Design and Test of a Novel Closed-Loop System That Exploits the Nociceptive Withdrawal Reflex for Swing-Phase Support of the Hemiparetic Gait

A novel closed-loop system for improving gait in hemiparetic patients by supporting the production of the swing phase using electrical stimulations evoking the nociceptive withdrawal reflex was designed. The system exploits the modular organization of the nociceptive withdrawal reflex and its stimulation site-and gait-phase modulation in order to evoke movements of the hip, knee, and ankle joints during the swing phase. A modified model-reference adaptive controller (MRAC) was designed to select the best stimulation parameters from a set of 12 combinations of four electrode locations on the sole of the foot and three different stimulation onset times between heel-off and toe-off. It was hypothesized that the MRAC system would result in a better walking pattern comparedwith an open-loop preprogrammed fixed pattern of stimulation (FPS) controller. Thirteen chronic or subacute hemiparetic subjects participated in a study to compare the performance of the two control schemes. Both control schemes resulted in a more functional gait compared to no stimulation (P < 0.05) with a weighted joint angle peak change of 4.0 +/- 1.6 (mean +/- Standard deviation) degrees and 3.1 +/- 1.4 degrees for the MRAC and FPS schemes, respectively. This indicates that the MRAC scheme performed better than the FPS scheme (P < 0.001) in terms of reaching the control target.