tasks such as obstacle negotiation, which demands efficient motor planning and reallocation of attentional resources. This study proposed a multi-objective optimal control (MOOC) technique to assess the changes in motor control strategies during obstacle negotiation in older people affected by amnestic MCI.

Methods: Motion data from 12 older adults with MCI and 12 controls when crossing obstacles were measured using a motion capture system, and used to obtain the control strategy of obstacle-crossing as the best compromise between the conflicting objectives of the MOOC problem, i.e., minimising mechanical energy expenditure and maximising foot-obstacle clearance. Comparisons of the weighting sets between groups and obstacle heights were performed using a two-way analysis of variance with a significance level of 0.05.

Results: Compared to the controls, the MCI group showed significantly lower best-compromise weightings for mechanical energy expenditure but greater best-compromise weightings for both heel- and toe-obstacle clearances. This altered strategy involved a trade-off, prioritising maximising foot-obstacle clearance at the expense of increased mechanical energy expenditure. The MCI group could successfully navigate obstacles with a normal foot-obstacle clearance but at the cost of higher mechanical energy expenditure.

Conclusions: MCI alters the best-compromise strategy between minimising mechanical energy expenditure and maximising foot-obstacle clearances for obstacle-crossing in older people. These findings provide valuable insights into how MCI impacts motor tasks and offer potential strategies for mitigating fall risks in individuals with MCI. Moreover, this approach could serve as an assessment tool for early diagnosis and a more precise evaluation of disease progression. It may also have applications for individuals with impairments in other cognitive domains.

背景:轻度认知障碍(MCI)可能会导致在运动过程中难以保持姿势稳定和平衡。在执行障碍协商等任务时,这种对跌倒的高度易感性尤为明显,因为这些任务需要高效的运动规划和注意力资源的重新分配。本研究提出了一种多目标最优控制(MOOC)技术,以评估受失忆性 MCI 影响的老年人在障碍协商过程中运动控制策略的变化:使用运动捕捉系统测量了12名患有MCI的老年人和12名对照组老年人跨越障碍物时的运动数据,并利用这些数据获得了跨越障碍物的控制策略,该策略是MOOC问题中相互冲突的目标(即机械能消耗最小化和脚与障碍物间隙最大化)之间的最佳折中方案。采用显著性水平为 0.05 的双向方差分析对各组之间的加权集和障碍物高度进行了比较:与对照组相比,MCI 组在机械能消耗方面的最佳折衷权重明显较低,但在脚跟和脚趾与障碍的间隙方面的最佳折衷权重较高。这种策略的改变涉及到一个权衡问题,即以增加机械能消耗为代价,优先考虑最大化脚与障碍物的间隙。MCI 组能以正常的脚与障碍物间隙成功通过障碍物,但代价是更高的机械能消耗:MCI改变了老年人穿越障碍时机械能消耗最小化和脚与障碍间隙最大化之间的最佳折衷策略。这些发现为了解 MCI 如何影响运动任务提供了宝贵的见解,并为降低 MCI 患者的跌倒风险提供了潜在的策略。此外,这种方法还可以作为一种评估工具,用于早期诊断和更精确地评估疾病的进展。这种方法也可应用于其他认知领域受损的患者。
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引用次数: 0
Is lateral external perturbation training more beneficial for protective stepping responses than voluntary stepping training in stroke? A pilot randomized control study. 侧向外部扰动训练是否比中风患者的自主迈步训练更有利于保护性迈步反应?一项试验性随机对照研究。
IF 8.3 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-11-05 DOI: 10.1186/s12984-024-01495-7
Marcel B Lanza, Masahiro Fujimoto, Larry Magder, Sandy McCombe-Waller, Mark W Rogers, Vicki L Gray

The study examined whether lateral perturbation training could improve stepping performance and balance in individuals post-stroke. Thirty-one participants with hemiparesis were randomly allocated to PERT (external perturbation) or VOL (voluntary stepping) step training. The PERT and VOL group consisted of 80 step trials predominantly in the lateral direction, with a small proportion of steps in the anterior/posterior direction. Outcome measures based on step type (medial and lateral) included step initiation time, step length, step clearance, step velocity during an induced waist pull perturbation and voluntary step, and clinical balance assessments. The PERT group initiated a lateral step faster with the non-paretic leg during the induced waist pull perturbation step (P = 0.044) than the VOL group after training. Both groups improved the non-paretic step length and step velocity during lateral steps. During the voluntary steps, the PERT group significantly initiated a voluntary step faster. No significant changes were observed in the paretic leg. Both groups significantly improved on the Community Balance & Mobility Scale and Activities Specific Balance Confidence Scale. Overall, we demonstrated that an exercise to improve stepping performance with external perturbations might provide more benefits in protective stepping responses than training with voluntary steps for individuals with a stroke.

该研究探讨了侧向扰动训练能否改善中风后患者的步态表现和平衡能力。31名患有偏瘫的参与者被随机分配到PERT(外部扰动)或VOL(自主步法)步法训练中。PERT和VOL组包括80次主要在横向方向上的步法试验,以及一小部分在前/后方向上的步法试验。根据台阶类型(内侧和外侧)进行的结果测量包括台阶启动时间、台阶长度、台阶间隙、诱导腰部牵拉扰动和自主台阶时的台阶速度以及临床平衡评估。与 VOL 组相比,PERT 组在训练后,在诱导腰部牵拉扰动步时,用非瘫痪腿启动侧向步的速度更快(P = 0.044)。两组都提高了非瘫痪腿的步长和横向步速。在自主步中,PERT 组明显更快地开始自主步。瘫痪腿没有明显变化。两组在社区平衡与活动能力量表和特定活动平衡信心量表方面均有明显改善。总之,我们的研究表明,对于中风患者来说,在外部扰动下提高迈步能力的训练可能比自主迈步训练更有利于保护性迈步反应。
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引用次数: 0
Role of joint interactions in upper limb joint movements: a disability simulation study using wearable inertial sensors for 3D motion capture. 关节相互作用在上肢关节运动中的作用:利用可穿戴惯性传感器进行三维运动捕捉的残疾模拟研究。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-11-05 DOI: 10.1186/s12984-024-01480-0
Nishtha Bhagat, Preeti Raghavan, Vikram Kapila

Background: Restriction of movement at a joint due to disease or dysfunction can alter the range of motion (ROM) at other joints due to joint interactions. In this paper, we quantify the extent to which joint restrictions impact upper limb joint movements by conducting a disability simulation study that used wearable inertial sensors for three-dimensional (3D) motion capture.

Methods: We employed the Wearable Inertial Sensors for Exergames (WISE) system for assessing the ROM at the shoulder (flexion-extension, abduction-adduction, and internal-external rotation), elbow (flexion-extension), and forearm (pronation-supination). We recruited 20 healthy individuals to first perform instructed shoulder, elbow, and forearm movements without any external restrictions, and then perform the same movements with restriction braces placed to limit movement at the shoulder, elbow, and forearm, separately, to simulate disability. To quantify the extent to which a restriction at a non-instructed joint affected movement at an instructed joint, we computed average percentage reduction in ROM in the restricted versus unrestricted conditions. Moreover, we performed analysis of variance and post hoc Tukey tests (q statistic) to determine the statistical significance (p < 0.05 denoted using *) of the differences in ROM of an instructed joint in the unrestricted versus restricted conditions.

Results: Restricting movement at the shoulder led to a large reduction in the average ROM for elbow flexion-extension (21.93%, q = 9.34*) and restricting elbow movement significantly reduced the average ROM for shoulder flexion-extension (17.77%, q = 8.05*), shoulder abduction-adduction (19.80%, q = 7.60*), and forearm pronation-supination (14.04%, q = 4.96*). Finally, restricting the forearm significantly reduced the average ROM for shoulder internal-external rotation (16.71%, q = 3.81*) and elbow flexion-extension (10.01%, q = 4.27*).

Conclusions: Joint interactions across non-instructed joints can reduce the ROM of instructed movements. Assessment of ROM in the real-world using 3D motion capture, for example using the WISE system, can aid in understanding movement limitations, informing interventions, and monitoring progress with rehabilitation.

背景:由于疾病或功能障碍导致的关节活动受限会因关节相互作用而改变其他关节的活动范围(ROM)。在本文中,我们通过使用可穿戴惯性传感器进行三维(3D)运动捕捉的残疾模拟研究,量化了关节限制对上肢关节运动的影响程度:方法:我们使用可穿戴惯性传感器系统(WISE)来评估肩关节(屈-伸、外展-内收、内旋-外旋)、肘关节(屈-伸)和前臂关节(代-上举)的ROM。我们招募了 20 名健康人,首先让他们在没有任何外部限制的情况下完成肩部、肘部和前臂的指令性动作,然后分别戴上限制支架限制肩部、肘部和前臂的动作,以模拟残疾。为了量化非指令关节的限制对指令关节运动的影响程度,我们计算了在限制与非限制条件下ROM的平均减少百分比。此外,我们还进行了方差分析和事后Tukey检验(q统计量),以确定在非限制与限制条件下,指示关节的活动度差异的统计学意义(p *):限制肩部运动导致肘部屈伸的平均 ROM 大幅减少(21.93%,q = 9.34*),限制肘部运动显著减少了肩部屈伸(17.77%,q = 8.05*)、肩部外展-内收(19.80%,q = 7.60*)和前臂前伸-上举(14.04%,q = 4.96*)的平均 ROM。最后,限制前臂显著降低了肩关节内旋-外旋(16.71%,q = 3.81*)和肘关节屈-伸(10.01%,q = 4.27*)的平均 ROM:结论:非指导关节间的关节相互作用会降低指导动作的 ROM。使用三维运动捕捉(如使用 WISE 系统)评估真实世界中的 ROM 有助于了解运动限制,为干预措施提供信息,并监测康复进展。
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引用次数: 0
A machine learning approach for the design optimization of a multiple magnetic and inertial sensors wearable system for the spine mobility assessment. 用于脊柱活动度评估的多磁场和惯性传感器可穿戴系统的机器学习优化设计方法。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-11-05 DOI: 10.1186/s12984-024-01484-w
Dalia Y Domínguez-Jiménez, Adriana Martínez-Hernández, Gustavo Pacheco-Santiago, Julio C Casasola-Vargas, Rubén Burgos-Vargas, Miguel A Padilla-Castañeda

Background: Recently, magnetic and inertial measurement units (MIMU) based systems have been applied in the spine mobility assessment; this evaluation is essential in the clinical practice for diagnosis and treatment evaluation. The available systems are limited in the number of sensors, and neither develops a methodology for the correct placement of the sensors, seeking the relevant mobility information of the spine.

Methods: This work presents a methodology for analyzing a system consisting of sixteen MIMUs to reduce the amount of information and obtain an optimal configuration that allows distinguishing between different body postures in a movement. Four machine learning algorithms were trained and assessed using data from the range of motion in three movements (Mov.1-Anterior hip flexion; Mov.2-Lateral trunk flexion; Mov.3-Axial trunk rotation) obtained from 12 patients with Ankylosing Spondylitis.

Results: The methodology identified the optimal minimal configuration for different movements. The configuration showed good accuracy in discriminating between different body postures. Specifically, it had an accuracy of 0.963 ± 0.021 for detecting when the subject is upright or bending in Mov.1, 0.944 ± 0.038 for identifying when the subject is flexed to the left or right in Mov.2, and 0.852 ± 0.097 for recognizing when the subject is rotated to the right or left in Mov.3.

Conclusions: Our results indicate that the methodology developed results in a feasible configuration for practical clinical studies and paves the way for designing specific IMU-based assessment instruments.

Trial registration: Study approved by the Local Ethics Committee of the General Hospital of Mexico "Dr. Eduardo Liceaga" (protocol code DI/03/17/471).

背景:最近,基于磁性和惯性测量单元(MIMU)的系统被应用于脊柱活动度评估;这种评估在临床实践中对诊断和治疗评估至关重要。现有系统的传感器数量有限,而且都没有制定正确放置传感器的方法,以寻求相关的脊柱活动度信息:本研究提出了一种分析由十六个多传感器单元组成的系统的方法,以减少信息量,获得最佳配置,从而区分运动中的不同身体姿势。利用从 12 名强直性脊柱炎患者处获得的三个动作(Mov.1-髋关节前屈;Mov.2-躯干侧屈;Mov.3-躯干轴向旋转)的运动范围数据,对四种机器学习算法进行了训练和评估:该方法确定了不同运动的最佳最小配置。该配置在区分不同身体姿势方面表现出良好的准确性。具体地说,在运动 1 中,该配置检测主体直立或弯曲的准确率为 0.963 ± 0.021;在运动 2 中,该配置识别主体向左或向右弯曲的准确率为 0.944 ± 0.038;在运动 3 中,该配置识别主体向右或向左旋转的准确率为 0.852 ± 0.097:我们的结果表明,所开发的方法为实际临床研究提供了可行的配置,并为设计基于 IMU 的特定评估工具铺平了道路:研究获得了墨西哥 "爱德华多-利萨加博士 "总医院地方伦理委员会的批准(方案代码 DI/03/17/471)。
{"title":"A machine learning approach for the design optimization of a multiple magnetic and inertial sensors wearable system for the spine mobility assessment.","authors":"Dalia Y Domínguez-Jiménez, Adriana Martínez-Hernández, Gustavo Pacheco-Santiago, Julio C Casasola-Vargas, Rubén Burgos-Vargas, Miguel A Padilla-Castañeda","doi":"10.1186/s12984-024-01484-w","DOIUrl":"10.1186/s12984-024-01484-w","url":null,"abstract":"<p><strong>Background: </strong>Recently, magnetic and inertial measurement units (MIMU) based systems have been applied in the spine mobility assessment; this evaluation is essential in the clinical practice for diagnosis and treatment evaluation. The available systems are limited in the number of sensors, and neither develops a methodology for the correct placement of the sensors, seeking the relevant mobility information of the spine.</p><p><strong>Methods: </strong>This work presents a methodology for analyzing a system consisting of sixteen MIMUs to reduce the amount of information and obtain an optimal configuration that allows distinguishing between different body postures in a movement. Four machine learning algorithms were trained and assessed using data from the range of motion in three movements (Mov.1-Anterior hip flexion; Mov.2-Lateral trunk flexion; Mov.3-Axial trunk rotation) obtained from 12 patients with Ankylosing Spondylitis.</p><p><strong>Results: </strong>The methodology identified the optimal minimal configuration for different movements. The configuration showed good accuracy in discriminating between different body postures. Specifically, it had an accuracy of 0.963 ± 0.021 for detecting when the subject is upright or bending in Mov.1, 0.944 ± 0.038 for identifying when the subject is flexed to the left or right in Mov.2, and 0.852 ± 0.097 for recognizing when the subject is rotated to the right or left in Mov.3.</p><p><strong>Conclusions: </strong>Our results indicate that the methodology developed results in a feasible configuration for practical clinical studies and paves the way for designing specific IMU-based assessment instruments.</p><p><strong>Trial registration: </strong>Study approved by the Local Ethics Committee of the General Hospital of Mexico \"Dr. Eduardo Liceaga\" (protocol code DI/03/17/471).</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"21 1","pages":"198"},"PeriodicalIF":5.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Detecting muscle fatigue among community-dwelling senior adults with shape features of the probability density function of sEMG. 利用 sEMG 概率密度函数的形状特征检测社区老年人的肌肉疲劳。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-11-04 DOI: 10.1186/s12984-024-01497-5
Jiarui Ou, Na Li, Haoru He, Jiayuan He, Le Zhang, Ning Jiang

Background: Physical exercise is an important method for both the physical and mental health of the senior population. However, excessive exertion can lead to increased risks of falls, severe injuries, and diminished quality of life. Therefore, simple and effective methods for fatigue monitoring during exercise are highly desirable, particularly in community settings. The purpose of this study was to explore the possibility of real-time detection of exercise-induced fatigue using surface Electromyogram (sEMG) features, including the kurtosis and skewness of the Probability Density Function (PDF) in the community settings to solve the issues of low sensitivity and high computational complexity of commonly used sEMG features.

Methods: sEMG signals from six forearm muscles were recorded during hand grip tasks at 20% maximal voluntary contraction (MVC) task-to-failure contractions from 30 healthy community-dwelling elders at their respective community centers. PDF shape features of the sEMG, namely kurtosis and skewness, were computed from 25 s of non-fatigue stable phase and 25 s of fatigue data for comparison. Statistical tests were conducted to compare and test for the significance of these features. We further proposed a novel fatigue indicator, Temporal-Mean-Kurtosis (TMK) of channel-averaged kurtosis, to detect fatigue with relatively low computational complexity and adequate sensitivity in community settings. ANOVA and post-hoc analyses were performed to examine the performance of TMK.

Results: Statistically significant differences were found between the non-fatigue period and the fatigue period for both kurtosis and skewness, with increasing values when approaching fatigue. TMK was shown to be sensitive in detecting fatigue with respect to time with lower computational complexity than the Sample Entropy.

Conclusion: This study investigated PDF shape features of sEMG signals during a handgrip exercise to identify muscle fatigue in older adults in community experiments. Results revealed significant changes in kurtosis upon fatigue, indicating that PDF shape features were suitable convenient detectors of muscle fatigue in community experiments. The proposed indicator, TMK, showed potential sensitivity in tracking muscle fatigue over time in community-based settings with limited computational complexity, highlighting the promise of sEMG's PDF features in detecting muscle fatigue among the elderly.

背景:体育锻炼是老年人身心健康的重要方法。然而,过度劳累会导致跌倒风险增加、严重受伤和生活质量下降。因此,简单有效的运动疲劳监测方法非常必要,尤其是在社区环境中。本研究的目的是探索在社区环境中使用表面肌电图(sEMG)特征(包括概率密度函数(PDF)的峰度和偏度)实时检测运动引起的疲劳的可能性,以解决常用 sEMG 特征灵敏度低和计算复杂度高的问题。从 25 秒的非疲劳稳定阶段和 25 秒的疲劳数据中计算出了 sEMG 的 PDF 形状特征,即峰度和偏度,以进行比较。我们进行了统计检验,以比较和检验这些特征的显著性。我们进一步提出了一种新的疲劳指标,即信道平均峰度的时均峰度(TMK),用于检测疲劳,其计算复杂度相对较低,在社区环境中具有足够的灵敏度。对 TMK 的性能进行了方差分析和事后分析:结果:非疲劳期和疲劳期的峰度和偏度在统计学上存在明显差异,当接近疲劳期时,峰度和偏度值会增加。与样本熵相比,TMK 的计算复杂度更低,在时间方面对疲劳的检测也更灵敏:本研究调查了社区实验中老年人在进行手握运动时通过 sEMG 信号的 PDF 形状特征来识别肌肉疲劳的情况。结果表明,疲劳时峰度发生了明显变化,这表明在社区实验中,PDF 形状特征是合适、方便的肌肉疲劳检测器。所提出的指标 TMK 显示了在社区环境中以有限的计算复杂性跟踪肌肉疲劳随时间变化的潜在灵敏度,突出了 sEMG 的 PDF 特征在检测老年人肌肉疲劳方面的前景。
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引用次数: 0
Immersive virtual reality for learning exoskeleton-like virtual walking: a feasibility study. 沉浸式虚拟现实技术用于学习类似外骨骼的虚拟行走:一项可行性研究。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-11-01 DOI: 10.1186/s12984-024-01482-y
Antonio Rodríguez-Fernández, Alex van den Berg, Salvatore Luca Cucinella, Joan Lobo-Prat, Josep M Font-Llagunes, Laura Marchal-Crespo

Purpose: Virtual Reality (VR) has proven to be an effective tool for motor (re)learning. Furthermore, with the current commercialization of low-cost head-mounted displays (HMDs), immersive virtual reality (IVR) has become a viable rehabilitation tool. Nonetheless, it is still an open question how immersive virtual environments should be designed to enhance motor learning, especially to support the learning of complex motor tasks. An example of such a complex task is triggering steps while wearing lower-limb exoskeletons as it requires the learning of several sub-tasks, e.g., shifting the weight from one leg to the other, keeping the trunk upright, and initiating steps. This study aims to find the necessary elements in VR to promote motor learning of complex virtual gait tasks.

Methods: In this study, we developed an HMD-IVR-based system for training to control wearable lower-limb exoskeletons for people with sensorimotor disorders. The system simulates a virtual walking task of an avatar resembling the sub-tasks needed to trigger steps with an exoskeleton. We ran an experiment with forty healthy participants to investigate the effects of first- (1PP) vs. third-person perspective (3PP) and the provision (or not) of concurrent visual feedback of participants' movements on the walking performance - namely number of steps, trunk inclination, and stride length -, as well as the effects on embodiment, usability, cybersickness, and perceived workload.

Results: We found that all participants learned to execute the virtual walking task. However, no clear interaction of perspective and visual feedback improved the learning of all sub-tasks concurrently. Instead, the key seems to lie in selecting the appropriate perspective and visual feedback for each sub-task. Notably, participants embodied the avatar across all training modalities with low cybersickness levels. Still, participants' cognitive load remained high, leading to marginally acceptable usability scores.

Conclusions: Our findings suggest that to maximize learning, users should train sub-tasks sequentially using the most suitable combination of person's perspective and visual feedback for each sub-task. This research offers valuable insights for future developments in IVR to support individuals with sensorimotor disorders in improving the learning of walking with wearable exoskeletons.

目的:虚拟现实(VR)已被证明是运动(再)学习的有效工具。此外,随着目前低成本头戴式显示器(HMD)的商业化,沉浸式虚拟现实(IVR)已成为一种可行的康复工具。然而,如何设计沉浸式虚拟环境来加强运动学习,尤其是支持复杂运动任务的学习,仍然是一个未决问题。穿戴下肢外骨骼时触发台阶就是此类复杂任务的一个例子,因为它需要学习多个子任务,如将重心从一条腿转移到另一条腿、保持躯干直立和启动台阶。本研究旨在找到促进复杂虚拟步态任务的运动学习所需的虚拟现实元素:在这项研究中,我们开发了一个基于 HMD-IVR 的系统,用于训练感知运动障碍患者控制可穿戴式下肢外骨骼。该系统模拟了一个虚拟化身的行走任务,类似于使用外骨骼触发步法所需的子任务。我们对 40 名健康参与者进行了实验,以研究第一人称视角(1PP)与第三人称视角(3PP)以及提供(或不提供)参与者动作的并行视觉反馈对步行表现(即步数、躯干倾斜度和步长)的影响,以及对体现、可用性、晕机和感知工作量的影响:我们发现,所有参与者都学会了执行虚拟行走任务。结果:我们发现,所有参与者都学会了执行虚拟行走任务。然而,视角和视觉反馈之间并没有明显的交互作用,无法同时提高所有子任务的学习效果。相反,关键似乎在于为每个子任务选择适当的视角和视觉反馈。值得注意的是,在所有训练模式中,参与者都化身为化身,晕机程度很低。尽管如此,参与者的认知负荷仍然很高,导致可用性得分勉强可以接受:我们的研究结果表明,为了最大限度地提高学习效果,用户应该使用最合适的个人视角和视觉反馈组合,对每个子任务进行顺序训练。这项研究为 IVR 的未来发展提供了有价值的见解,可帮助患有感知运动障碍的人提高使用可穿戴外骨骼行走的学习能力。
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引用次数: 0
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Journal of NeuroEngineering and Rehabilitation
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