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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An optimal control strategy for FES-induced cyclical leg movements in paraplegics is proposed. The control of the cyclical movement of a freely swinging leg is considered as an example. Quadriceps and the flexion withdrawal reflex are stimulated in order to generate a cyclical movement, of which the forward swing resembles the swing phase of gait. Optimal stimulation patterns are determined on the basis of an optimization criterion and a dynamic model of the system. The criterion is based on desired movement parameters and a minimal duration of the stimulation bursts. The movement parameters should ensure the generation of the desired cyclical movement: a desired hip angle range, sufficient foot clearance during the forward swing and knee extension at the beginning of the backward swing. Minimal duration of the stimulation bursts is assumed to yield minimal fatigue. A dynamic model, describing the dynamics of the neural system, the muscles and the leg, was constructed and its parameters identified on the basis of preliminary experiments and literature. Optimal timing of the quadriceps and flexion reflex stimulation bursts was determined by means of computer simulation. These simulations predicted that the flexion reflex should be stimulated in a short burst approximately 150 ms before the start of the forward swing. The quadriceps should be stimulated approximately starting 200 ms before the end of the forward swing in order to ensure knee extension at the beginning of the backward swing. The duration of one cycle of the movement was between 1300 and 1500 ms in these simulations. These results predict that the movement specified by the functional objectives can be realised using only two channels of stimulation. On the basis of the optimal timing, an adaptive control strategy can be designed, which varies the stimulation burst width when muscles fatigue.
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PMID:Modelling the optimal control of cyclical leg movements induced by functional electrical stimulation. 149 50

In order to assess the effects of FES on muscle output, chronic electrical stimulation of the quadriceps muscle was applied for half an hour twice a day for 2 months, in 10 thoracic level traumatic paraplegic patients. Results concerning torque (at 6 different muscle lengths) and fatigue were measured using a strain gauge transducer in isometric condition, and compared with the findings in 15 paraplegic patients who had not received electrical stimulation, and with 10 able bodied subjects with normal motor functions. With training, muscle strength was very significantly improved whilst fatigue resistance remained at a low level. The peak torque was not found to be of the same muscle length when comparing paraplegics and control subjects; it seemed to demonstrate that length-tension relationship of the muscular actuator was changing when it was electrically activated. Moreover, the force recorded in paraplegics remained markedly lower than in able bodied people.
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PMID:Effects of functional electrical stimulation (FES) on evoked muscular output in paraplegic quadriceps muscle. 150 60

Hybrid FES gait restoration systems which combine stimulation with controllable mechanical damping elements at the joints show promise for providing good control of limb motion despite variations in muscle properties. In this paper we compared three controllers for position tracking of the free swinging shank in able-bodied subjects. The controllers were open-loop (OL), proportional-derivative closed-loop (PD), and bang-bang plus controlled-brake control (CB). Both OL and PD controllers contained a forward path element, which inverted a model of the electrically stimulated muscle and limb system. The CB control was achieved by maximally activating the appropriate muscle group and controlling the brake to be a "moving-wall" against which the limb pushed. The CB control resulted in superior tracking performance for a wide range of position tracking tasks and muscle fatigue states but required no calibration or knowledge of muscle properties. The disadvantages of CB control include excess mechanical power dissipation in the brake and impact forces applied to the skeletal system.
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PMID:Regulating knee joint position by combining electrical stimulation with a controllable friction brake. 228 82

This paper describes and discusses the employment of EMG pattern analysis to provide upper-motor-neuron paraplegics with patient-responsive control of FES (functional electrical stimulation) for the purpose of walker-supported walking. The system described employs above-lesion surface EMG signals to activate standing and walking functions in a patient-responsive manner. This system has been experimentally applied to paraplegics at Michael Reese Hospital and Medical Center in Chicago since early 1982. Below-lesion response-EMG control from the stimulated sites has been added in 1987 to regulate stimuli levels in the face of fatigue. Although transcutaneous FES alone is being employed, the system is applicable in principle also to implantable FES systems.
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PMID:EMG pattern analysis for patient-responsive control of FES in paraplegics for walker-supported walking. 278 79

In a previous work, we studied the mechanical and the metabolic profiles of fatigue of paralyzed quadriceps muscle under activation by FES. The metabolic state of the muscle during stimulation of paraplegic patients was monitored, simultaneously with the decaying force, by using 31P nuclear magnetic resonance spectroscopy. In the present work, a musculotendon model was developed to enable prediction of the force output during continuous electrical stimulation. The model consisted of five elements, including the tendon, the parallel elastic, contractile and damper muscle elements, as well as the muscle mass. The mechanism of the contractile element was based upon the length-tension and the velocity-tension curves, the activation trajectory, and the experimentally obtained relationship between force and intracellular pH. In the equations obtained, three sets of parameters were used: 1) general muscle parameters, associated with the length-tension curves of tendon, fascia, and muscle and the velocity-tension curve of the contractile element; 2) specific anthropometric parameters of the muscle; and 3) fatigue parameters which were obtained from our previously recorded experimental data. The model was formulated to allow prediction of the quadriceps muscle force under dynamic activation and at various levels of stimulation. The model solution was for isometric contraction in supermaximal stimulation, and it provided the force decaying profiles, which were compared to those obtained experimentally. The parameters yielding the best fit between the model and the experimental results were indicated. Particularly, two muscle nonspecific parameters, namely, the muscle stress parameter and the parameter representing the ratio between the muscle's slack length and its length in vivo at various knee angles, were determined using the model. The muscle stress parameter was found to be between 60 and 64 N/cm2, and the length ratio was 0.952, 0.935, 0.920, and 0.901 for the 0, 30, 60, and 90 degrees knee angle, respectively. Finally, a sensitivity analysis was conducted of the model to perturbations of these two estimated parameters, revealing that the model was sensitive to these parameters.
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PMID:A musculotendon model of the fatigue profiles of paralyzed quadriceps muscle under FES. 824 27

A physiologically based mathematical model for skeletal muscle activated by neural impulses is presented. This model is developed specifically to capture the behavior for mammalian skeletal muscle activated by N-lets (sets of N high-frequency pulses with variable interpulse intervals). N-let pulse trains have been demonstrated as a possible means of producing contractions with reduced fatigue and fiber-type transformation, while maximizing the force-time integral per pulse (FTIpP) of electrically stimulated muscle. This model is developed by modeling the underlying biophysical processes responsible for the initiation and maintenance of force generation in muscle. The release and reaccumulation dynamics of calcium ions from the sarcoplasmic reticulum are modeled and proposed as the governing mechanism for the observed N-let effects. It is found that the new model is robust, numerically stable and easily implemented. Simulation results are presented that demonstrate the model's ability to capture a variety of the nonlinear summation, force and stiffness variation effects seen experimentally when activating skeletal muscle with N-lets. General properties of FES muscle are also predicted by the model. The significant insight provided by this model into the internal dynamics of skeletal muscle is used to assess a variety of mechanisms proposed for N-let behavior. It is postulated that the calcium release and reaccumulation dynamics, as incorporated in this model, are responsible for the N-let effects found in experiment.
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PMID:A mathematical model for skeletal muscle activated by N-let pulse trains. 974 6

This short communication is a preliminary report on a study concerning slowing down the rate of muscle fatigue when FES (Functional Electrical Stimulation) is applied for standing and walking by complete (traumatic) thoracic-level paraplegics. It is shown that randomly modulating the inter-pulse interval between FES pulses (which serve to trigger action potentials in the peripheral nerves concerned) results in a significantly lower rate of muscle fatigue, as tested in a series of leg extensions, when FES was applied at the quadriceps. Specifically, we report that the best results (longest durations of leg extension prior to onset of muscle-fatigue) were achieved with a +/- 5 msec uniformly-distributed (pseudo-) white-noise modulation at a 42 msec inter-pulse interval (24 pulses per sec). These resulted in an average increase in duration of leg extension of approximately 37% in this pilot study, as compared with unmodulated (fixed-rate) trains of FES pulses. This significant increase, even in a very preliminary study appears to merit careful further examination, since it may allow a possibly significant increase in standing duration and in walking range of paraplegics using FES for ambulation.
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PMID:Stochastically-modulated stimulation to slow down muscle fatigue at stimulated sites in paraplegics using functional electrical stimulation for leg extension. 1109 76

Exercise-induced increases in cardiac output (CO) and oxygen uptake (VO2) are tightly coupled, as also in absence of central motor activity and neural feedback from skeletal muscle. Neuromodulators of vascular tone and cardiac function - such as calcitonin gene related peptide (CGRP) - may be of importance. Spinal cord injured individuals (six tetraplegic and four paraplegic) performed electrically induced cycling (FES) with their paralyzed lower limbs for 29 +/- 2 min to fatigue. Voluntary cycling performed both at VO2 similar to FES and at maximal exercise in six healthy subjects served as control. In healthy subjects, CGRP in plasma increased only during maximal exercise (33.8 +/- 3.1 pmol l(-1) (rest) to 39.5 +/- 4.3 (14%, P<0.05)) with a mean extraction over the working leg of 10% (P<0.05). Spinal cord injured individuals had more pronounced increase in plasma CGRP (33.2 +/- 3.8 to 46.9 +/- 3.6 pmol l-1, P<0.05), and paraplegic and tetraplegic individuals increased in average by 23% and 52%, respectively, with a 10% leg extraction in both groups (P<0.05). The exercise induced increase in leg blood flow was 10-12 fold in both spinal cord injured and controls at similar VO2 (P<0.05), whereas CO increased more in the controls than in spinal man. Heart rate (HR) increased more in paraplegic subjects (67 +/- 7 to 132 +/- 15 bpm) compared with controls and tetraplegics (P<0.05). Mean arterial pressure (MAP) was unchanged during submaximal exercise and increased during maximal exercise in healthy subjects, but decreased during the last 15 min of exercise in the tetraplegics. It is concluded that plasma CGRP increases during exercise, and that it is taken up by contracting skeletal muscle. The study did not allow for a demonstration of the origin of the CGRP, but its release does not require activation of motor centres. Finally, the more marked increase in plasma CGRP and the decrease in blood pressure during exercise in tetraplegic humans may indicate a role of CGRP in regulation of vascular tone during exercise.
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PMID:Leg uptake of calcitonin gene-related peptide during exercise in spinal cord injured humans. 1116 94

This article presents a theoretical design of an FES controller to be used for stimulation of multiple mono and biarticulate muscles to restore multiple degree-of-freedom (DOF) motion in paralyzed individuals. The overall control strategy is based on multiple DOF musculo-skeletal model, nonlinear sliding mode control design, constrained optimization techniques to determine the needed muscle activations, and an additional inversion of the neuro-muscular stimulation relationship in order to obtain the needed controller output (electrical current amplitude/pulse-width). The combination of these methods leads to a controller that guarantees asymptotically stable tracking of reference position trajectories while assuring minimal (optimal) muscle activation and fatigue.
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PMID:Design of multiple degree-of-freedom sliding mode FES controller for concurrent stimulation of multiple mono and biarticulate muscles. 1727 39

The etiology of skeletal muscle fatigue is not well understood partly because techniques portraying muscle performance in vivo are limited by either their invasiveness (e.g., needle electrodes) or poor spatial resolution (e.g., surface EMG). To better characterize effects of FES and muscle fatigue, we captured real-time high resolution dynamics of the human forearm before and after a fatigue exercise using ultrasound strain imaging. A 10 MHz linear ultrasound probe aligned with the fiber axis of the 3rd flexor digitorum superficialis (FDS) provided scans at 3-msec intervals during isometric twitch and tetanic contractions evoked by low and high frequency electrical stimuli (ES). Ultrasound images synchronized with traditional force and EMG were obtained for 5 healthy adults before and after a fatiguing exercise, induced by sustained maximal exertion of the middle finger pressed against a restraint until the initial force decreased by 75%. Immediately after fatigue, twitch and tetanic stimuli generated 55.1% and 19.5% less force, respectively, implying that low frequency fatigue dominated. The force deficit was associated with a decrease in several mechanical properties of the fatigued muscle during twitch contractions, such as transverse peak strain (34 +/- 15%) and half peak strain duration (32.3 +/- 12.5 msec). Changes were not uniform across the imaged section of the muscle, suggesting that boundary conditions or fiber heterogeneity affected the strain profile. Indeed, high stress zones appeared closer to the muscle-tendon junction during isometric contractions. This study provided new insight on the elastic behavior of muscle and potential mechanisms of injury, especially directed at prolonged stimulation and control of a neuromuscular prosthesis.
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PMID:Effect of fatigue on muscle elasticity in the human forearm using ultrasound strain imaging. 1794 90


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