Premio Juan López de Peñalver³n definitiva Dr. Rocon.pdf · • Supresión del temblor mediante...

Premio Juan López de Peñalver !

Ingeniería mejorando la calidad de vida de personas con temblor

Dr. Eduardo RoconCientífico Titular

Grupo de Bioingeniería, [email protected]

Premio Juan López de Peñalver !

Uso de Técnicas de Neuroingeniería para el Tratamiento del Temblor

• Motivación y Objetivos

• Características del temblor (desde una perspectiva “ingenieril”)

• Supresión del temblor mediante exoesqueletos robóticos

• Supresión del temblor mediante una neuroprótesis vestible

• Trabajo actual & líneas de futuro

Premio Juan López de Peñalver

!Real Academia de Ingeniería - 26 de Noviembre 2013


• Motivación y Objetivos





�3Premio Juan López de Peñalver


�4



Motivación• Principales Patologías1

- Ictus, Apoplejía (stroke) – 5,5 % de la población mundial (770 mil nuevos casos al año.)

- Lesionados medulares (800 por millón de habitantes) - Parálisis cerebral (2,8 por cada 1000 habitantes. España: 120.000) - Temblor (6% de las personas con más de 60 años)

1. World Healthy Organization (WHO)

�5



Motivación- Neurorehabilitación: Área de investigación multidisciplinar que combina

metodologías de la ingeniería y la medicina en la rehabilitación de pacientes. - Aplicaciones de neuroingeniería en la rehabilitación - Alto impacto

socioeconómico.



Neurorehabilitación

�8



Motivación

• Trastorno de movimiento más extendido (~15% personas >50 años1). Prevalencia se va a duplicar en 20502

• Causado por 10 “síndromes”diferentes

✦ Temblor esencial (TE) y enfermedad de Parkinson (EP)

✦ Tratamiento principal: fármacos, en algunos pacientes neurocirugía (estimulador cerebral profundo [DBS])

• Una gran proporción de pacientes (~25%3) no se beneficia de ningún tratamiento

• Gran impacto en calidad de vida, independencia

• Problemas sociales y psicológicos1. Wenning GK, Kiechl S, et al. Lancet Neurol 2005 2. Bach JP, Ziegler U, et al. Mov Disord 2011 3. Elble R, Koller J. “Tremor” 1990

Shneyder et al TOHD 2012


• Motivación





�9



¿Cómo “Es” y Cómo se Origina el Temblor?

CentrosSupraespinales

MédulaEspinal

Miembroafectado




actividad de motoneuronas


MédulaEspinal

Miembroafectado




actividad de motoneuronas

temblor

EMG de interferencia


MédulaEspinal

Miembroafectado

1 s

wris

t m

ov. (

a.u.

)sE

MG

ex

t. (a

.u.)

sEM

G

flex.

(a.u

.)



Movimiento Voluntario y Temblor

ampl

itud

1 s

ampl

itud

0 5 10 15frecuencia (Hz)

movimientovoluntario

temblor



¿Cómo Usar Esta Información?

Moviento

medido

Moviento

voluntario

Filtro Críticamente

Amortiguado

Weighted Frequency

Fourier Linear Combiner

–

Amplitud

del temblor

Frecuencia

del temblor

Filtro de Kalman

velo

cid

ad a

ngula

r

A

A

CB

B

C

5 H

zfr

equency



¿Cómo Usar Esta Información?

Extracción de lainformaciónSensores

Algoritmode control

Actuación


• Motivación





�16



El Exoesqueleto Robótico

• Estructura de duraluminio (850 g)

• Articulaciones: muñeca (flexo-extensión, pronosupinación) y codo (flexo-extensión)

• Medida: Sensores de fuerza (galgas extensométricas) y movimiento (giroscopios)

• Actuación: Motores eléctricos y reductora (par máximo 3 Nm)



El Exoesqueleto Robótico: Estudio Biomecánico

Estructura mecánica

Figura 4.8: Umbrales de tolerancia a la presión sobre el brazo. 1) Área de baja tolerancia(cerca de 450 kPa) 2) Área de tolerancia media 3) Área de alta tolerancia (cerca de 950kPa).

Figura 4.9: Ilustración de los apoyos de WOTAS sobre el brazo de un paciente. Los apoyosson fabricados en termoplástico para permitir una mejor adaptación a la morfología delbrazo de cada usuario.

figura 4.9 ilustra los apoyos de interfaz entre el exoesqueleto y el paciente, [161].

165

Estructuramecánica

Figura4.8:Umbralesdetoleranciaalapresiónsobreelbrazo.1)Áreadebajatolerancia

(cercade450kPa)2)Áreadetoleranciamedia3)Áreadealtatolerancia(cercade950

kPa).

Figura4.9:IlustracióndelosapoyosdeWOTASsobreelbrazodeunpaciente.Losapoyos

sonfabricadosentermoplásticoparapermitirunamejoradaptaciónalamorfologíadel

brazodecadausuario.

figura4.9ilustralosapoyosdeinterfazentreelexoesqueletoyelpaciente,[161].

165

Aplicación de fuerzas

Exoesqueleto para monitorización y supresión del temblor patológico

Figura 4.6: Par estimado para la tarea de llevar el dedo a la punta de la nariz en lascuatro articulaciones evaluadas

describe un movimiento sinusoidal perfecto, a una frecuencia de 3 Hz y una amplitudde 30 grados (temblor severo). Las estimaciones realizadas en este capítulo presentanresultados inferiores a los obtenidos por Rosen pero más fiables en la medida en queparten de datos reales de temblor en contraposición con la hipótesis de temblor severo ypuramente sinusoidal de Rosen.

158

Estimación de par articular (dimensionar)

Application of Load to Humans 137

The equation for a single Maxwell element (see Figure 5.4 (top right)) and Ferry (1980) is

k(t) = kie−t/λi (5.4)

where λi = Bi/ki . However, creep-related linear viscoelasticity cannot be described by Maxwellelements. To address this issue, Voight elements need to be introduced. The equation for a singleVoight element (see Figure 5.4 (bottom-right)) is

J (t) = Jie−t/λi (5.5)

where Ji = 1/ki .

Multidimensional models are more complex than uniaxial models and can be divided into the sametwo groups: elastic and viscoelastic. One of the most interesting multidimensional theories proposedmodels based on microstructural and thermodynamic considerations (Lanir, 1983). Other authorsproposed that tissues are composed of several networks of different types of fibres embedded in afluid matrix and present a strain energy function including angular and geometrical nonuniformities(Maurel, 1998). For additional information on tissue models the reader is referred to Fung (1993),Maurel (1998) and Tong and Fung (1976).

The models presented in this section are widely used in medicine, surgery and other fields. Inwearable robotics, the aim is to find the relationship between force applied and deformation of softtissues. This information may be useful in the design of control strategies for pHRI.

The basic properties of soft tissues, such as nonlinear elasticity or viscoelasticity, are consideredin the design of WR supports. Nevertheless, in practice, several simplifications of these models areused to address this problem, as many design details depend on the particularities of each application.For instance, in the context of evaluating the effect of upper limb soft tissues on control strategiesfor exoskeleton-based tremor suppression, a study was conducted to characterize the soft tissuesat different points on the upper limb (Rocon et al., 2005). According to this study, the equivalentstiffness of the tissue increases as the stress increases. A force–deformation curve of the soft tissuesat a particular point of the forearm is shown in Figure 5.5. It can be seen that, the behaviour ofthe curve is highly nonlinear and is characterized by hysteresis. Moreover, the study concluded thatthe soft tissues of the forearm could be modelled by a third-degree polynomial that describes thedeformation of the tissue as a function of the applied force.

Although this particular case illustrates the development of a model for a specific application,some principles can be generalized for wearable robots and used in the design of their supports, asdescribed in the next section.

4500

4000

3500

3000

2500

2000

1500

1000

0 2 4 6 8

Deformation (mm)

For

ce (

dN)

10 12

500

Figure 5.5 Force–deformation curve for a particular point of the forearm

Fuerza vs. deformación de tejidos blandos

368 IEEE TRANSACTIONS ON NEURAL SYSTEMS AND REHABILITATION ENGINEERING, VOL. 15, NO. 3, SEPTEMBER 2007

functional characteristics. Aesthetics is more directly related tosize, weight and appearance of the exoskeleton. Functionality isrelated to generating required torque and velocity while main-taining the robustness of operation.

In the framework of the DRIFTS (dynamically responsiveintervention for tremor suppression) project [7], the WOTASexoskeleton was presented with three main objectives: moni-toring, diagnosis, and validation of nongrounded tremor reduc-tion strategies [8]. This paper presents the development and val-idation of such a platform. In the next section, the biomechanicsof the upper limb is studied. In third section, the description ofthe WOTAS exoskeleton is given. Next, two novel nongroundedcontrol strategies for suppression of tremor by means of an or-thotic (wearable) exoskeleton are presented. Both are based onbiomechanical loading, but one is active and the other is passive.1) Tremor reduction through impedance control. This strategymodifies the stiffness, damping and mass properties of the upperlimb in order to suppress tremor. 2) Notch filtering at tremorfrequency. This strategy implements an active noise filter at thetremor frequency taking advantage of the repetitive characteris-tics of tremor. Section IV describes the clinical experiments forsystem validation. Finally, the conclusions and future work ofthis study are given.

II. WOTAS

An orthosis is defined as a medical device that acts in parallelto a segment of the body in order to compensate some dysfunc-tion. The main function of the arm is to position the hand forfunctional activities. The hand must be able to reach any pointin the space, especially any point on the human body, in sucha way, that the person can manipulate, draw on, and move ob-jects to or from the body. Therefore, the kinematic chain formedby the shoulder, elbow, forearm, wrist, and hand, has a high de-gree of mobility. In this way, the upper limb is one of the mostanatomic and physiologically complex parts of the body.

The upper limb is very important because it is able to ex-ecute cognition-driven, expression-driven, and manipulationactivities. Furthermore, it intervenes in the exploration of theenvironment and in all reflex motor acts. For this reason, anyalteration or pathology that affects the upper limb motionrange, muscle power, sensibility, or skin integrity will alterits operation. The concept of WOTAS is to develop an activeupper limb exoskeleton based on robotics technologies capableof applying forces to cancel tremor and retrieve kinematicinformation from the upper limb.

A. Mechanical Design

WOTAS was developed to provide a means of testingnongrounded tremor reduction strategies. WOTAS followsthe kinematic structure of the human upper limb and spansthe elbow and wrist joints, see Fig. 4. It exhibits three de-grees-of-freedom corresponding to elbow flexion–extension,forearm pronation–supination, and wrist flexion–extension.In the final design, WOTAS restricts the movement of wristadduction–abduction. This strategy was chosen because this isthe upper limb movement with the least impact in daily livingactivities, [9].

Fig. 1. Scheme of the pronation–supination control.

The mechanical design of the joints for elbow flexion–exten-sion, and wrist flexion–extension are similar to other orthoticsolutions and is based upon the behavior of those physiolog-ical joints as hinges. For orthotic purposes, flexion–extensionmovement is considered as a pure rotational movement. There-fore, this axis of rotation should be used for the rotational ac-tuator. The axis of rotation for the elbow joint is placed in theline between the two epicondyles. The axis of rotation for thewrist joint is located in the line between the capitate and lunatebones of the carpus. The mechanical design for the control forthe pronation supination movement is more complex and it isexplained below.

1) Pronation–Supination Control: The pronation–supina-tion movement of the forearm is a rotational movement of theforearm on its longitudinal axis which engages two joints thatare mechanically connected: the upper radioulnar joint (whichbelongs to the elbow) and the lower radioulnar joint (whichbelongs to the wrist) [10]. There are two bones in the forearmthat make this movement possible.

• The ulna is the bone that remains fixed during the prona-tion–supination movement. It constitutes the main part ofthe elbow, in particular the olecranon.

• The radius is the moving bone in the pronation and supina-tion. It rotates in proximal part (close to the elbow) andmoves distally along the axis formed by the ulna bone (seeFig. 1).

Both bones have a shape approximately pyramidal and theyare placed in such a way that the base of the radius is in the tipof the ulna and vice-versa.

The WOTAS platform controls the pronation–supinationmovement with the rotation control of a bar parallel to theforearm. This bar is fixed very close to the olecranon (Fig. 1,point B). Thus the bar is fixed to the ulnar position at elbowlevel. The distal fixation of the bar is made at the head ofthe radius, although the bar is maintained in the ulnar side inorder to minimize the excursion of the system. This fixation isexplained later in the support design section.

2) Design of the Support System: There are no static or-thoses that achieve tremor suppression due to the intrinsically

368 IEEE TRANSACTIONS ON NEURAL SYSTEMS AND REHABILITATION ENGINEERING, VOL. 15, NO. 3, SEPTEMBER 2007

functional characteristics. Aesthetics is more directly related tosize, weight and appearance of the exoskeleton. Functionality isrelated to generating required torque and velocity while main-taining the robustness of operation.

In the framework of the DRIFTS (dynamically responsiveintervention for tremor suppression) project [7], the WOTASexoskeleton was presented with three main objectives: moni-toring, diagnosis, and validation of nongrounded tremor reduc-tion strategies [8]. This paper presents the development and val-idation of such a platform. In the next section, the biomechanicsof the upper limb is studied. In third section, the description ofthe WOTAS exoskeleton is given. Next, two novel nongroundedcontrol strategies for suppression of tremor by means of an or-thotic (wearable) exoskeleton are presented. Both are based onbiomechanical loading, but one is active and the other is passive.1) Tremor reduction through impedance control. This strategymodifies the stiffness, damping and mass properties of the upperlimb in order to suppress tremor. 2) Notch filtering at tremorfrequency. This strategy implements an active noise filter at thetremor frequency taking advantage of the repetitive characteris-tics of tremor. Section IV describes the clinical experiments forsystem validation. Finally, the conclusions and future work ofthis study are given.

II. WOTAS

An orthosis is defined as a medical device that acts in parallelto a segment of the body in order to compensate some dysfunc-tion. The main function of the arm is to position the hand forfunctional activities. The hand must be able to reach any pointin the space, especially any point on the human body, in sucha way, that the person can manipulate, draw on, and move ob-jects to or from the body. Therefore, the kinematic chain formedby the shoulder, elbow, forearm, wrist, and hand, has a high de-gree of mobility. In this way, the upper limb is one of the mostanatomic and physiologically complex parts of the body.

The upper limb is very important because it is able to ex-ecute cognition-driven, expression-driven, and manipulationactivities. Furthermore, it intervenes in the exploration of theenvironment and in all reflex motor acts. For this reason, anyalteration or pathology that affects the upper limb motionrange, muscle power, sensibility, or skin integrity will alterits operation. The concept of WOTAS is to develop an activeupper limb exoskeleton based on robotics technologies capableof applying forces to cancel tremor and retrieve kinematicinformation from the upper limb.

A. Mechanical Design

WOTAS was developed to provide a means of testingnongrounded tremor reduction strategies. WOTAS followsthe kinematic structure of the human upper limb and spansthe elbow and wrist joints, see Fig. 4. It exhibits three de-grees-of-freedom corresponding to elbow flexion–extension,forearm pronation–supination, and wrist flexion–extension.In the final design, WOTAS restricts the movement of wristadduction–abduction. This strategy was chosen because this isthe upper limb movement with the least impact in daily livingactivities, [9].

Fig. 1. Scheme of the pronation–supination control.

The mechanical design of the joints for elbow flexion–exten-sion, and wrist flexion–extension are similar to other orthoticsolutions and is based upon the behavior of those physiolog-ical joints as hinges. For orthotic purposes, flexion–extensionmovement is considered as a pure rotational movement. There-fore, this axis of rotation should be used for the rotational ac-tuator. The axis of rotation for the elbow joint is placed in theline between the two epicondyles. The axis of rotation for thewrist joint is located in the line between the capitate and lunatebones of the carpus. The mechanical design for the control forthe pronation supination movement is more complex and it isexplained below.

1) Pronation–Supination Control: The pronation–supina-tion movement of the forearm is a rotational movement of theforearm on its longitudinal axis which engages two joints thatare mechanically connected: the upper radioulnar joint (whichbelongs to the elbow) and the lower radioulnar joint (whichbelongs to the wrist) [10]. There are two bones in the forearmthat make this movement possible.

• The ulna is the bone that remains fixed during the prona-tion–supination movement. It constitutes the main part ofthe elbow, in particular the olecranon.

• The radius is the moving bone in the pronation and supina-tion. It rotates in proximal part (close to the elbow) andmoves distally along the axis formed by the ulna bone (seeFig. 1).

Both bones have a shape approximately pyramidal and theyare placed in such a way that the base of the radius is in the tipof the ulna and vice-versa.

The WOTAS platform controls the pronation–supinationmovement with the rotation control of a bar parallel to theforearm. This bar is fixed very close to the olecranon (Fig. 1,point B). Thus the bar is fixed to the ulnar position at elbowlevel. The distal fixation of the bar is made at the head ofthe radius, although the bar is maintained in the ulnar side inorder to minimize the excursion of the system. This fixation isexplained later in the support design section.

2) Design of the Support System: There are no static or-thoses that achieve tremor suppression due to the intrinsically

Compatibilidad cinemática (2)

132 Human–Robot Physical Interaction

human joint will increasingly translate away from the exoskeleton joint ICR during motion. Thiswill result in large offsets between the exoskeleton joints and the anatomical joints.

Macromisalignments are thus induced by a mismatch between the degrees of freedom of humanlimb motion and exoskeleton link motion. In end-point-based exoskeletons, the negative effect ofsuch macromisalignments is not significant. In wearable exoskeleton interfaces, however, theyimpose severe restrictions on the common available workspace shared with the human limb. Tothe authors’ knowledge, at present most arm exoskeletons that feature a spherical joint set for theshoulder have a restricted shoulder workspace.

2. Micromisalignments are less obvious but occur in all wearable exoskeleton designs. They occureven if the number of degrees of freedom between the exoskeleton and the human joints iscorrect – for instance, if an exoskeleton has joints to track shoulder girdle movement by aligningtwo additional axes to the sternoclavicular joint (the joint that connects the shoulder girdle tothe torso). Micromisalignments are still caused by noncoincident joint rotation axes between theexoskeleton and the human limb. This is almost always the case because it is not possible to alignan exoskeleton perfectly to the human joints, due to intersubject variability and coverage of thejoints as explained above. Now, imagine an elbow exoskeleton as shown in Figure 5.3(a), i.e.worn by an operator on his elbow. The device’s ICR will always present a small offset towardthe human elbow ICR. This is, firstly, because the operator’s elbow ICR is not exactly known,so perfect manual alignment of the exoskeleton to this joint is impossible, and, secondly, becausethe biological joint surfaces are not ideally circular. This means that the ICR shifts during motion.Micromisalignment can furthermore be caused by slippage of the exoskeleton attachments on thehuman skin during motion. Slippage-induced offsets have been reported in the literature (Colombo,Wirz and Dietz, 2001) for the LOKOMAT gait orthosis. There, it caused greater misalignmentsbetween the orthosis joints and the human joints, leading to stumbling during test sessions withpatients. A significant negative effect of micromisalignments is the creation of interaction forces,

Figure 5.3 (a) Illustration of the creation of an interaction force as a consequence of joint misalignments betweenthe exoskeleton and the human limb. During motion, the exoskeleton slides on the human limb. (b) If passivejoints are added into the structure (Schiele and van der Helm, 2006), these forces are not created and the jointscompensate for the slipping of the device. Reproduced from ESA

Compatibilidad cinemática (1)



¿Cómo Suprimir el Temblor?Extracción de la

informaciónSensores

Algoritmode control

Actuación

Reducción del temblor a través de control de impedancia

Figura 5.2: El sistema músculo-esquelético es modelado como un sistema de segundoorden.

Miembro�superiorSistema�de

segundo�orden

ExoesqueletoWOTAS

Algoritmos�deestimación�del

temblor

K Ki vs+

Control�deadmitancia

qqtfmt

Sensor�deFuerza

+

Giroscopios

q

Sensores�deEfecto�Hall

-+

-

+

+

f!

fdt

fdv

!d

Figura 5.3: Estrategia de control para la modificación de la impedancia del miembrosuperior implementada en cada articulación del exoesqueleto WOTAS. El funcionamientodel bloque control de admitancia es descrito en el epígrafe 5.1.1.1. e ilustrado en la figura5.4.

205

Explotación de las características repetitivas del movimiento tembloroso

Figura 5.10: Estrategia de control repetitivo de velocidad implementada en el exoesque-leto WOTAS.

q̇c

= q̇f

+ ˙qtr

= kf

(fdv

° f) + ( ˙qdt

+ z°Mk · q̇t

) (5.6)

Como en la aproximación pasiva, esta estrategia también está compuesta por dos la-zos. El lazo superior es responsable de la acción de supresión activa del temblor, mientrasque el lazo inferior es responsable de la reducción de los efectos de carga biomecánicasobre el movimiento natural, [11].

En el lazo superior, el algoritmo presentado en el capítulo 3 realiza una estimación dela velocidad del movimiento tembloroso, q̇

t

. La amplitud de la velocidad del movimientotembloroso sufre un retardo de M segundos. Como se puede apreciar en la ecuación 5.5, elvalor de este retardo es definido por la frecuencia del movimiento tembloroso, !

t

. De estamanera, la amplitud del movimiento tembloroso, sumada a una consigna de velocidad,˙qdt

, es realimentada al controlador de velocidad interno del exoesqueleto WOTAS. Así,los actuadores de WOTAS describirán un perfil de velocidad de igual amplitud pero encontra fase al movimiento tembloroso estimado, cancelando activamente y substrayendo

223

Control de admitancia Control repetitivo



Resultados

-2

0

2

Ve

l. a

ng

. (r

ad

/s)

MONITORIZACIÓN

CONTROL REPETITIVO

CONTROL DE ADMITANCIA

Ve

l. a

ng

. (r

ad

/s)

Ve

l. a

ng

. (r

ad

/s)

0 2 4 6 8 10 12

2

0

2

tiempo (s)

2

0

2

0

200

400

600

Po

t. t

em

blo

r (r

ad2/s

3)

0

200

400

600

Po

t. t

em

blo

r (r

ad2/s

3)

0 4 8 12 16 20

0

200

400

600

Frecuencia (Hz)

Po

t. t

em

blo

r (r

ad2/s

3)



Discusión y Conclusiones

• Atenuación sistemática del temblor del temblor a partir de cierta severidad!

• Limitaciones:

• Solución voluminosa

• Ineficiencia transmitir cargas pequeñas

• Tecnologías de actuación

• No cumple las expectativas funcionales, estéticas que los usuarios esperan de un producto comercial

Resultados experimentales y discusión

10−2 10−1 100 101 102 1030

50

100

150

200

250

Potencia del temblor (rad2/s3)

P ms /

P mm

(%)

Figura 6.3: Relación entre la potencia espectral del movimiento tembloroso del pacientecon WOTAS operando en modo de monitorización, P

ms

, y la potencia espectral delmovimiento tembloroso del paciente con WOTAS operando en los modos de supresióndel temblor P

mm

. Esta relación cuantifica la reducción en la amplitud del temblor con laaplicación de las estrategias de control.

moderado, los temblores con una densidad espectral entre 2 y 10 rad

2

s

3 son clasificadoscomo temblores severos y los que poseen una densidad espectral superior a 10 rad

2

s

3 sonclasificados como muy severos, [49].

La existencia de un límite inferior de funcionamiento de WOTAS era esperado pues,para pequeñas amplitudes de temblor, el movimiento relativo entre la piel del usuario y laestructura del exoesqueleto actúa como una zona muerta. Además, las propias holgurasdel sistema impiden que el mismo actúe sobre temblores con amplitudes tan pequeñas.De hecho, como se puede apreciar en la figura 6.3, para algunos pacientes con un temblor

241


• Motivación





�22



La Neuroprótesis

• Solución textil, para llevar debajo de la ropa

• Solución modular (personalización)

• Actuación en la muñeca y el codo

• Medida: sensores de movimiento (giroscopios)

• Actuación: estimulación eléctrica funcional

!

• Estrategia: Modular el nivel de co-contracción de un par de músculos antagonistas

• Equivale al control de admitancia del exoesqueleto

Neurostim.electrodes

Controller

Inertialsensor

(A) (B)



Neuroprótesis



Resultados



Resultados

vel. a

ng. (

rad/

s)d.

e.p.

(rad

2 s-3)

vel. a

ng. (

rad/

s)

-0.8

0

0.8

0

0.08

frec. (Hz) frec. (Hz)(A) (B)

-1

0

1

00.10.2

-0.8

0

0.8

0

0.02

0.04

frec. (Hz)(C)

frec. (Hz) frec. (Hz) frec. (Hz)d.e.

p. (r

ad2 s-3

)

0.04

0 0

1

-1.2

0

1.2

-4

0

4

-2

0

2

0

0.1

0.2

(D) (E) (F)

1 Hz

1 s

Resultados

�27

10-2 10-1 100 101 102 1030

50

100

150

200

250

densidad espectral de potencia (rad s )2 -3

aten

uació

n te

mblor

, R

(%)

att



Resultados Funcionales


• Motivación





�29



Supresión del Temblor Mediante Estimulación Aferente

Con EstimulaciónSin Estimulación

• Usar estimulación aferente para reducir la “resonancia” de los husos musculares y atenuar el temblor

• No contracción muscular!



Diagnóstico Asistido por Ordenador

nonivasive(surface(EMG(acqusi1on(

1"s"surface"EMG"

Decomposi)on""

discharges*of*individual*motor*units*3*each*dot*is*a*discharge*of*a*motor*unit*(MU)*

MU*1*MU*2*MU*3*MU*4*MU*5*MU*6*MU*7*MU*8*MU*9*MU*10*MU*11*MU*12*

Control'of'individual'motor'units'0'each'line'is'a'smoothed'discharge'rate'of'a'motor'unit'(note'common'

flucta7ons)'

3''

5''

4''

disc

harg

es p

er s

econ

d

Distribu(ons+of+recurrence+(mes+(i.e.+distances+from+the+discharge+of+the+first+motor+unit+to+the+forward+and+backward+discharges+of+

the+second+motor+unit)+in+normal+and+tremor+condi(on+

-60 -40 -20 0 20 40 60

Normal condition

-60 -40 -20 0 20 40 60 recurrence time (ms) recurrence time (ms)

Tremor



Futuro de la ingeniería en la neurorehabilitación

Neurostim.electrodes

Controller

Inertialsensor

(A) (B)

ICHR BNCI

IFHR EEF

Desarrollo Tecnológico NP

ICHR BMI

IFHR PNS

Desarrollo Tecnológico NR



Nota histórica

“This amazing feat shall revolutionize the way in which paraplegic Scientists continue their honorable work in the advancement of Science! Even in this modern day and age, some injuries cannot be healed. Even with all the Science at our command, some of our learned brethren today are without the use of their legs. This Device will change all that. From an ordinary-appearing wheelchair, the Pneumatic Bodyframe will transform into a light exoskeleton which will allow the Scientist to walk about normally. Even running and jumping are not beyond its capabilities, all controlled by the power of the user’s mind. The user simply seats himself in the chair, fits the restraining belts around his chest, waist, thighs and calves, fastens the Neuro-Impulse Recognition Electrodes (N.I.R.E.) to his temples, and is ready to go!”

!Prof. H Wangestein, 1883

¡Gracias por su atención!

Dr. J.A. Gallego (CSIC)Dr. Andrés Ruiz (CSIC)Dª Aikaterini Koutsou (CSIC)D. Jaime Ibáñez (CSIC)Prof. José Luis Pons (CSIC)Dr. Juan-Manuel Belda-Lois (IBV)D. Juan-Pablo Romero (Hosp 12 Oct)Dr. Julián Benito-León (Hosp 12 Oct)

Dr. Strahinja Dosen (UMG-GOE)Dr. Jakob Lund Dideriksen (UMG-GOE)Dr. Silvia Muceli (UMG-GOE)Prof. Dario Farina (UMG-GOE)D. Vojko Glaser (UMaribor)Dr. Ales Holobar (UMaribor)...

! !

Premio Juan López de Peñalver³n definitiva Dr. Rocon.pdf · • Supresión del temblor mediante...

Documents

Transcript of Premio Juan López de Peñalver³n definitiva Dr. Rocon.pdf · • Supresión del temblor mediante...