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Wearables para la salud y prevención de riesgos laborales


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- Thierry Keller – TECNALIA.
Título: Clinical experience with wearable FES Technologies

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Wearables para la salud y prevención de riesgos laborales

  1. 1. Jornada Wearables para la salud y prevención de riesgos laborales Thierry Keller Donostia – San Sebastián, 12 de noviembre 2019 Clinical Experience with Wearable FES Technologies
  2. 2. Índice Pág. FES Dropfoot Upper Limb FES Maxsens 07 12 03 Clinical Experience with Wearable FES Technologies
  3. 3. 3 Conclusion for Functional Electrical Stimulation in Lower Extremity There is strong (Level 1a) evidence that FES and gait retraining results in improvements in hemiplegic gait. Functional Electrical Stimulation combined with gait training improves hemiplegic gait. FES Dropfoot Evidence FES in Stroke Rehabilitation , Canadian Stroke Network (CSN), Lower Extremity FES after Stroke
  4. 4. 4 Stripe multi pad electrode Counter electrode Deep peroneal nerve for dorsiflexion and superficial branch for plantar flexion are stimulated IMU for gait phase detection: Position on shank or foot under investigation FES Dropfoot Multi-pad FES Dropfoot System
  5. 5. 5 Position and variability of selected pads for dorsiflexion and plantar flexion in 20 clinical sessions (N=10): DorsiflexionPlantar flexion Mean selected pad centroid variability (N=10, 20 trials): • 2.72 cm for dorsiflexion • 2.21 cm for plantar flexion FES Dropfoot Results in sub-acute and chronic stroke subjects [Malešević J et al,“A decision support system for electrode shaping in multi-pad FES foot drop correction”, J NeuroEng & Rehab 14:66, 2017]
  6. 6. 6 Assistive vs. therapeutic effect in ankle joint angle (dorsiflexion) FES Dropfoot Results Dropfoot RCT in Sub- acute Stroke Subjects Gait speed: FES vs. Control [Dujovoic S., et al., L., NeuroRehabilitation, 41(4):791-800, 2017]
  7. 7. 7 Conclusions Regarding the Efficacy of FES Therapy in Acute Stroke There is strong (Level 1a) evidence that FES treatment improves upper extremity function in acute stroke. Among the studies evaluating ES in the acute stage of stroke, most assessed the same treatment comparison, physical therapy plus FES (or sham FES) vs. physical therapy alone. The results most of the studies indicated that FES was an associated with improvements in motor function, ADL and dexterity. Upper Limb FES Evidence FES in Stroke Rehabilitation, Canadian Stroke Network (CSN), Upper Extremity FES in Acute and Subacute Stroke
  8. 8. 8 Conclusions Regarding the Efficacy of FES Therapy in Chronic Stroke There is strong (Level 1a) evidence that FES treatment improves upper extremity function in chronic stroke. There is moderate (Level 1b) evidence that EMG-triggered FES is not superior to cyclic FES. Functional Electrical Stimulation therapy improves hemiparetic upper extremity function. Upper Limb FES Evidence FES in Stroke Rehabilitation, Canadian Stroke Network (CSN), ), Upper Extremity FES in Chronic Stroke
  9. 9. 9 Description of the Upper Extremity FES System 1. Multipad electrodes in a streachable garment designed to stimulate all the forearm muscles needed to produce a functional grasp 2. Inteligent stimulator communicates over bluetooth interface to the PC, tablet or smartphone 3. Sensor glove enables automatic electrode calibration. Main Features: • Multi-field electrodes for higher selectivity and better functional performance • Easy donning/doffing • 8 distinct functional activation primitives • Automatic calibration algorithms (in development) Upper Limb FES System Upper Limb FES
  10. 10. 10 ✗ ✗ ✗ Upper Extremity FES: Results Achievable Grasps Upper Limb FES
  11. 11. 11 Spatial and temporal change of stimulation zones Upper Limb FES Subject 1 Subject 2 Subject 3 Subject 4
  12. 12. 12 Spatial Stimulation zones for Finger, Wrist, and Thumb Extension (N=12) Upper Limb FES [J. Malesevic et al., “Temporal and spatial variability of surface motor activation zones in hemiplegic patients during 20 FES therapy sessions”, Artif Organs 44:166-77, 2017 2017]
  13. 13. 13 Focus of the research in the MAXSENS project is to investigate advantages of time and space distributed stimulation using array electrodes for afferent stimulation. MAXSENS stimulation device should provide the user proprioceptive and sensory feedback from the artificial hand through electrotactile stimulation. Aim is to define intuitive feedback mapping through stimuli localization and parameters of electrical stimulation. Maxsens Maxsens, Afferent Feedback
  14. 14. 14 Maxsens Maxsens Functions
  15. 15. 15 Success Rate: discrimination of dynamic afferent stimulation patterns Maxsens This demonstrates that the amputees were able to consistently discriminate a set of presented dynamic patterns after very short training despite the diversity of the individual characteristics, such as, amputation level, type of trauma, surgical procedure, time elapsed after the procedure, overall physical and psychological condition of the subject, and even the location of the electrotactile feedback The average SR was very high for 6 amputees and 10 able-bodied subjects when discriminating the dynamic stimulation patterns. Able-bodied subjects were able to perceive and identify stimulation patterns with an average SR of 99 3%. The average SR for amputees was 86 10%. Štrbac, M., et. Al. (2016). Integrated and flexible multichannel interface for electrotactile stimulation. Journal of Neural Engineering, 13(4)
  16. 16. 16 Summary: Preliminary clinical results Maxsens • MaxSens working principle has been tested in 15 upper limb amputees • Amputees were able to recognize 8 prosthesis states with more than 90% accuracy • It required only 20 minutes of training