Functional electrical stimulation mediated by iterative learning control and 3D robotics reduces motor impairment in chronic stroke
Novel stroke rehabilitation techniques that employ electrical stimulation (ES) and robotic technologies are effective in reducing upper limb impairments. ES is most effective when it is applied to support the patients’ voluntary effort; however, current systems fail to fully exploit this connection. This study builds on previous work using advanced ES controllers, and aims to investigate the feasibility of Stimulation Assistance through Iterative Learning (SAIL), a novel upper limb stroke rehabilitation system which utilises robotic support, ES, and voluntary effort.
Five hemiparetic, chronic stroke participants with impaired upper limb function attended 18, 1 hour intervention sessions. Participants completed virtual reality tracking tasks whereby they moved their impaired arm to follow a slowly moving sphere along a specified trajectory. To do this, the participants’ arm was supported by a robot. ES, mediated by advanced iterative learning control (ILC) algorithms, was applied to the triceps and anterior deltoid muscles. Each movement was repeated 6 times and ILC adjusted the amount of stimulation applied on each trial to improve accuracy and maximise voluntary effort. Participants completed clinical assessments (Fugl-Meyer, Action Research Arm Test) at baseline and post-intervention, as well as unassisted tracking tasks at the beginning and end of each intervention session. Data were analysed using t-tests and linear regression.
From baseline to post-intervention, Fugl-Meyer scores improved, assisted and unassisted tracking performance improved, and the amount of ES required to assist tracking reduced.
The concept of minimising support from ES using ILC algorithms was demonstrated. The positive results are promising with respect to reducing upper limb impairments following stroke, however, a larger study is required to confirm this.
- National Audit Office Department of Health: Progress in improving stroke care. 2010.
- Stroke association: Stroke statistics. 2006, 1–7.
- Carroll K, Murad S, Eliahoo J, Majeed A: Stroke incidence and risk factors in a population -based prospective cohort study. Heal Stat Q 2001, 12:18–26.
- Broeks JG, Lankhorst GJ, Rumping K, Prevo AJH: The long-term outcome of arm function after stroke: results of a follow-up. Disabil Rehabil 1999, 21:357–364. CrossRef
- Nicholls-Larsen DS, Clark PC, Zeringue A, Greenspan A, Blanton S: Factors influencing stroke survivors’ quality of life during subacute recovery. Stroke 2005, 36:1480–1484. CrossRef
- Barreca S, Wolf SL, Fasoli S, Bohannon R: Treatment interventions for the paretic upper limb of stroke survivors: A critical review. Neurorehabil Neural Repair 2003, 17:220–226. CrossRef
- Langhorne P, Coupar F, Pollock A: Motor recovery after stroke: a systematic review. Lancet Neurol 2009, 8:741–751. CrossRef
- Kwakkel G, Kollen BJ, Wagenaar RC: Therapy impact on functional recovery in stroke rehabilitation: A critical review of the literature. Physiotherapy 1999, 85:377–391. CrossRef
- Kwakkel G: Impact of intensity of practice after stroke: Issues for consideration. Disabil Rehabil 2006, 26:823–830. CrossRef
- Oujamaa L, Rlave I, Froger J, Mottet D, Pelissier J-Y: Rehabilitation of arm function after stroke. Literature review. Annu Phys Rehabil Med 2009, 52:269–293.
- Dobkin BH: Strategies for stroke rehabilitation. Lancet Neurol 2004, 3:528–536. CrossRef
- De Kroon JR, IJzerman MJ, Chae J, Lankhorst GJ, Zilvold G: Relation between stimulation characteristics and clinical outcome of the upper extremity in stroke. Rehabil Med 2005, 37:65–74. CrossRef
- De Kroon JR, van der Lee JH, IJzerman MJ: Therapeutic electrical stimulation to improve motor control and functional abilities of the upper extremity after stroke: a systematic review. Clin Rehabil 2002, 16:350–360. CrossRef
- Kwakkel G, Kollen BJ, Krebs HI: Effects of robot-assisted therapy on upper limb recovery after stroke: A systematic review. Neurorehabil Neural Repair 2008, 22:111–121.
- Sveistrup H: Motor rehabilitation using virtual reality. NeuroEng Rehabil 2004, 1:10. CrossRef
- Johnson MJ: Recent trends in robot-assisted therapy environments to improve real-life functional performance after stroke. NeuroEng Rehabil 2006, 3:29. CrossRef
- Meilink A, Hemmen B, Seelen HAM, Kwakkel G: Impact of EMG-triggered neuromuscular stimulation of the wrist and finger extensors of the paretic hand after stroke: A systematic review. Clin Rehabil 2008, 22:291–305. CrossRef
- Zhang D, Guan TH, Widjaja F, Ang WT: Functional electrical stimulation in rehabilitation engineering: A survey. Singapore; 2007.
- Hincapie JG, Kirsch RF: Feasibility of EMG-based neural network controller for an upper extremity neuroprosthesis. IEEE Trans Neural Syst Rehabil Eng 2009, 17:80–90. CrossRef
- Giuffrida JP, Crago PE: Functional restoration of elbow extension after spinal-cord injury using a neural network-based synergistic FES controller. IEEE Trans Neural Syst Rehabil Eng 2005, 13:147–152. CrossRef
- Bristow DA, Tharayil M, Alleyne AG: A survey of iterative learning control a learning-based method for high-performance tracking control. IEEE Control Syst Mag 2006, 26:96–114. CrossRef
- Freeman CT, Rogers E, Hughes AM, Burridge JH, Meadmore KL: Iterative Learning Control in Healthcare Electrical Stimulation and Robotic-assisted Upper Limb Stroke Rehabilitation. IEEE Contr Syst Mag 2012,32(1):18–43. CrossRef
- Freeman CT, Tong D, Meadmore KL, Hughes AM, Rogers E, Burridge JH: FES based Rehabilitation of the Upper Limb using Input/Output Linearization and ILC. Montréal; 2012. In press
- Hughes AM, Freeman CT, Burridge JH, Chappell PH, Lewin PL, Rogers E: Feasibility of iterative learning control mediated by functional electrical stimulation for reaching after stroke. Neurorehabil Neural Repair 2009, 23:559–568. CrossRef
- Hughes AM, Freeman CT, Burridge JH, Chappell PH, Lewin PL, Rogers E: Shoulder and elbow muscle activity during fully supported trajectory tracking in people who have had a stroke. Electromyogr Kinesiol 2010, 20:465–476. CrossRef
- Freeman CT, Hughes AM, Burridge JH, Chappell PH, Lewin PL, Rogers E: Iterative learning control of FES applied to the upper extremity for rehabilitation. Control Eng Pract 2009, 17:368–381. CrossRef
- Le F, Markovsky I, Freeman CT, Rogers E: Identification of electrically stimulated muscle models of stroke patients. Control Eng Pract 2010, 18:396–407. CrossRef
- Meadmore KL, Cai Z, Tong D, Hughes A-M, Freeman CT, Rogers E, Burridge JH: Upper limb stroke rehabilitation: The effectiveness of stimulation assistance through iterative learning (SAIL). In IEEE International Conference on Rehabilitation Robotics (ICORR). Zurich, Switzerland; 2011.
- Freeman CT, Tong D, Meadmore KL, Cai Z, Rogers E, Hughes AM, Burridge JH: Phase Lead Iterative Learning Control Algorithms for Functional Electrical Stimulation based Stroke Rehabilitation. Proc IME Part I: J Syst Contr Eng 2011,225(6):850–859.
- Lyle RC: A performance for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res 1981, 4:483–492. CrossRef
- Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S: The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med 1975, 7:13–31.
- Wilson B, Cockburn J, Halligan P: Development of a behavioral test of visuospatal neglect. Arch Phys Med Rehabil 1987, 68:98–102.
- Leyland L, Meadmore KL, Godwin HJ, Benson V, Burridge JH, Freeman CT, Hughes AM, Rogers E, Liversedge SP: Patterns of Eye Movements during Cancellation Tasks in Stroke Patients Exhibiting Hemispatial Neglect. In 10thEuropean Conference on Eye Movements. Marseille, France; 2011.
- Van der Lee JH, De Groot V, Beckerman H, Wagenaar RC, Lankhorst GJ, Bouter LM: The intra- and interrater reliability of the action research arm test: A practical test of upper extremity function in patients with stroke. Arch Phys Med Rehabil 2001, 82:14–19. CrossRef
- Rabadi MH, Rabadi FM: Comparison of the action research arm test and the fugl-meyer assessment as measures of upper-extremity motor weakness after stroke. Arch Phys Med Rehabil 2006, 87:962–966. CrossRef
- Freeman CT, Hughes AM, Burridge JH, Chappell PH, Lewin PL, Rogers E: A model of the upper extremity using FES for stroke rehabilitation. ASME J Biomech Eng 2009,131(3):031011. CrossRef
- Matthews JNS, Altman DG, Campbell MJ, Royston P: Analysis of serial measurements in medical research. BMJ 1990, 300:230–235. CrossRef
- Functional electrical stimulation mediated by iterative learning control and 3D robotics reduces motor impairment in chronic stroke
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of NeuroEngineering and Rehabilitation
- Online Date
- June 2012
- Online ISSN
- BioMed Central
- Additional Links
- Functional electrical stimulation
- Upper limb
- Stroke rehabilitation
- Iterative learning control
- Robotic support
- Virtual reality
- Author Affiliations
- 1. School of Electronics and Computer Science, University of Southampton, Southampton, SO17 1BJ, UK
- 2. Faculty of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK