Muscle selection and walking performance of multichannel FES systems for ambulation in paraplegia.
Muscle selection and walking performance of multichannel FES systems for ambulation in paraplegia.
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DOI：
10.1109/86.559346
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发表时间：
1997-03-01
期刊：
影响因子：
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通讯作者：
Marsolais, E B
中科院分区：
文献类型：
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作者：
Kobetic, R;Triolo, R J;Marsolais, E B
一组最少数量的肌肉（8到16块）被确定为可植入临床系统的候选肌肉，以便利用功能性电刺激（FES）为完全性截瘫患者提供行走功能。三名完全性运动和感觉截瘫患者在控制躯干、髋部、膝盖和脚踝的所有主要肌肉中都植入了经皮肌内电极。针对8块和16块不同肌肉组生成了使用FES行走的刺激模式。确定了由不同肌肉组合构成的行走模式所产生的步态质量和可重复性。大多数八通道刺激模式导致剪刀步或髋关节屈曲不足，阻碍了向前行进。一种八通道系统允许的最大速度为0.1米/秒，步频为22步/分钟，步长小于0.3米。使用16通道刺激观察到行走性能有所改善。其范围从0.1米/秒的缓慢移步态到0.5米/秒的平稳交替步态。在所有三名受试者中，16个通道的理想组合包括用于躯干伸展的竖脊肌；用于髋关节伸展的臀大肌、大收肌后部和腘绳肌；用于髋关节屈曲的阔筋膜张肌以及缝匠肌或髂腰肌；用于膝关节伸展的股外侧肌/股中间肌；用于踝关节背屈的胫骨前肌/腓骨长肌。在一名受试者中，16通道FES系统提供了可重复的日常步态，平均速度为0.4米/秒，步频为58步/分钟，步长为0.8米。16通道可重复行走的最大距离为34米。多次34米的试验是可能的，行走之间只需短暂休息。髋关节伸肌和上半身的疲劳是一个限制因素。植入目标肌肉的选择对FES系统的性能至关重要。这项研究根据步态性能的客观测量结果，为使用FES行走的肌肉选择提供了指导原则。研究结果表明，用于完全植入的16通道FES系统对于截瘫患者可重复的短距离、独立、借助助行器的行走是可行的。
A minimal set of muscles (8 to 16) were identified as candidates for implantation in a clinical system to provide walking function to individuals with complete paraplegia using functional electrical stimulation (FES). Three subjects with complete motor and sensory paraplegia had percutaneous intramuscular electrodes implanted in all major muscles controlling the trunk, hips, knees, and ankles. Stimulation patterns for walking with FES were generated for different sets of eight and 16 muscles. The quality and repeatability of the resulting gait produced by walking patterns consisting of various combinations of muscles were determined. Most eight-channel stimulation patterns resulted in scissoring or insufficient hip flexion, preventing forward progression. One eight-channel system allowed a maximum speed of 0.1 m/s with a cadence of 22 steps/min and a stride length less than 0.3 m. Improved walking performance was observed with 16 channels of stimulation. This ranged from slow step- to gait at 0.1 m/s to smooth reciprocal gait at 0.5 m/s. In all three subjects, the favored combination of 16 channels included erector spinae for trunk extension; gluteus maximus, posterior portion of adductor magnus and hamstrings for hip extension; tensor fasciae latae and either sartorius or iliopsoas for hip flexion; vastus lateralis/intermedius for knee extension; and tibialis anterior/peroneous longus for ankle dorsiflexion. In one subject the 16-channel FES system provided repeatable day-to-day gait averaging 0.4 m/s, 58 steps/min and a stride length at 0.8 m. A maximum repeatable walking distance with 16 channels was 34 m. Multiple 34-m trials were possible with minimal rests between walks. Fatigue of both the hip extensors and upper body was a limiting factor. The selection of target muscles for implantation is critical to the performance of FES systems. This study provides guidelines to muscle selection for walking with FES based on objective measures of gait performance. The findings indicate that a 16-channel FES system for total implantation is feasible for repeatable short distance, independent, walker-support walking in paraplegia.