Low-cost personalised instrumented clothing with integrated FES electrodes for upper limb rehabilitation

中风是英国成年人残疾的主要原因。每年有15万人中风，其中5.4万人无法恢复上肢功能，导致每年个人和社会护理成本达到55亿英镑。这些数字将随着人口老龄化而增加；到2040年，65岁以上的人口预计将增长67%。政府将这种情况称为“一颗定时炸弹”，并呼吁创新技术，让中风患者可以在自己的家中使用。肌肉的功能性电刺激（FES）是一项技术，已被证明可以帮助PwS重新学习失去的技能，使他们能够练习和恢复失去的手臂运动，从而在他们的大脑中建立新的神经连接。FES的工作原理是通过放置在皮肤上的电极用电脉冲刺激肌肉。不幸的是，商用FES系统不适合日常密集使用，因为它们僵硬和不舒服，并且不能帮助PwS进行必要的精确运动，因为只有有限数量的肌肉受到刺激。在我们之前的研究中，我们已经在传统的可穿戴织物上开发了一个FES阵列的原型，使FES可以像普通衣服一样穿着来实现康复。因此，FES阵列灵活，透气，穿着舒适，并且可以按比例扩大以覆盖所需的尽可能多的肌肉。通过刺激阵列中电极元件的优化选择，实现了一系列精确的手部功能，包括捏，指向和手开口。这种刺激是用一种叫做“迭代学习控制”的高级软件来控制的，这种软件模仿了大脑学习新技能的方式。该控制器可以通过在任务中多次尝试学习最佳刺激模式来潜在地实现高度精确的运动。我们的项目将使用打印技术来制作定制的FES服装，以精确地适应个人的手臂和特定需求。定制的FES阵列设计将通过使用商用3D扫描仪扫描手臂并使用该项目开发的软件处理图像来生成。每个FES阵列将被打印在标准的日常织物上，然后集成到一件衣服中（例如袖口/臂章、袖子、长袖t恤）。制成的服装穿着非常舒适，而且每天使用都很方便。FES服装将使用无线控制系统与传感器相结合来操作，该系统可以自动调整FES以实现精确的活动，例如协助进食、洗涤和穿衣。我们将与由PwS及其护理人员、FES工程师和医疗保健专业人员组成的专家用户组密切合作，制定详细的设备规范。这将提供设备在舒适性、稳健性、刺激功能和成本标准方面的要求。在开发之后，该设备将根据此规范进行测试，并在整个项目中进行改进，以确保它完全满足PwS的需求。我们的技术将为PwS家庭带来负担得起的、有效的物理治疗，使他们能够在家里练习目标导向的功能活动，而不需要护理人员或治疗师。因此，它在不增加临床接触时间的情况下增加了康复的强度。这将带来更好的结果，如减少损伤，更大程度地恢复功能，提高生活质量和增加社会活动。这反过来将转化为更大的独立性，从而减少对护理人员的依赖，并有可能重返工作岗位。这项技术的第一个应用将是上肢残疾的残疾人，其次是下肢残疾的残疾人。这项技术还可能进一步应用于治疗其他神经系统疾病，如脊髓损伤和多发性硬化症。

Stroke is the leading cause of adult disability in the UK. Every year 150,000 strokes occur and 54,000 of these fail to regain upper limb function, resulting in yearly personal and societal care costs of £5.5bn. These numbers will increase with the aging population; by 2040 the number of people over 65 is expected to grow by 67%. The government has termed this situation 'a ticking time bomb' and has called for innovative technology that Persons with Stroke (PwS) can use in their own homes.Functional Electrical Stimulation (FES) of muscles is a technology that has been shown to help PwS re-learn lost skills by enabling them to practice and regain lost arm movement, and in-so-doing create new nerve connections in their brain. FES works by stimulating muscles with electrical pulses via electrodes placed on the skin. Unfortunately, commercial FES systems are not suitable for intensive daily use as they are rigid and uncomfortable, and not able to assist PwS in performing the necessary precise movements because only a limited number of muscles are stimulated. In our previous research we have developed a prototype FES array on a conventional wearable fabric enabling the FES to be worn as normal clothing to achieve rehabilitation. The FES array thus is flexible, breathable and comfortable to wear, and can be scaled up to cover as many muscles as are needed. A range of precise hand functions including pinching, pointing and hand opening have been achieved by stimulating an optimised selection of electrode elements in the array. The stimulation is controlled using advanced software called "iterative learning control" which mimics the way the brain learns new skills. This controller can potentially achieve highly accurate movement by learning the optimal stimulation pattern over multiple attempts at a task.Our project will use printing to fabricate customised FES garments to precisely fit the individual's arm and specific needs. The customised FES array design will be generated by scanning the arm using a commercial 3D scanner and processing the image using software developed in this project. Each FES array will be printed on standard everyday fabric and then integrated into a piece of clothing (e.g. cuff/armband, sleeve, long sleeved T-shirt). The resulting garment will be very comfortable to wear and convenient to use every day. The FES clothing will be operated using a wireless control system combined with sensors which automatically adjust the FES to enable precise activities, such as assisting eating, washing and dressing. We will work closely with an expert user group consisting of PwS and their carers, FES engineers and healthcare professionals to produce a detailed device specification. This will provide the device requirements in terms of comfort, robustness, stimulation function and cost criteria. Following development, the device will be tested against this specification and refined throughout the project to ensure it fully meets the needs of PwS. Our technology will bring affordable, effective physical therapy into the homes of PwS, allowing them to practice goal-orientated functional activities at home without needing a carer or therapist. It thereby increases the intensity of rehabilitation without an increase in clinical contact time. This will lead to better outcomes, such as reduced impairment, greater restoration of function, improved quality of life and increased social activity. This in turn will translate to greater independence leading to less dependence on carers, and the possibility of return to work. The first application of the technology will be with PwS with upper limb impairments followed by those with lower limb impairments. The technology can also potentially be further applied to treat other neurological conditions such as spinal cord injuries and multiple sclerosis.