Exploiting the nociceptive withdrawal reflexes in rehabilitation of hemiplegic gait : a case study
Emborg, Jonas ...
Background: A closed loop system for improving gait in hemiplegic patients by supporting the production of the swing phase using electrical stimulations evoking the nociceptive withdrawal reflex was ...designed and evaluated in one chronic hemiplegic subject. Methods: Electrical stimulation were delivered to 4 locations on the sole of the foot at 3 different time points between heel-off and toe-off. The system exploits the modular organization of the nociceptive withdrawal reflex and its site and phase modulation during gait in order evoke optimal flexion of the hip, knee and ankle joints in early swing phase. A Model Reference Adaptive Controller (MRAC) was designed to select the optimal stimulation parameters. The hypothesis was that the MRAC-system result in better walking pattern compared with a pre-programmed fixed pattern controller. Based on the patient unperturbed gait and his withdrawal strategies an individual controller target for hip, knee and ankle flexion were set. The patient walked 10 min with the MRAC-system, 10 min with the fixed pre-programmed pattern and 10 min with no-stimulation. Results and conclusions: The results indicate that both stimulation paradigms resulted in a more functional gait compared with no-stimulation and that the control strategy in the MRAC system is superior and will be able to adapt better to the varying needs during rehabilitation therapy.
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