[논문]Identifications of Reflex Muscle Activities and Joint Moments Triggered by Electrical Stimulation to Sole of the Foot during Lokomat Treadmill Walking

Kim, Yong-Chul

doi:10.9718/jber.2010.31.5.344

Identifications of Reflex Muscle Activities and Joint Moments Triggered by Electrical Stimulation to Sole of the Foot during Lokomat Treadmill Walking 원문보기

Journal of biomedical engineering research : the official journal of the Korean Society of Medical & Biological Engineering, v.31 no.5, 2010년, pp.344 - 350

Kim, Yong-Chul (Department of Rehabilitation Science and Technology, Daegu University)

Abstract ▼ AI-Helper

The aim of this study was to investigate the characteristics of the flexion withdrawal reflex modulated during Lokomat treadmill walking in people with spinal cord injury. The influence of the limb position and movement were tested in 5 subjects with chronic spinal cord injury. EMG activities from tibialis anterior and moments of the hip joint elicited by the foot stimulation were examined during Lokomat treadmill walking. To trigger the flexion withdrawal reflex during Lokomat treadmill walking, a train of 10 stimulus pulses was applied at the skin of the medial arch. The TA EMG activity was modulated during gait phase and the largest TA reflex was obtained after heel-off and initial swing phase. During swing phase, TA EMG was 40.9% greater for the extended hip position (phase 6), compared with flexed hip position (phase 8). The measured reflex moment of the hip joint was also modulated during gait phase. In order to characterize the neural contribution of flexion reflex at the hip joint, we compared estimated moments consisted of the static and dynamic components with measured moment of the hip joint. The mean static gains of reflex hip moments for swing and stance phase are -0.1, -0.8, respectively. The mean dynamic gains of reflex hip moments are 0.25 for swing, 0.75 for stance phase. From this study, we postulate that the joint moment and muscle response of flexion withdrawal reflex have the phase-dependent modulation and linear relationship with hip angle and angular velocity for swing phase during Lokomat treadmill walking.

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문제 정의

The aim of this study is to investigate the influence of hip conditions on the flexor reflex elicited by nociceptive electrical stimulation of the skin afferents of the foot in SCI subjects during bodyweight supported treadmill walking with Lokomat System. The joint moment responses of the hip and the EMG (electromyogram) of the tibialis anterior (TA) were measured in order to characterize the flexor reflex response during gait cycle.
The Lokomat System also has advantages in respect to research purpose for rehabilitation [7,8]: It will become possible to measure different parameters of gait, change loading condition for body weight support and the degree of assistance of leg movements. This will facilitate investigation of the influence of these parameters on the effects of training.

제안 방법

In order to elicit the flexor reflex during Lokomat treadmill walking, the electrical stimuli by constant current stimulator (Model DS-7A, Digitimer Stimulator, Hertfordshire, UK) were applied at the medial arch of the foot in one of the following phases of the gait cycle: heel contact, foot flat, mid stance, heel off; toe off, initial swing, mid swing, terminal swing (Fig. 2). The electrical stimulus train consisted of a 50mA, 200-Hz pulse train composed of 10 monophasic pulses (each pulse of 1-ms duration).
Our current observations are consistent with the modulation pattern of the flexion reflex in SCI subjects by hip positions, which is facilitated during hip extension and depressed during hip flexion [17,18]. In this study, flexion reflexes were facilitated at the step cycle phases at which the hip was extended and depressed when the hip was flexed as occurs during the swing-to-stance transition. The nociceptive flexion reflex was also modulated in a phase dependent manner in non-injured subjects [20,21], similar to our observations.
5 Hz (8th order Butterworth filter), rectified and smoothed using a low pass filter (5 Hz, 8th order Butterworth filter). The rectified, smoothed TA EMG data were integrated for each of the three trials at each condition to obtain a measure of the EMG area associated with the flexor reflex response. The muscle activation (EMG) pattern for each stride was then time normalized, expressed as a percentage of the total gait cycle (e.

대상 데이터

Five subjects were recruited into this study through the inpatient and outpatient physical therapy clinics of the Rehabilitation Institute of Chicago. The patients included were sensory and motor complete (American Spinal Injury Association (ASIA) Scale A) or sensory and motor incomplete (ASIA C, D) at levels ranging from C5 to C7, as summarized in Table I.
2). The electrical stimulus train consisted of a 50mA, 200-Hz pulse train composed of 10 monophasic pulses (each pulse of 1-ms duration).
Five subjects were recruited into this study through the inpatient and outpatient physical therapy clinics of the Rehabilitation Institute of Chicago. The patients included were sensory and motor complete (American Spinal Injury Association (ASIA) Scale A) or sensory and motor incomplete (ASIA C, D) at levels ranging from C5 to C7, as summarized in Table I. Subject consent was obtained and all procedures were conducted in accordance with the Helsinki Declaration of 1975 and approved by the Institutional Review Boards of Northwestern University, Chicago, Illinois.
The primary equipment used in this study was the Lokomat System developed by Hocoma AG (Volkestswil, Switzerland). This system consists of the Lokomat (robotic gait orthosis), body weight support system and a treadmill (Woodway Inc.

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Identifications of Reflex Muscle Activities and Joint Moments Triggered by Electrical Stimulation to Sole of the Foot during Lokomat Treadmill Walking 원문보기

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Identifications of Reflex Muscle Activities and Joint Moments Triggered by Electrical Stimulation to Sole of the Foot during Lokomat Treadmill Walking 원문보기

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