Professional Documents
Culture Documents
Neuropsychological Effect
Detrimental effect by STN-DBS in apathy
and depression
Quality of Life
STN-DBS decreased communication
Increased mobility
Better patient preparation (unrealistic
expectations)
LOWER LIMB ANATOMY
Sacral plexus (L4-S4)
Obturator and Femoral nerves (L2-L4)
Sciatic nerve (L5-S3) -> Common peroneal
+ Tibial
Femoral Nerve (L1-L4)
MUSCLES
Gluteal grp: maximus; medius; minimus;
tensor fasciae latae
Lateral rotator grp: Obturator; piriformis;
gemelles; quadratus femoris
Adductor grp: longus; magnus; brevis;
pectineus; gracilis
Iliopsoas grp: iliacus; psoas.
Flexors knee: Biceps femoris;
Types reflex
1. Vestibulocervical reflex: Stabilize head on
body with Medial vestibulospinal pathway.
Head rotates/tilts in one direction, contract
neck muscles to oppose motion (2-3 Hz
oscillation)
2. Vestibulospinal reflex: Stabilize body with
Lateral vestibulospinal pathway. Body
rotates/tilts in one direction, contract ipsilateral
extensor muscle to counteract.
Strategies Postural Control (4) IESA
1. Interaction of the 3 Sensory systems
2. Environmental conditions
3. Sensorimotor strategies: interaction b/w
motor and sensory systems
4. Attentional strategies
a) Ankle strategy:
1. Ford sway = Para, Ham, Gast
2. Back sway = Abd, Quad, Tib Ant.
b) Hip strategy:
3. Ford sway = Abd, Quad
4. Back sway = Para, Ham
Loss of sensory system affect postural strategy
. Vestibular loss -> ankle stategy
3 main errors:
1. Magnitude moment is incorrect
2. Polarity of the moments would be
wring
3. Cant be used to calculate moments in
non-weight bearing times
.
.
.
1.
2.
Calf
Gastrocnemius: early stance (up to 40%
step cycle).
Soleus: early stance; last third of stance
Tibialis ant: end swing/beginning stance;
swing
Gastronemius stabilize ankle
Gastro lateral: help lower toe
Gastro medial: activated during propulsion
Tibialis anterior prevents foot drop and
gives toe clearance
Neural control Walking
1. Central Pattern Generators (CPG)
2. Afferent Input: regulate pattern and
activity
3. Descending control from higher centres
CPG
. Cats could walked with full spinal
transection
. Proposed half-centre: excitatory neurons
(flexor extensor) mutually inhibitory
through interneurons
. two-layer effect: rhythm and timing
CPG (SEIFSI)
1. Each limb controlled by separate CPG
2. Each CPG contain 2 excitatory grps that
control flexor and extensor motoneurons
respectively
3. Mutual inhibitory interconnections b/w halfcenters ensure only one center activated at
the time
4. fatigue: gradually reduces excitation in
active half-center
5. Phase switching: reduction in the excitability
of one half-center below critical value and
opposing center released from inhibition
6. Inhibition of antagonist motoneurons is tightly
coupled to excitation agonist
Unit Burst Generator: unilateral, multipartite,
shared and modular
7. Control an agonist at a single joint of a
hindlimb
8. Produce rhythmic bursts of output even when
the generator of its antagonist is quiescent
9. Shared: each UBG used in different behaviours
CPG (+2 levels)
. Rhythm generation and amount of
motorneurons recruited are executed by
Brain stem
Cochlear nucleus, cuneate nucleus, substatia
grisea centralis and spinocerebellar tract:
induce locomotion
Lateral hypothalamic area: walk slowly, head
extended, looking around
Cerebellum
Damage causes ataxic gait: wide-base
staggering
Lack of modulation of firing in reticulospinal
neurons
Basal ganglia
Initiation of locomotor activity
Proper force generation development in
extensor muscles for postural adjustment
Cerebrum
Modulation of gait cycle
Visual input to cortex permits planning of
foot landing while avoiding obstacles
Expected obstacle avoidance activates
pyramidal tract (corticospinal neuron)
Unanticipated gait perturbations activated
motor neuron graded to the size of
perturbations
PROSTHETIC LEGS
Main concern is a stable, sturdy limb.
JaipurKnee project
Components Above knee amputation
1. Socket: Suction suspension
2. Knee:
3. Shank: support
4. Foot-ankle
Functions
5. Support body during standing, walking
. Transtibial amputees expend 20% more
energy than those without
. O2 requirements increase at each higher
amputation level
Prosthetic Joints
. Passive in action. 60% more metabolic
energy
. Rely upon ground force effects, sliding
joints, and mechanical components
(hydraulics)
. Control prosthesis come from extra
movements from hip and residual limb
. Vanderbilt: powered knee-ankle, load
The Foot
3c level: Control, Comfort and Cosmetics
Types: Conventional, Energy-storing-andrelease (ESR) and bionic
A. Conventional:
1. Solid Ankle Cushioned Heel (SACH)
. Most common and cheapest
. Solid ankle, rigid foot, cushioned heel
. Pediatric or geriatrics; when potential
functional level yet to be determined
2. Single axis foot:
. Bumpers control ankle flexion
. Little shock absorption or energy return
B. ESR
. Dynamic elastic response feet flex at heel
strike and midstance and spring back at late
stance
. Reduces energy expenditure
. Seattle foot (1985): monolithic keel. Allow
energy storage, expenditure.
1. Carbon graphite foot:
. lightweight, integrated pylon.
. Moderately active below or above knee
amputee
. Excellent shock absorption, flexibility, energy
Socket Technology
Patient-prosthetic interface. Can create sense of
instability and uncertainty in the control
Custom fitted: donning stocking net over residual
limb, identify anatomic landmarks, and casting
with plaster. Stump changes over time (atrophy)
Ie transtibial amputee: patellar tendon, tibial
condyles, are able to support higher loads
Problems Inappropriate fitting (PEVI)
a. Pressure sores
b. Edema
c. Vascularity Compromised
d. Infections
Dynamic loading during walking
Finite element (FE) analysis predicts excessive
loading in a user-socket interface
Function:
1. Gait training 2. Shift weight b/w feet 3.
Restore faith
Patient type: incomplete/complete SCI,
stroke TBI.
Design considerations (SAD JoPPP)
2. Power supply: battery
3. Actuators: servomotors
4. Skeletal components: titanium/ carbon
fiber
5. Joint flexibility
6. Power control and modulation
7. Detection of incorrect/unsafe
motions
8. Pinching/joint fouling
. ReWALK: Powered hip-knee, fully
assistive. Mode sit, walk, stair.
. Exoskeleton Lower Extremity Gait
Systmem (eLEGS): 6hrs battery. Walk
Modes: First, Active, Pro, Pro Plus. Assist
Modes: Bilateral, Adaptive, Fixed.
. Hybrid Assistive Limb (HAL): 3hrs battery,
Japan. Cybernic Voluntary Control (CVC)