||Application of Near Infrared Spectroscopy for Developing Neurorehabilitation Program of Stroke Patients During Electrical Stimulation Assisted Cycling
||Department of BioMedical Engineering
electrical stimulation assisted cycling
Stroke is a leading cause for hemiparesis and such asymmetrical movement is the main goal of neurorehabilitation. Electrical stimulation assisted cycling has been proved to improve the symmetrical movement for stroke patients for immediate and long term effect. In addition to generate functional limb movement via electrical stimulation, other research proposed lower intensity stimulation for stroke patients from proprioceptive and neuro-biofeedback aspects. Thus the aim of the study is to develop neurorehabilitation program for stroke patients during electrical stimulation assisted cycling by using near infrared spectroscopy (NIRS). Therefore this study investigates the effects of different intensity levels of electrical stimulation during passive cycling on cortical activation using multichannel NIRS covering premotor cortex (PMC), supplementary motor area (SMA), sensorimotor cortex (SMC), and secondary sensory cortex (S2) regions. Normal subjects were first recruited to develop a autodetermination of dead spots and electrical stimulation ranges. Theoretical dead spots were measured by horizontal and vertical distances of hip joint and crank center. Experimental dead spots were obtained from torque value during passive cycling for 10 seconds. The result showed that there is no significant differences between the two methods. It indicated that the use of passive cycling for 10 s is capable of determining dead spots and electrical stimulation ranges. Electromyography measurement is needed to verify muscle activation pattern and hypothesized electrical stimulation ranges. Then, sixteen subjects, including nine stroke patients and seven normal subjects, were instructed to perform passive cycling driven by an ergometer at a pace of 50 rpm under conditions without (NES) and with low-intensity electrical stimulation (LES) at 10 mA and high-intensity electrical stimulation (HES) at 30 mA. Changes in oxyhemoglobin in different brain regions and the derived interhemispheric correlation coefficient (IHCC) representing the symmetry in response of two hemispheres were evaluated to observe cortical activation and cerebral autoregulation. Our results showed that cortical activation of normal subjects exhibited overall deactivations in HES compared with that under LES and NES. In stroke patients, bilateral S2 activated significantly greater under LES compared with those under NES and HES. The IHCC of the normal group displayed a significant higher value in SMC compared to that of the stroke group. Our study utilized noninvasive NIRS to observe hemodynamic changes and bilateral autoregulation symmetry from IHCC suggesting that passive cycling with low-intensity electrical stimulation could better facilitate cortical activation compared with that obtained with no or high-intensity electrical stimulation. The results of this study could provide general guidelines to simplify the settings of electrical stimulation-assisted-passive cycling in clinical use. The findings of our study can be adopted in neurorehabilitation program in the future and implanted into the brain-based neurorehabilitation medical device using electrical stimulation assisted cycling for stroke patients.
Table of Contents X
List of Figure XIIII
List of Table XV
Chapter 1 Introduction 1
1.1 Stroke 1
1.2 Passive cycling 2
1.3 Electrical stimulation-assisted cycling 3
1.4 Timing for electrical stimulation 4
1.5 Electrical stimulation intensity 6
1.6 Non-invasive measurement for brain information 8
1.7 Near infrared spectroscopy (NIRS) 9
1.8 Cortical activation during cycling 11
1.9 Symmetrical Evaluation of stroke 12
Chapter 2 Methods 15
2.1 Determination of dead spots 15
2.1.1 Theoretical dead spots 15
2.1.2 Experimental dead spots 17
2.1.3 Subjects and experimental procedure 18
2.1.4 Data analysis 18
2.2. Electrical stimulation-assisted cycling 19
2.2.1 System setup 19
2.2.2 NIRS recording 21
2.2.3 Subjects 23
2.2.4 Experimental procedure 23
2.2.5 Data analysis and statistical analysis 26
Chapter 3 Results 30
3.1 Comparison of the theoretical and experimental dead spots 30
3.2 Electrical stimulation assisted cycling 32
3.2.1 Subjects 32
3.2.3 IHCC for cerebral organization 38
Chapter 4. Discussion 42
4.1 Auto-determination of electrical stimulation ranges 42
4.2 Cortical activation during ES-assisted cycling 43
4.3 IHCC for cerebral organization 47
4.4 Study limitation 49
Chapter 5. Conclusion 50
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