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JULY I991 687

Feedback Control of Coronal Plane Hip Angle in

Paraplegic Subjects Using Functional
Neuromuscular Stimulation
James J. Abbas, Student Member, IEEE, and Howard J. Chizeck, Senior Member, IEEE

Abstract-This paper reports on an investigation of feedback ity, FNS has been used in the laboratory for standing,
control of coronal plane posture in paraplegic subjects who
stand using functional neuromuscular stimulation (FNS). A walking and stair climbing. Although feasibility has been
feedback control system directed at regulating coronal plane demonstrated [20], [22], [24], [25], [32], current lower
hip angle in neutral position was designed, implemented, and extremity FNS technology is deficient in ways which have
evaluated in two paraplegic subjects. The control system in- delayed and limited its clinical use. In general, FNS sys-
cluded sensor mounting and signal processing techniques, a tems need to be easier to use, more reliable, and safer;
two-stage feedback controller, stimulation hardware, and a set they also must provide a greater level of function to the
of percutaneous intramuscular electrodes. The feedback con-
troller consisted of two-stages in cascade: a modified discrete- user. The use of feedback control in lower extremity FNS
time proportional-integral-derivative (PID) stage and a nonlin- systems has been proposed as a means to overcome these
ear single-input, multiple-output stage to determine the stim- limitations [9], [30].
ulation to be sent to several muscles. The focus of this work Various stimulation controllers have been developed
was on evaluating the performance of the feedback controller and tested either in computer simulation, in animal ex-
by comparing the response of the feedback-eontrolled system
to that of an open-loop stimulation system. In an evaluation periments, or in human experiments. These control sys-
based on temporal response characteristics the controlled sys- tems modulate stimulus parameters in order to regulate
tem exhibited a 41% reduction in root-meamsquared (rms) er- one or more system outputs (e.g., joint angle or angular
ror (where error is defined as the deviation from the desired velocity, joint torque, contact force). Control systems for
angle), a 52% reduction in steady-state error, and a 22% re- FNS act on sets of nonlinear actuators. Controllers con-
duction in hip compliance. In addition, the feedback-controlled
system exhibited significant reductions in variability of these sisting of two stages in cascade have often been used: one
measures on several days. These results demonstrate the ability stage to control the system dynamics and a second to ef-
of the feedback controller to improve the temporal response fect co-stimulation and compensate for nonlinearities [26].
characteristics of the FNS control system. Both fixed-parameter feedback controllers [lo], [29],
[30], [33] and adaptive controllers [3], [6] have been in-
vestigated. Proportional [30], PID [ 131, pole-placement
[ 101, and adaptive [6] controllers have been used for the
I N recent years, researchers have investigated the use of
functional neuromuscular stimulation (FNS) as a tool
in the rehabilitation of patients with spinal cord injury,
first stage.
Discrete-time proportional-integral-derivative (PID)
controllers have been utilized during stance at the knee
stroke, and other neurological disorders. This technique [5], [12] and at the knee and ankle [ l l ] . These earlier
employs electrical pulses to activate paralyzed muscle for attempts demonstrated disturbance resistance and the abil-
the purpose of achieving functional movements. It has ity to stabilize a particular joint, but did not directly result
been used to restore or enhance lower and upper extremity in improved stance for the user. Upper body movements
functional movements as well as a variety of other phys- during stance caused unwanted motion at the hip and trunk
iological functions [9], [ 151, [22], [28]. For individuals in both the coronal and sagittal planes. This suggested
with neurological impairments affecting the lower extrem- that feedback control of the hip and trunk was also needed.
Initial attempts at using PID control of coronal plane
Manuscript received July 20, 1989; revised January 29, 1991. This work hip angle were made on subjects who wore braces which
was supported by the Rehabilitation Research and Development Service of
the Department of Veterans Affairs. restricted all motion at the ankle, knee, hip, and trunk
J . J. Abbas is with the Department of Biomedical Engineering, Case except for coronal plane motion at the hip [ 131. Feedback
Western Reserve University, Cleveland, OH 44106 and the Motion Study of coronal plane hip angle was provided by goniometers
Laboratory, Cleveland Veterans Affairs Medical Center, Cleveland, OH
44106. mounted on the braces. These preliminary experiments
H. J . Chizeck is with the Department of Systems Engineering, Case demonstrated the feasibility of the approach [ 131, but the
Westem Reserve University, CLeveland, OH 44106 and the Motion Study practicality of this implementation was limited by the ex-
Laboratory, Cleveland Veterans Affairs Medical Center, Cleveland, OH
44106. tensive bracing used. Comparative trials with and without
IEEE Log Number 9100509. feedback control were not performed.

00 18-9294/9 I /0700-06887$01.00 0 1991 IEEE


One purpose of the work presented here was to imple-

ment the coronal plane hip angle controller without the
use of such extensive bracing, thus making the system
more suitable for eventual clinical use. A second purpose
was to compare the response of the closed-loop system
with that of the open-loop system, based on standard con-
trol system performance criteria. The coronal plane hip
angle subsystem controller is intended to be a component
of a more general postural and locomotor control system
[9] currently being developed at the Cleveland Veterans
Affairs Medical Center (CVAMC) as part of a lower ex-
tremity neural prosthesis [25]. The application of this
controller in isolation is not expected to restore normal
standing function or to provide a level of function greater
than that of other rehabilitative techniques (such as con- (b)
ventional or advanced bracing). This work explores the Fig. 1 . (a) Model of human posture in the sagittal plane. The four seg-
use of feedback control as a tool for providing improve- ments are a foot, shank, thigh, and head-arms-trunk (HAT). (b) Model of
human posture in the coronal plane. The four segments are two legs, a
ments to a lower extremity FNS system. This work was pelvis and HAT. With the assumption that both feet are on the ground and
not intended to compare the performance of the FNS con- the legs are parallel, the hip angle can be defined as the angle that the thigh
trol system to either that of neurologically intact individ- makes with the vertical. Note that the single inverted pendulum model as-
sumes that the HAT segment remains vertical.
uals or that of other rehabilitative techniques; such an
evaluation should await further developments of FNS
technology. external bracing. Barring the application of auxiliary sag-
ittal plane forces, motion in this plane would be minimal.
Coronal plane posture has most often been described
SYSTEMDESCRIPTION using a four-link model [Fig. l(b)] consisting of two legs,
pelvis, and the HAT [16]. The equations describing the
The system to be controlled involves complex interac-
motion of this general four-link system can be simplified
tions among several joints in a multi-joint skeleton. Each
by imposing certain constraints. If both feet are assumed
of these joints may have several degrees of freedom and
to be on the ground and the legs are assumed to be par-
certain constraints on its motion. The complexity of the
allel, the equations reduce to those of a double inverted
system poses a formidable control problem, but the sys-
pendulum. Furthermore, activation of the trunk extensor
tem can be described in a simplified manner by a set of
muscles stiffens the trunk. Under these conditions, the
two planar models. This approach is limited in its ability
HAT segment can be assumed to remain vertical; the set
to describe motions which are not confined to either plane,
of equations then reduces to those of a single inverted
but greatly simplifies the description and thus assists in
pendulum. That is, motion in the coronal plane is consid-
developing a control strategy. In this study, a sagittal
ered to occur only at the hip. The hip angle is defined as
plane model was used to devise a method of maintaining
the angle formed by lines of the femurs, which are parallel
upright sagittal plane posture, and a coronal plane model
to each other, and the vertical. The joint is characterized
was used in the development of the hip controller.
by a passive stiffness; motion is generated by muscle
In the sagittal plane, a four-link model [Fig. l(a)] con-
stimulation. The control of this simplified system has been
sisting of a foot, shank, thigh, and head-arms-trunk
previously considered in simulation studies [ 161 and in
(HAT) has most often been used to study human stance
preliminary experimental trials [13]. In this study, co-
[4], [17], [19], [21]. Extensor moments at the hip or knee,
ronal plane hip angle was monitored and controlled by
whether provided passively by the posture or actively by
adjusting the level of stimulation sent to the abductor-
muscle forces, are countered by ligaments to restrict mo-
adductor pairs.
tion at either joint in full extension. Passive torques at the
ankle are relatively insignificant within the range of mo-
tion seen during normal stance. A fixed-ankle, ankle-foot- CONTROL SYSTEMSTRUCTURE
orthosis (AFO) can be used to restrict both plantar flexion In this work, the first stage of the two-stage FNS con-
and dorsiflexion at the ankle. In addition, when the weight troller [Fig. 2(a)] was a modified discrete-time PID al-
of the body is positioned such that it exerts a dorsiflexion gorithm. It consisted of a weighted linear combination of
moment at the ankle, the counteracting plantar flexion three terms; the error signal, a weighted sum of past er-
moment provided by the orthosis acts to provide an ex- rors (an integral approximation), and the difference be-
tension moment at the knee. Thus, sagittal plane motion tween the last two error measurements (a derivative ap-
of the four-link body is restricted by a combination of proximation). Thus, the control signal varied with the
passive moments provided by the postural configuration, error signal, with the accumulation of past errors and with
muscular activation of the hip and knee extensors, and the rate of change in error. To apply this type of control-


This implementation of a PID controller uses joint angle 8(r) to calculate

its output c(t):
PW I c'(r) K,,* e(t) + K, * ff * esum ( t ) + K.,* ( e @ )- e(( - I))/T
if (c'(t) > 1.05 * cmax) c(t) 1.05 * cmax

else if (c'(f)< - 1.05 * cmax) r(t) - 1.05 * cmax


else c(t) + c'(t)

e(r) = 8" - 8(r)
esum ( t ) ff * esum ( t
+ - 1) + e(t) * T
8" is the setpoint
T is the sampling period
K,,. K,,K,, are arbitrary constants
(b) ff is a forgetting factor, the value o f which depends on the
Fig. 2. (a) Two stage subsystem controller. A digital implementation of a magnitude of the error signal: for errors > 20 pma, ff =
PID controller in cascade with a pulsewidth map. (b) An example of a 0.95; for errors < 20 pma, ff = 0.99
pulsewidth map. The output of the first stage, c(r), was used to determine cmax is the value of controller output which would saturate the
the pulsewidth (PW) sent to the various muscles being driven by the con- actuators
troller. In the figure, r, are threshold pulsewidth values and s, are saturation
pulsewidth values, et, and cs, are the controller output values which would
result in threshold or saturation pulsewidths, respectively. Within a region
near the set point both muscle groups are stimulated. As c(t) moves away
from zero the stimulation sent to one muscle group is increased, while EXPERIMENTAL
stimulation sent to its antagonist is decreased, then eventually turned off.
On each experiment day, the initial settings of the parameters was taken Control System Hardware and Sofware
CSI = cs2 = loo, csz = cs4 = - loo, The controller software [2] was designed to implement
Ctl = -20, Ctz = -30, Ct3 = 20, = 30, bi-level control systems of the form described in [9]. The
f, = threshold pulsewidth for the ith electrode,
s, = saturation pulsewidth for the ith electrode, software allows for the specification of various system
states, the events which mark state transitions, and the set
of subsystem controllers to be active. Several subsystem
ler, a good model of the system dynamics is not needed; controller types are available for use in any of the speci-
only knowledge of the direction in which the system re- fied states. One of these is a two-stage PID as described
sponds to an input and the input-output time delay is re- above. In this bi-level structure, feedback signals can be
quired. PID controllers are known to be relatively robust used by the upper level controller to trigger state transi-
and insensitive to model uncertainties. One concern is in- tions, or by the subsystem controllers to determine the
tegrator windup: if the error signal is continually of the stimulation parameters. In addition to performing the con-
same sign, the integral term would grow, thus compro- trol functions, the software also allows for sampling and
mising the ability of the controller to correct for setpoint storage of up to 32 analog input channels.
changes or disturbances that change the error sign. To A block diagram of the control system hardware and
avoid this problem, the integral term is scaled by a vari- software is given in Fig. 3. The feedback controller has
able forgetting factor and the accumulated term was been implemented on a MicroVax I1 laboratory minicom-
clipped at a maximum of 105% of the value that would puter (Digital Equipment Corp.). It has been designed and
fully activate the muscles. The equations for the PID con- built around the open-loop stimulation system described
troller used in this work are shown in Table I. in [7], which is based on a V40 microprocessor (NEC).
The second stage of the controller has been designed to Communication between the two processors is executed
compensate for the nonlinearity of the actuators and to use via a dual-port RAM (DPR). The stimulator is capable of
the output of the first stage to determine the stimulation providing biphasic, asymmetrical, balanced-charge, cur-
sent to several muscles. As shown in Fig. 2(b), a piece- rent regulated (20 mA) pulses to a maximum of 48 elec-
wise linear mapping has been used to describe the rela- trodes. Pulses are delivered to each of the channels in a
tionship between the output of the first controller stage sequential manner. Sequences of pulsewidth values (0-
c(t) and the pulsewidth (PW) sent to each of the muscles. 255 p s ) and stimulus period values (0-255 ms) for each .
Defining these curves such that both sets of an agonist- of the channels are specified in the software.
antagonist pair were stimulated for small values of c(t) For operation of the open-loop system [7], stimulation
results in co-stimulation [13], [26].This can serve to in- sequences are first generated on the VAX and transferred
crease the stiffness at the joint and diminish the effect of via the DPR to RAM while the stimulator is off-line. The
the threshold nonlinearity. Note that this mapping makes subject then uses the command processor via a finger
no attempt to perfectly invert the recruitment character- switch mounted on a ring to control the stimulator. It reads
istic (the relationship between PW and force), or to ac- the stored stimulation pulse parameters from RAM (or
count for any time variations in the system. from EPROM) and delivers the appropriate stimulation to


Fig. 3. Feedback control system implementation. This diagram illustrates the various components o f the feedback control sys-
tem and their interaction; functional units are enclosed in solid line boxes and physical devices are indicated by the shaded
boxes. The feedback controller calculations are performed by a MicroVAX I1 laboratory minicomputer (DEC). The stimulator
and command processor components of the system are contained in a V40 microprocessor (NEC) based unit. Communication
between the feedback controller and the stimulator/command processor is executed via a dual-port RAM (DPR). Note that the
open-loop control system utilizes only the V40 and the EPROM components of the system.

the muscles. The system-to-patient interface displays sys- A mounting and signal processing procedure was de-
tem status information and menu selections for the user. veloped [Fig. 4(a)] to measure the coronal plane hip angle
In the closed-loop system, the stimulus phase parame- while the subject is standing with both feet touching the
ters are read from tables on the DPR, rather than from ground. A sensor pair was mounted on each side of the
RAM. The VAX-based feedback controller generates the frontal aspect of the pelvis such that the line formed by
stimulation parameters based on sensor measurements. It the sensor was parallel to the femur and passes just lateral
then sends stimulation parameters to the stimulator via the to the anterior superior iliac spine (ASIS). This mounting
DPR in real-time. Also, real-time communication be- location was adequate, but not necessarily optimal; the
tween the V40 and the VAX via the message board of the effect of different mounting locations was not exhaus-
DPR is enabled to allow for upper level control actions, tively explored. Using circuitry and processing for the set
such as switching between control modes. of sensor signals [Fig. 4(b)], the accuracy of the mea-
surement was improved to within 3.2". This noisy mea-
Sensors and Signal Processing surement was adequate, however, for contro1,purposes and
The liquid-metal strain gage (Whitney Gage, Park for discerning the differences between the two control
Medical Electronics) consists of a silastic tube (outer di- strategies compared in this study, as is demonstrated be-
ameter = 0.04 in) filled with liquid mercury. As the tube low.
is elongated, the diameter of the liquid-metal capillary is
reduced and its length increased, resulting in an increase Subject Description-Electrodes and Muscles
in electrical resistance. These gages can be used in a stan- The evaluation of the coronal plane hip controller was
dard modification of a Wheatstone bridge circuit (as typ- performed on two adult male subjects with complete tho-
ically used with low resistance strain gages) to obtain a racic-level lesions of the spinal cord. The subjects are
voltage output. In static tests the gages have been shown long-term participants in the lower extremity FNS re-
to generate outputs linearly proportional to strain up to search and development project at the Motion Study Lab-
levels of 40%; in dynamic tests they have been shown to oratory at the CVAMC [24]. One subject (CG), level T7,
be frequency-independent with no phase-shift up to 50 Hz was 32-years-old, three years post-injury , and had been
[8]. The sensors can be easily mounted on the skin using in the program for seven months. The other subject (RL),
Tegaderm" (3M), a stretchable medical adhesive dress- level T9, was 42-years-old, nine years post-injury , and
ing. The size, shape, and elasticity of the sensors are such had been in the program for four years.
that they are nonrestricting and cosmetically acceptable. As a part of their participation in the research program,
There are several examples of biomedical applications of both subjects were equipped with a set of functioning per-
these gages [31]. cutaneous, intramuscular (IM) electrodes implanted in
The accuracy of these sensors is compromised by sev- several muscles of the lower extremities. The electrodes
eral factors. When mounted on the skin, they directly were made from 76 pm 10-strand, stainless-steel, Teflon-
measure skin stretch, not joint angle. Also, as motion at coated wire; with each strand 25 pm in diameter. Details
the joint is transduced through the skin, spatially-distrib- of the electrode design and implantation procedure was
uted noise is added and the signal is filtered. Comparison given in [24]. In this study, a subset of those electrodes
of measurements of skin stretch at locations about the joint was used for muscular activation. In particular, IM elec-
center of rotation with measurements of joint angle ob- trodes were used bilaterally for activation of the vasti of
tained using a strobe photographic technique exhibited a quadriceps for knee extension, gluteus maximus for hip
velocity-dependent hystersis [ 11. The viscoelastic prop- extension, gluteus medius for hip abduction, and the pos-
erties bf skin which could be responsible for this observed terior portion of adductor magnus for hip adduction-hip
hysteresis have been documented elsewhere [23]. extension. To supplement the set of percutaneous elec-


Fig. 4. (a) Four stages of sensor signal processing. First, a coordinate transformation converts measurements of skin stretch to
joint angles. This was done by differentially mounting pairs of sensors about the joint center. Second, spatially distributed noise
was reduced by averaging the outputs of several pairs of sensors. Third. high-frequency noise was reduced by smoothing.
Finally, the velocity-dependent hysteresis was reduced by the addition of a derivative-dependent term. (b) Sensor circuitry and
processing for estimating joint angle. The two sensors on the left side (R1 and R2) were placed in series in one arm of a
Wheatstone bridge (also in series with a fixed resistance), and the two on the right (R3 and R4) were placed in series in the other
arm. The coordinate transformation and spatial averaging were done in the circuitry. The outputs of the bridge were differentially
amplified (IOOOX). low-pass filtered ( A = 25 Hz).and sampled at a rate of 50 Hz.The signal was then smoothed using a five-
point rectangular window ( J = 6 Hz),the difference approximation to the derivative was calculated, scaled, and added to the
smoothed signal.

trodes, surface electrodes placed on the lower back were disturboncc

used to activate erector spinae for trunk extension. In some ext hip 0%
O Loddd system

cases, surface electrodes placed on the posterior aspect of
the thigh were used to activate hamstrings for additional
hip extension. a

Systems to be Evaluated
PW mop
The objective of the coronal plane hip controller was to
maintain neutral upright hip angle position in the coronal Fig. 5 . Diagrams of the OPen-looP (OL)and closed-loop (CL)control SYs-
tem compared in this study.
plane. A set of experiments was designed to compare its
performance with the response of an open-loop stimula-
tion system. Block diagram representations of the systems
tested are given in Fig. 5 . The first system (OL) uses open-
loop stimulation of extensors at the knee, hip, and trunk,
and of hip abductors and adductors. The second system
(CL) adds the two-stage .subsystem controller to control
coronal plane hip angle. Note that the OL system was
equivalent to the CL system with the feedback loop cut.
That is, the OL system utilized stimulation levels for all
muscles that were the same as those of the CL system
under a condition of zero error. When using either the OL
or CL system, the subject stood with his hands on an in-
strumented horizontal bar for auxiliary support.

Application of the Disturbance Fig. 6. Sketch of experimental setup illustrating the subject and instru-
The two controllers were evaluated by comparing their .mentation used in the experiments.
performance in maintaining upright coronal plane posture
as the subject stood wiFh both feet on the ground and with that would not corrupt the skin stretch sensor measure-
both hands on a horizontal support bar. Disturbances were ments. A rectangular frame (24 X 15 in) made of light-
applied in the form of ap impulse-like force which moved weight aluminum was placed around the subject's waist
the pelvis laterally, thus causing the subject to bend in the (Fig. 6 ) . The frame was held in place by two bolts, each
coronal plane at the -hip. Application of the disturbance of which passed through the frame on either side and ter-
was done such that the applied force was measurable and minated at a pad which was placed on the lateral aspect
the region of application was restricted to areas of &e skin of the pelvis just below the iliac spine. With proper place-

ment of the pads, the disturbance force was applied in the TABLE I1
region of the bony landmark, thus limiting the deforma-
tion of the skin to a small area. The disturbance was ap- A static, planar double inverted pendulum model with arms added as
plied by tugging on a rope attached to one side of the rigid segments was used to study the moments acting at the hip due to the
aluminum frame. Although this type of disturbance is not hands. Assuming that any deviation from upright does not affect the
moment arm significantly, the following equations describe the moment
perfectly repeatable, the applied disturbance force was at the hip due to the hands (Mhh), the sum of the forces acting on the
measured using a load cell (Model 3167, Lebow Assoc. horizontal bar in the coronal and vertical directions (Fhh.,.
Fhh.;),and the
sum of the moments about right support point of the horizontal bar (MI):
Inc.) placed in series with the rope (Fig. 6).
Mhh == (FLX + FRx) * /I + (FLZ + FRZ) * w/2

Data Collection Fhb., Fix + F2x + FLX+ FRX= 0

For the purposes of evaluation, the joint angle data was Fhh.; = FIZ+ F2z + FLZ+ FRZ= 0
supplemented with data collected from other laboratory MI = -Fzz * (2d + S) - FLZ * (d + S) - FRZ * (d) = 0
instruments. Force platforms (model OR6-5- 1 , Advanced where
Medical Technology, Inc .) were used to monitor the
FR, FL are the forces acting on the horizontal bar at the right and left
forces acting at the subjects feet. The output of the load hands,
cell was recorded to measure the disturbance forces ap- F,, F2 are the forces measured at support points 1, 2 of the horizontal
plied to the pelvis. Video records of both the frontal and bar,
h, w are the height and weight of the HAT segment,
side views were kept to allow visual review of the exper- s is the distance between the two hands,
iments. The subject stood with his hands on a horizontal d is the distance from a hand to the nearest support bar (assumed
bar which was sqpported by two instrumented vertical to be the same for each hand),
posts [18] (Fig. 6). The measurements obtained from these and subscripts x, 2, on forces indicate coronal and vertical components,
respectively, with positive x defined to the subjects left and positive z
vertical support posts do not provide measures of the downward. Solving for M h h in terms of the measured forces on the
forces acting on each hand; they do provide the informa- horizontal bar yields
tion needed to determine the components of the moment Mht, = (FIX+ F ~ x*) ( - h ) + (Fzz - FIT.)* ( - ( d w /S) - (w/2))
exerted at the hip by the hands. With the use of the co-
ronal plane model of the system (Fig. l), it can be shown
that the coronal plane hip moment due to the action of the cedure. Initial tuning was performed using a standard
hands is the weighted sum of two terms: the sum of the Zeigler-Nichols method [ 141. This standard procedure of
coronal plane forces measured on the support posts control engineering uses the gain at which a proportional
(Mhh,c),and the difference between the vertical plane controller results in sustained oscillations (which is found
forces measured on the support posts (Mhh,,,). Further de- experimentally) to determine the PID parameters. Sec-
tails are given in Table 11. ondary tuning based on measures of rms error and visual
observation was performed in the course of the experi-
Controller Tuning ment. For example, when the controllers response ap-
The controller was tuned by adjusting the PID param- peared sluggish (i.e., the response was comparable to
eters and the parameters of the pulsewidth map. A two- OL), the three controller gains were increased; when a
step tuning procedure was used: working ranges for pa- steady-state error was observed, only the integral gain was
rameters of both stages were determined in preliminary increased; when a large overshoot was observed (e.g.,
experiments; then minor adjustments were made as nec- > 25 % peak), only the derivative gain was increased. This
essary. retuning was performed for the purposes of the evalua-
The PW map was first set so that the full range of ac- tion, but it is impractical for everyday use. As a practical
tivation of all muscles would be utilized over the range of matter, automated rule-based or adaptive tuning proce-
controller outputs c(r) = -100 to 100. For small con- dures may be required in order to implement this feedback
troller outputs (-30 < c(t) < 30), both muscle groups controller outside of a laboratory setting.
would be activated. For large controller outputs, only one
muscle group would be activated. The values for PW Experimental Protocol
thresholds and saturation were obtained from laboratory Experiments were done on five days: two days with
records based on biweekly muscle tests. Example values subject no. 1, three days with subject no. 2. At the begin-
of the initial settings are presented in Fig. 2(b). Over the ning of each experiment day, the sensor gains were de-
course of the experiments, certain parameters of the PW termined using a static two-port calibration procedure.
map were adjusted as necessary. For example, when a The sensors were calibrated in units of percent-maximum
consistent offset was noticed, the slope of either muscle abduction (pma). With the subject standing erect, the pel-
group was adjusted to alter the levels of activation near vis was pushed to the right and the trunk bent to the left,
the setpoint. It should be noted that the structure and tun- thus providing a sensor reading for 100%abduction to the
ing of the PW maps were ad hoc, and were by no means left. Then the pelvis and trunk were moved in the opposite
optimal. direction and a sensor reading for - 100%abduction was
The PID parameters were also tuned in a two-step pro- taken. These readings were used to calculate the sensor


dlsturbunco form coronal support forcos

0 0.5 1

hi0 onole vortlcal suooort torcoo

Fig. 7. Example traces showing the applied disturbance, the resulting hip angle trajectories, and the two components of the
Support force measurements. The top plot displays example disturbance force tracings for an OL (solid line) and a CL (dashed
line) trial. The observed difference in the traces was due to the trial-to-trial variation in the application of the disturbances; in
general, there was no significant difference between the OL and CL disturbances. The second plot displays the resulting coronal
plane hip angle trajectories for each system. While the observed reduction in peak angular excursion and increase in natural
frequency were typical, the improvement in steady-state error was, in general, greater than that which was observed in the
example. The third and fourth plots display the coronal plane support forces ( F , x F z x ) and the difference in the vertical plane
support forces (Flz - Fzz) measured on the horizontal support bar. Also note here that the observed differences in the traces
were due to trial-to-trial variations; there were no consistently significant differences between the support force measurements
of the OL and CL trials.

gain, which was then used throughout that day. To ac- CL trial are given in Fig. 7. Two different types of quan-
count for any changes in sensor offset, the sensor offset tities were calculated for each trial. First, three pei$or-
was recalibrated at the beginning of each run with the sub- mance measures were used to compare the responses of
ject standing. For the subjects used in this study, 100% the two control systems: rms error, steady-state error and
abduction corresponded to approximately 20". compliance. The error was defined as the deviation from
Each day of experimentatiod consisted of four to eight the desired hip angle (0'). The root-mean-squared ( h S )
runs. In a run, either the OL or the CL system was tested; error provided an overall measure of system output track-
the order in which the systems were tested was varied and ing. This has often been used as the primary measure of
the subject was not aware of which system was being performance for FNS control systems, as well as other
tested. Each run lasted approximately three minutes with types of control systems. Steady-state error was calcu-
six to eight minutes of rest between runs. In each run the lated as the mean value of hip angle over the last half-
subject first stood up using prespecified stimulation se- second of the trial. The ratio of initial peak angular ex-
quences. The frame used for application of the distur- cursion of the hip to the peak disturbance force was used
bance was then secured about his waist and his feet placed as a measure of compliance.
on markers Axed on the force plates. Upon a trigger from Secondly, four other response attributes were calcu-
the subject, either CL or OL operation was initiated. If lated, each with respect to the steady-state value for that
the CL system was being tested, the real-time controller trial (Fig. 8). Rms-wrt-ss was calculated as the square
was then activated. The subject was instructed to look root of the mean squared deviation from the steady-state
straight ahead and to use his arms as little as possible for value. Overshoot, return time, and setting time were cal-
support. Disturbances were then applied repeatedly (every culated as described in Fig. 8. Together, they characterize
5-10 s) for the duration of the run. A trial was defined as the transient response of the system.
a 3-s segment of data which was triggered by the appli-
cation of the disturbance. The results reported below were RESU LTS
based on 448 such trials over five days. When the subject
signalled the termination of a run the feedback controller, Pei$ormance Measures
if active, was deactivated. A fixed level of stimulation to The purpose of the evaluation was to compare the re-
the extensors was maintained while the frame was re- sponse of the CL system with that of the OL system. The
moved; the subject then sat down using pre-specified first objective was to determine if, on any given day, the
stimulation sequences. action of the controller resulted in significant changes in
the performance measures. For each trial, the values of
Temporal Response Measures each of the measures were calculated; then the values ob-
Sample tracings of input disturbance force, hip angle tained on each day were grouped by controller type. The
trajectory, and auxiliary support forces for an OL and a data for each of the measures for the OL and the CL


experiment day 1 2 3 4 5
subject # I 1 2 2 2
# OL trials 12 26 21 23 69
# CL trials 38 34 60 56 43
Performance measures
r m s error X X X X X
S . S . error X X X X X
compliance X X X X
Fig. 8. Diagrammatic representation of the temporal response character- System attributes (with respect to steady-state value)
istics used for the control system evaluation. The quantities shown are de- rms-wrt-ss X X X
fined as follows: overshoot = l(p2 - s ~ ) \ return
, time = irlO% - rpl. return time X X
settling time = is 10%- t p l . where pl = initial peak of the angular tra- settling time 0 0
jectory (positive or negative), p? = second peak of the angular trajectory overshoot 0 0
(positive or negative), fpl = time at which p l occurred, ss = steady-state ~~ ~ ~

value of hip angle, dh = 10%* I(pl - ss)J trlO% = time at which the The top four rows indicate the experiment day, subject, and the number
angle had returned to within ss f dh, is 10% = time at which the angle of OL and CL trials performed on that day. The middle three rows denote
had settled to within ss f dh. statistically significant differences ( P < 0.05 using the Kurskal-Wallis
nonparametric test) between the OL and CL performance measyes on each
of the five experiment days. X indicates that the CL values for that day
groups were tested for normality of distribution using the were significantly less than the OL values, 0indicates that the OL val-
ues were significantly less than the CL. An empty slot in the table indicates
chi-square test. For some df the measures the normality that there was no significant difference between the two groups. Similarly,
of the distribution could not be confirmed on some days. the bottom four rows indicate statistically significant differences for the
Therefore, statistical significance of the difference be- system attributes calculated with respect to the steady-state value.
tween the OL and the CL data was evaluated using the
Kmskal-Wallis nonparametric test (see Table 111) [27].
Differences were considered significant for P < 0.05. days, reduced return time on two days, increased settling
Mean values and standard error bars for each of the tem- time on two days, and increased overshoot on two days.
poral measures on each day are shown in Fig. 9. Note that
on all five days the CL controller resulted in a statistically Disturbance Forces
significant reductiorl in fms error. Although this improve- As indicated earlier, the disturbances for each trial were
ment was primarily a reflection of the reduction in steady- not precisely identical, but they were measured for each
state error, it was also influenced by the transient char- trial. The possibility that differences in disturbance rms
acteristics of the response. The CL controller resulted in value, peak value, energy, or rate of application might
a significantly reducedLcompliance on four days. have influenced the system response was tested via cor-
In addition to comparing daily performance of the two relation analysis. On all days, all of the performance
controllers, the overall performance with regard to each measures were found to be poorly correlated with the dis-
measure was evaluated. The daily mean values of each turbance measures ( p << 0.5); none of the correlation
performance measure were normalized with respect to the coefficients were consistently different from zero. Thus,
OL mean value for that day. For each day, the percent the disturbances for each trial were treated as being iden-
reduction for each measure due to the action of the con- tical, i.e., the data were not normalized.
troller was calculated as 100 * (1 - (CL measure/OL
measure)). A paired t-test was used to determine the sig- Support Forces
nificance of the changes in the absolute measures over the The measurements of auxiliary support force were used
set of all days. Results indicate that the CL controller gen- to determine whether or not the observed differences in
erated significant reductions in each of the performance performance were due to differences in support force used
measures: a 41 % reduction in rms error, a 52% reduction by the subjects. Recall that the hip moment due to the
in steady-state error, and a 22% reduction in compliance. action of the hands is the weighted sum of two terms: the
sum of the coronal plane forces measured on the support
System Attributes (Calculated with Respect to Steady- posts (Mhh,c),and the difference between the vertical plane
State) forces measured on the support posts (Mhhqt,).The rms
The quantities of rms-wrt-ss, return time, settling time, value, rms kalculated with respect to the initial value, and
and overshoot were all calculated with respect to the the peak value of the force component of each of these
steady-state value for each trial. The influence of the two terms, and of their weighted sum were calculated for
steady-state error must be considered in interpreting these each trial. These data were then analyzed to determine if
results. For example, a fast return to an incorrect steady- there were significant differences between the OL and CL
state position may result in a faster return or settling time trials. Results indicated that, for any given measure, there
or a smaller Overshoot than the same controller would was no consistent difference across the five days. The rms
achieve if it did not have the steady-state error. This said, value of cpronal plane force was lower for the CL trials
we note that the CL controller reduced rms-wrt-ss on three on three days, lower for the OL trials on one day, and

ruI hip angle steady-state error cowliance


m 4
%a 4
Y * m
1 2 3 4 5 1 2 3 4 5 1 2 7 4 5
mxperiment day experiment day experiment day

(b) (C)
rma-m-t-ss return ti-

o h

1 2 3 4 5 1 2 3 4 5
experimnt day experiment day


- 0

1 2 3
( 4
r e t t l i n g time

4 5

ot *. . . . .
1 1

3 4 5
experimnt day experiment day

(f) ( g)
Fig. 9. Mean values of the performance measures and system attributes versus experiment day for both the OL and CL systems.
Subject no. 1 was used on days 1. 2 and subject no. 2 was used on days 3, 4, and 5 . (a) Displays the mean value of rms error
for the OL system (0) and for the CL system (X) versus experiment day. Vertical bars indicate f one standard error;
the units of the y-axis are given in percent-maximum-abduction (pma) as described in the text. Similar plots for steady-state
error, compliance, rms-wrt-ss, return time, settling time and overshoot are shown in (b)-( g), respectively.

showed no difference on one day. This was the most con- System Response Variability
sistent of the measures; no other.measure was higher or The variance of the performance measures and system
lower for one group on more than two days. The lack of attributes was used to evaluate the effect of the controller
observed consistent differences in the measures of the mo- on system variability. Results of this analysis are pre-
ments exerted by the hands during the OL and CL trials sented in Table IV. The chi-square test was used to eval-
suggests that the differences observed in the OL and CL uate the normality of the distribution of each group. If the
system responses cannot be attributed to the action of the distribution of the data for either the OL or CL group was
hands. Tracings of the time course of the forces contrib- determined not to be normal for a given day, comparison
uting to each component of the moment exerted by the of the variances would not be valid. These cases are in-
hands for the sample trials are given in Fig. 7(c) and (d). diated in the table with a + . For the remaining entries

Although in these trials the CL system required less upper in the table, Bartletts test [27] was used to test the equal-
body support this was not a general trend. ity of the variances. As indicated in Table IV, in several
In the course of the experiments, an additional differ- instances the CL controller brought about significant re-
ence between the OL and CL systems was observed. Fol- ductions of the variance of the performance measures. The
lowing the disturbances, the CL system often resulted in reduction in variance brought about by the CL controller
larger weight shifts between the two legs than the OL sys- was seen most clearly on days 1, 2, and 5.
tem. To quantify this observation, the rms values of the
difference in the vertical component of the two ground
reaction force vectors were calculated. On three days this
measure was lower for the OL system, which reflects the Performance Measures
higher compliance of that system. In some situations, this Lower extremity FNS systems which provide stance
result may be undesirable, thus weight distribution on the currently have two primary deficiencies: the high level of
feet may be a useful feedback signal for the controller. energy expenditure and the limited ability to respond to


TABLE IV room for improvement. Analysis of these measures indi-

cates that the CL controller affected the transient response
experiment day 1 2 3 4 5 of the system. The instances of reductions in return time
subject # I I 2 2 2 indicate improvements in the initial return towards the
# OL trials 12 26 21 23 69
# CL trials 38 34 60 56 43 steady-state value. The instances of increases in settling
Variability of performance measures
time and in overshoot indicate increased oscillations about
rms error X X X the steady-state value. This suggests that, on these days,
S.S. error + X + + X one effect of the CL controller was to decrease the damp-
compliance X X X ing ratio of the system response. This type of behavior
Variability of system attributes could be avoided by a more appropriate controller tuning
rms-wrt-ss X X X
return time + + + + procedure. Future trials with this and other FNS feedback
settling time + X controllers may benefit from a consideration of these
overshoot + X X 0 measures in the tuning protocol.
Entries in the table indicate statistically significant differences (P < 0.05
using Bartletts test) between the variances of the OL and CL quantities
reported in Table 111. X indicates that the CL variance for that day was System Response Variability
significantly less than the OL variance, 0 indicates that the OL variance The data presented in this study exhibit two types of
was significantlyless than the CL, and an empty slot indicates that there
was no significant difference between the two groups. A + in the table variability which are discussed below: variability within
indicates that a chi-square test determined that either the OL or CL measure a population of performance measures on a given day and
was not normally distributed, thus making a comparison of the variances variability of the mean value of a population across sev-
eral days. Analysis revealed two important aspects of the
performance of the CL control system. First, on four of
disturbances. The former limits the duration of standing, five days, the variability of the CL system was signifi-
while the latter limits the users ability to use the hands cantly lower than that of the OL system for several of the
to perform various tasks. This work addresses the latter measures used. Second, although there was day-to-day
of these issues. The demonstrated reductions in rms error, variability, the CL controller consistently performed bet-
steady-state error, and compliance provided by the CL ter than the OL controller with regards to the three per-
controller suggest an improvement in the disturbance re- formance measures used in the study. This ability to pro-
jection capability. This would be a desirable characteris- vide improvements under varied conditions is an important
tic of an FNS control system that is active during func- aspect of any biomedical control system, and attests to the
tional standing, i.e., when the user stands while robustness of the control strategy used here.
performing activities with the hands. The variability of the data observed on a given day may
This evaluation focused on three performance meas- have had several causes. First, the base of postural sup-
ures: rms error, steady-state error, and compliance. These port in the coronal plane is broad and stiffness at the hip
measures were chosen because rms error provides an joint in that plane provides stability in quiet stance over a
overall measure of the system response to a disturbance; wide range of joint positions. Thus, the system is tolerant
compliance provides a measure of the ability of the sys- to some level of deviations about the erect position. Such
tem to resist an impact; and steady-state error provides a changes in position, although acceptable to the subject,
measure of the ability of the system to return to an upright could significantly affect the systems response to a dis-
position. It should be noted, however, that these improve- turbance. That is, changes in initial starting position may
ments afforded by the CL controller do not guarantee that account for some of the variability exhibited in the data
its use will enhance the clinical utility of the FNS system. presented here. Other sources of response variability could
Clinical testing is required to evaluate the relevance of be sagittal plane movements, the actions of hands in ex-
these measures, to develop definitions of clinically desir- erting auxiliary support forces, sensor measurement noise,
able characteristics, and to compare the performance of changes in muscle response, and variations in the trajec-
these systems to normal function. Such testing is beyond tory of disturbance force. Throughout the experiments at-
the scope of this study. However, this study does dem- tempts were made to minimize these effects, but it was
onstrate the ability of the CL controller to favorably mod- not possible to eliminate them. It should be noted that the
ify the system response characteristics. statistical analysis indicated that in many instances a
straightforward difference between the two groups was
System Attributes (Calculated with Respect to Steady discernible, despite the observed variability in the data.
State) Such variability, however, may limit the usefulness of an
These measures (rms-wrt-ss, return time, settling time, FNS standing system.
and overshoot) are of limited use in evaluating system The observed day-to-day variability was probably due
performance because they are calculated with respect to to several factors. The experiments were run on two dif-
very different steady-state errors. However, they do in- ferent subjects. There were several days (sometimes
dicate which characteristics of the system response have weeks) between experiments. Occasionally different elec-
been affected by the controller, and where there may be trodes were used on consecutive experiment days. The

amount of weight supported by the arms varied from day trically stimulated muscle, IEEE Trans. Biomed. Eng., vol. BME-
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[7] G. A. Borges, K. R. Ferguson, and R. Kobetic, Development and
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(Fig. 9). Subject no. 1joined the program three years post- walking in paraplegic subjects, IEEE Trans. Biomed. Eng., vol. 36.
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and I. Donner, Control of Functional Neuromuscular Stimulation
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control of isometric muscle force using pulsewidth modulation, IEEE
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Cleveland, Ohio, 1986.
CONCLUSIONS 1141 G. F. Franklin, I . D. Powell, and A. Emami-Naeimi, Feedback Con-
A feedback controller of coronal plane hip angle has trol of Dynamic Systems. Reading, MA: Addison-Wesley, 1986,
pp. 103-106.
been implemented in paraplegic subjects using FNS. The 151 T. F. Hambrecht and J. B. Reswick, Eds., Funcrional Electrical
performance of the feedback-controlled system has been Stimulation: Applications in Neural Prostheses, Vol. 3. New York:
quantitatively compared to that of an open-loop control Marcel Dekker, 1977, vol. 3, 1977, pp. 119-140.
161 H. Hemami and B. F. Wyman, Modeling and control of constrained
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171 R. T. Jaeger, Design and simulation of closed-loop electrical stim-
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1241 E. B. Marsolais and R. Kobetic, Functional electrical stimulation
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Howard Jay Chizeck (S74-M79) was born on
G. F. Wilhere. P. E. Crago, and H. J. Chizeck, Design and eval-
March 27, 1952 in Columbus, OH. He received
uation of a digital closed-loop controller for the regulation of muscle
the B.S. and M.S. degrees in systems and control
force by recruitment modulation, IEEE Trans. Biomed. Eng., vol.
Engineering from Case Western Reserve Univer-
BME-32, pp. 668-676, Sept. 1985.
sity, Cleveland, OH. in 1974 and 1976, respec-
tively, and the Sc.D. degree in Electrical Engi-
neering and Computer Science from the
Massachusetts Institute of Technology, Cam-
bridge, in 1982.
James J. Abbas (S88) was born in Lawrence, He is an associate professor in the Systems En-
MA in 1961. He received the Sc.B. degree in gineering and Biomedical Engineering Depart-
bioelectrical engineering from Brown University, ments at Case Western Reserve University. His research interests involve
Providence, RI, in 1982 and the M.S. degree in applications of control engineering to biomedical problems. Current proj-
biomedical engineering from Case Western Re- ects include the design and analysis of controllers for the electrical stimu-
serve University, Cleveland, OH in 1989. He is lation of paralyzed muscle, adaptive control of drug delivery, identification
currently working towards the Ph.D. degree in and control of cerebral ventricle volume dynamics for hydrocephalus man-
Biomedical Engineering at Case Westem Reserve agement, algebraic modelling of DNA sequence-geometry relationships and
University. applications of algebraic systems theory to coding.
From 1982 to 1984 he taught secondary school Dr. Chizeck is a member of the AAAS, Sigma Xi, the Rehabilitation
mathematics in Mzuzu, Malawi. Since 1986 he has Society of North America (RESNA), and the International Federation of
been employed as a Biomedical Engineer at the Motion Study Laboratory Automatic Control (IFAC) Technical Committee on Biomedical Engineer-
at the Cleveland Veterans Affairs Medical Center in Cleveland, OH. His ing.