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WO2005011494A1 - Procede et dispositif biomecaniques d'elimination de tremblements pathologiques - Google Patents

Procede et dispositif biomecaniques d'elimination de tremblements pathologiques Download PDF

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Publication number
WO2005011494A1
WO2005011494A1 PCT/ES2004/070055 ES2004070055W WO2005011494A1 WO 2005011494 A1 WO2005011494 A1 WO 2005011494A1 ES 2004070055 W ES2004070055 W ES 2004070055W WO 2005011494 A1 WO2005011494 A1 WO 2005011494A1
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WO
WIPO (PCT)
Prior art keywords
tremor
point
strategy
pathological
identification
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/ES2004/070055
Other languages
English (en)
Spanish (es)
Inventor
José Luis PONS ROVIRA
Eduardo Rocon De Lima
Leandro Bueno
Andres F Ruiz Olaya
Leopoldo CALDERÓN ESTÉVEZ
Ramón CERES RUIZ
Antonio R JIMÉNEZ RUIZ
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Consejo Superior de Investigaciones Cientificas CSIC
Original Assignee
Consejo Superior de Investigaciones Cientificas CSIC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Consejo Superior de Investigaciones Cientificas CSIC filed Critical Consejo Superior de Investigaciones Cientificas CSIC
Publication of WO2005011494A1 publication Critical patent/WO2005011494A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices ; Anti-rape devices
    • A61F5/01—Orthopaedic devices, e.g. long-term immobilising or pressure directing devices for treating broken or deformed bones such as splints, casts or braces
    • A61F5/0102—Orthopaedic devices, e.g. long-term immobilising or pressure directing devices for treating broken or deformed bones such as splints, casts or braces specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations
    • A61F5/013—Orthopaedic devices, e.g. long-term immobilising or pressure directing devices for treating broken or deformed bones such as splints, casts or braces specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations for the arms, hands or fingers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Measuring devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/11—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor or mobility of a limb
    • A61B5/1101—Detecting tremor
    • G—PHYSICS
    • G05—CONTROLLING; REGULATING
    • G05B—CONTROL OR REGULATING SYSTEMS IN GENERAL; FUNCTIONAL ELEMENTS OF SUCH SYSTEMS; MONITORING OR TESTING ARRANGEMENTS FOR SUCH SYSTEMS OR ELEMENTS
    • G05B5/00—Anti-hunting arrangements
    • G05B5/01—Anti-hunting arrangements electric
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/40—Detecting, measuring or recording for evaluating the nervous system
    • A61B5/4076—Diagnosing or monitoring particular conditions of the nervous system
    • A61B5/4082—Diagnosing or monitoring movement diseases, e.g. Parkinson, Huntington or Tourette
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6801—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be attached to or worn on the body surface
    • A61B5/6813—Specially adapted to be attached to a specific body part
    • A61B5/6824—Arm or wrist

Definitions

  • the present invention relates to biomechanical or biomedical devices for the cancellation, reduction, or control of involuntary pathological tremor. As such, they are applicable in the prosthetic and orthotic rehabilitation industry.
  • Pathological tremor is an effect of some neurological diseases that results in the disability of the affected person. It is characterized by rhythmic and involuntary contractions of the patient's muscles. As a consequence the affected person is subjected to involuntary oscillations of his upper limbs and possibly other parts of the body.
  • the frequency of these oscillations varies depending on whether the type of tremor is resting (characteristic of Parkinson's disease), postural (characteristic of patients with essential tremor) or kinetic (characteristic of patients with traumatic brain damage).
  • the commonly accepted range ranges from 2Hz to 12Hz.
  • the present patent relates to a selective tremor cancellation method.
  • the method is structured around a repetitive control loop.
  • patent US5740090 focuses on the protection of a type of filter tuned with a main frequency component, "notch filters", of order equal to or greater than two, and of repetitive control and learning strategies developed from said filter.
  • This patent also cites other previous patents, such as US4821168, which focuses on robustness aspects of the aforementioned control loops.
  • Pathological tremor is characterized by rhythmic oscillations of some member of the human body. These rhythmic oscillations are superimposed on the patient's voluntary movement.
  • the amplitude and frequency characteristics of the trembling oscillations depend on the type of tremor, be it resting, postural or kinetic. In addition, for the same patient, these characteristics may be altered depending on the activity or conditions that he develops or is subjected to.
  • a clinically established procedure to reduce the effects of tremor is the application of resistive mechanical loads, whether these are dissipative or inertial.
  • the ideal solution is to apply loads of this type only to shaky movement.
  • all the embodiments described in the state of the art apply the biomechanical load to the combination of the voluntary and trembling movement. This results in resistance to the patient's intentional movement, and as a consequence a lack of comfort.
  • the present patent aims to protect a method that allows the selective cancellation, reduction or suppression of tremor, that is, without affecting the voluntary movement of the patient. Furthermore, the proposed method allows this cancellation action to be adapted automatically to any type of tremor or to any tremor condition of a patient.
  • the proposed method basically consists of two stages: 1.
  • the first stage is a strategy to identify the characteristics of the tremor based on information collected by a variety of biomechanical (position, speed, acceleration, or force) or physiological (signal) sensors. electromyographic).
  • the characteristics obtained by this strategy are at least the frequency, phase and amplitude of the trembling signal, differentiating it from the voluntary signal, using any digital algorithm or digital or analog electronic circuit designed for this purpose.
  • the second stage is made up of a repetitive control loop, which tuned with the tremor information obtained in the previous phase to the specific characteristics of the trembling signal, selectively cancels the trembling part of the movement. For this, a multiplicity of actuators allow the cancellation action of the control loop to be applied, through the application of internal forces (solution orthotic) or by applying external forces (tabletop solution, for wheelchairs ).
  • the identification and monitoring of the trembling signal allows its application to any type of tremor or to any condition or activity of the user.
  • Pathological tremor presents a rhythmic oscillation of the different segments of the upper limb of patients with some diseases of neurological origin. This oscillation is characterized by frequencies in the range of 2 to 4 Hz for the case of resting tremor characteristic of Parkinson's disease. Postural tremor is however characterized by a frequency range of 5 to 8 Hz and is characteristic of essential tremor disease. For its part, kinetic tremor can occur at frequencies between 4 and 12 Hz and is characteristic of patients with traumatic brain damage.
  • Voluntary movement is generally characterized by significantly lower frequencies than tremor. Furthermore, the latter is an essentially harmonic (rhythmic) movement. Taking advantage of these two characteristics, it is possible to determine strategies that allow differentiating both types of movement. Specifically, one possible strategy is: a) filtering of the motion signal with low or high pass filters designed with cutoff frequencies in the frequency range between voluntary and shaky motion. Filters thus designed can be implemented both digitally and analogically and can be of any order, that is, with rejection slopes at the highest or lowest prohibited frequencies.
  • ⁇ k The error, ⁇ k , can be established between the model of equation (1) and the signal actually obtained through a variety of sensors at time k, s k , according to equation (2).
  • e k S k ⁇ l w rk • sin K ⁇ k + Wr + Mk C0S * f ⁇ k (2)
  • This error can be used to propose a least squares optimization process for the model parameters of equation (1).
  • the described process allows, through the proper selection of the convergence parameters of the optimization process, the obtaining of a recursive method for the instantaneous estimation of the frequency, phase and amplitude characteristics of the trembling signal.
  • the described strategy allows obtaining an instantaneous estimate of the characteristics of the tremor, differentiating these from the voluntary movement.
  • two alternatives have been described for the implementation of this strategy, it is the strategy itself that allows the implementation of the method protected in this patent and as a consequence combinations of both or third digitally developed methods can be used in the domains of time or frequency or analog.
  • Repetitive control is a variant of learning control in which prior information on the type of disturbance to which a child is subjected is used. system to improve rejection of them. Specifically, it is applicable when the disturbances are periodic.
  • the system to be controlled is the upper limb of the patient and the disturbance is the oscillation caused by the tremor and which, as indicated above, is rhythmic (harmonic). Therefore, selective tremor cancellation or rejection can be approximated by repetitive control loops.
  • the strategy described in the previous paragraphs allows, once the main frequency of the tremor is known, to perform a selective cancellation of the disturbance represented by the tremor to the voluntary movement. If, as described above, the identification strategy allows instantaneous identification of the tremor characteristics from the information from the sensors, the proposed method automatically adapts to the type of tremor and the patient's conditions.
  • control method can be carried out both digitally and analogically without affecting the basis of the protected method.
  • the control action described above results in the application of a series of biomechanical stresses to the trembling limb. These efforts can be internal, that is, applied to the limb taking another segment of the human body as a reference, leading to orthotic solutions. Efforts can also be external, that is, taking as reference any external element (table, wheelchair %), leading to non-ambulatory applications.
  • the described method is shown schematically in the diagram of figure 3.
  • the development of an orthotic solution to cancel tremor at the elbow is presented as an example of embodiment of the invention.
  • the orthosis is formed by a rigid structure that allows supporting a set of sensors and actuators to implement blocks 1 and 4 of the cancellation method described schematically in Figure 3.
  • two gyroscopes located on both sides of the joint are used as sensors that provide information on the absolute angular velocity of the arm and forearm in the plane of movement of the joint.
  • the measurement frequency range is between 0 and 50 Hz, thus covering the entire frequency range of possible tremors.
  • An ultrasonic motor is also included to generate the tremor cancellation torque at the joint of interest.
  • the motor torque is 1 mN, enough to counteract the average torque of the tremor at this level.
  • the set is controlled by a personal computer that incorporates acquisition cards of sufficient capture speed and resolution, in this case 200 Khz. and 12 bits respectively.
  • a tremor identification and monitoring strategy is implemented according to the IEEE-STD-1057 standard to develop block 2 of figure 3. This strategy assumes that the tremor follows a harmonic pattern and develops a model of it according to the equation (1). The recursive least squares optimization of the error between this model and the actual measurement of the tremor allows instantaneous identification of the frequency, phase and amplitude of the tremor.
  • the selected sample rate for the identification loop is 1 Khz.
  • the estimate delay is reduced to 1ms, negligible compared to the intrinsic frequency of the tremor that is between 2 and 12 Hz
  • the estimated frequency of the tremor is used to tune the repetitive control loop of block 3 of figure 3.
  • a vector is used for this, in which the error between the reference and the signal in the previous period is stored.
  • a linear combination is used with a single previous value, the one corresponding to a one-period delay of the identified tremor signal. This linear combination is the input to a classic integral proportional controller.
  • Figure 1 The figure schematically represents a repetitive control loop.
  • Block 1 represents the plant to be controlled, which in this case is made up of the whole of the member and the device used for applying forces.
  • Block 2 represents the controller that, based on the error signal e r , generates the control action.
  • Block 3 develops a linear combination of M previous values of error e. In this scheme the error e is determined from the difference between the reference value r and the measured signal s.
  • the figure represents the control action represented by a repetitive loop.
  • the tremor center frequency, f 0 is used to tune this repetitive loop resulting in a large attenuation or rejection centered on this frequency and the corresponding harmonics.
  • Block 1 is made up of a variety of sensors that collect kinematic or kinetic information about the tremor in a given limb (position, speed, acceleration, force or mechanical torque) and / or physiological information about it (electromyographic signal).
  • Block 2 represents the strategy for identifying and monitoring the characteristics of the tremor, using as input the sensory information provided by block 1 and generating an estimate of the frequency, phase and amplitude of the trembling part of the movement of the affected limb.
  • Block 3 represents the application of a repetitive control loop tuned with the information provided by block 2 to implement a rejection zone of frequencies adjusted to the characteristics of the tremor.
  • control action represented by block 3 is the input of block 4 that represents the biomechanical application of the action of cancellation of the tremor by means of a multiplicity of actuators arranged in a system of internal (orthotic) and / or external efforts (desktop devices). , wheelchair).

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Physics & Mathematics (AREA)
  • Animal Behavior & Ethology (AREA)
  • Biomedical Technology (AREA)
  • Molecular Biology (AREA)
  • Physiology (AREA)
  • Pathology (AREA)
  • Surgery (AREA)
  • Biophysics (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Dentistry (AREA)
  • Medical Informatics (AREA)
  • Nursing (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Vascular Medicine (AREA)
  • General Physics & Mathematics (AREA)
  • Automation & Control Theory (AREA)
  • Orthopedics, Nursing, And Contraception (AREA)
  • Rehabilitation Tools (AREA)

Abstract

L'invention concerne un procédé permettant l'élimination biomécanique sélective de tremblements pathologiques. L'action d'élimination se concentre sur les fréquences caractéristiques des tremblements sans incidence négative sur le mouvement volontaire du patient. Il est utilisé pour divers types de tremblements et divers types de situations par adaptation automatique de l'action d'élimination en accord avec les caractéristiques particulières du signal tremblant. Tout le système acquiert la forme d'une orthèse des membres supérieurs pouvant être appliquée à un ensemble vaste d'activités journalières. Les caractéristiques des produits commerciaux sont beaucoup plus restreintes puisque ceux-ci sont limitées à des activités concrètes (alimentation), appliquent une action biomécanique non sélective puisqu'ils ne s'adaptent pas aux caractéristiques concrètes du type de tremblement ou de patient, sont des dispositifs de table puisqu'ils ne sont pas portatifs.
PCT/ES2004/070055 2003-07-25 2004-07-21 Procede et dispositif biomecaniques d'elimination de tremblements pathologiques Ceased WO2005011494A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ESP200301767 2003-07-25
ES200301767A ES2222819B1 (es) 2003-07-25 2003-07-25 Metodo y dispositivo biomecanico de cancelacion de temblor patologico.

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Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005122894A1 (fr) * 2004-06-11 2005-12-29 Consejo Superior De Investigaciones Científicas Procede et dispositif electronique et informatique de suppression et d'evaluation des tremblements et mouvements spastiques dans des moyens peripheriques d'entree et de commande
US7960606B2 (en) 2006-06-20 2011-06-14 The J. David Gladstone Institutes Mouse model of chronic heart failure and coronary atherosclerosis regression
US9107614B2 (en) 2011-07-12 2015-08-18 Xanadu Christina Halkias Systems, methods, and media for finding and matching tremor signals
US20220031194A1 (en) * 2020-08-03 2022-02-03 Gyrogear Limited Systems and methods for automated tremor management, tracking and recommendations

Families Citing this family (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ES2272137B1 (es) * 2004-12-14 2008-06-16 Consejo Superior Investig. Cientificas. Dispositivo ortesico dinamico para la monitorizacion, diagnostico y supresion de temblor patologico.
US12453853B2 (en) 2013-01-21 2025-10-28 Cala Health, Inc. Multi-modal stimulation for treating tremor
ES2889752T3 (es) 2013-01-21 2022-01-13 Cala Health Inc Dispositivos y métodos para controlar temblores
JP6606105B2 (ja) 2014-06-02 2019-11-13 カラ ヘルス，インコーポレイテッド 振戦を治療するための抹消神経刺激用のシステム及び方法
WO2016201366A1 (fr) 2015-06-10 2016-12-15 Cala Health, Inc. Systèmes et procédés pour la stimulation des nerfs périphériques pour traiter des tremblements avec une thérapie détachable et des unités de surveillance
CN108348746B (zh) 2015-09-23 2021-10-12 卡拉健康公司 用于手指或手中的周围神经刺激以治疗手震颤的系统和方法
IL286747B2 (en) 2016-01-21 2024-05-01 Cala Health Inc A wearable device for the treatment of symptoms related to the urinary system
CA3030029A1 (fr) 2016-07-08 2018-01-11 Cala Health, Inc. Systemes et procedes pour stimuler n nerfs avec exactement n electrodes et electrodes seches ameliorees
AU2017315764B2 (en) 2016-08-25 2022-11-10 Cala Health, Inc. Systems and methods for treating cardiac dysfunction through peripheral nerve stimulation
WO2018187241A1 (fr) 2017-04-03 2018-10-11 Cala Health, Inc. Systèmes, procédés et dispositifs de neuromodulation périphérique pour le traitement de maladies associées à une hyperactivitévésicale
US11857778B2 (en) 2018-01-17 2024-01-02 Cala Health, Inc. Systems and methods for treating inflammatory bowel disease through peripheral nerve stimulation
US12251560B1 (en) 2019-08-13 2025-03-18 Cala Health, Inc. Connection quality determination for wearable neurostimulation systems
US11890468B1 (en) 2019-10-03 2024-02-06 Cala Health, Inc. Neurostimulation systems with event pattern detection and classification
EP4477135A1 (fr) * 2023-06-12 2024-12-18 Koninklijke Philips N.V. Système et procédé de détection de tremblements
EP4483783A1 (fr) * 2023-06-27 2025-01-01 Koninklijke Philips N.V. Système et procédé de détection et de compensation de tremblements

Citations (7)

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EP0535508A1 (fr) * 1991-09-23 1993-04-07 Vitatron Medical B.V. Système et procédé destinés à la détection de tremblements, en particulier ceux résultant de la maladie de Parkinson
WO1996013898A1 (fr) * 1994-10-28 1996-05-09 Philips Electronics N.V. Filtre, systeme de commande repetitif et systeme de commande autodidactique munis tous deux dudit filtre
US6145381A (en) * 1998-11-12 2000-11-14 Alliedsignal Inc. Real-time adaptive control of rotationally-induced vibration
US20030023191A1 (en) * 2001-04-20 2003-01-30 Tripp Robert M. Method and apparatus for producing oscillating signals representing tremor, for filtering the signals, and for generating interpretations of the data to diagnose conditions associated with the tremor
US6561993B2 (en) * 2001-02-26 2003-05-13 International Business Machines Corporation Device driver system for minimizing adverse tremor effects during use of pointing devices
WO2004008427A1 (fr) * 2002-07-17 2004-01-22 Yoram Baram Appareil en boucle fermee pour realite augmentee
WO2004034886A2 (fr) * 2002-10-15 2004-04-29 Medtronic Inc. Decalage de phase de signaux neurologiques dans un systeme de dispositif medical

Patent Citations (7)

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Publication number Priority date Publication date Assignee Title
EP0535508A1 (fr) * 1991-09-23 1993-04-07 Vitatron Medical B.V. Système et procédé destinés à la détection de tremblements, en particulier ceux résultant de la maladie de Parkinson
WO1996013898A1 (fr) * 1994-10-28 1996-05-09 Philips Electronics N.V. Filtre, systeme de commande repetitif et systeme de commande autodidactique munis tous deux dudit filtre
US6145381A (en) * 1998-11-12 2000-11-14 Alliedsignal Inc. Real-time adaptive control of rotationally-induced vibration
US6561993B2 (en) * 2001-02-26 2003-05-13 International Business Machines Corporation Device driver system for minimizing adverse tremor effects during use of pointing devices
US20030023191A1 (en) * 2001-04-20 2003-01-30 Tripp Robert M. Method and apparatus for producing oscillating signals representing tremor, for filtering the signals, and for generating interpretations of the data to diagnose conditions associated with the tremor
WO2004008427A1 (fr) * 2002-07-17 2004-01-22 Yoram Baram Appareil en boucle fermee pour realite augmentee
WO2004034886A2 (fr) * 2002-10-15 2004-04-29 Medtronic Inc. Decalage de phase de signaux neurologiques dans un systeme de dispositif medical

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005122894A1 (fr) * 2004-06-11 2005-12-29 Consejo Superior De Investigaciones Científicas Procede et dispositif electronique et informatique de suppression et d'evaluation des tremblements et mouvements spastiques dans des moyens peripheriques d'entree et de commande
US7960606B2 (en) 2006-06-20 2011-06-14 The J. David Gladstone Institutes Mouse model of chronic heart failure and coronary atherosclerosis regression
US9107614B2 (en) 2011-07-12 2015-08-18 Xanadu Christina Halkias Systems, methods, and media for finding and matching tremor signals
US20220031194A1 (en) * 2020-08-03 2022-02-03 Gyrogear Limited Systems and methods for automated tremor management, tracking and recommendations
US12295724B2 (en) * 2020-08-03 2025-05-13 Gyrogear Limited Systems and methods for automated tremor management, tracking and recommendations

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Publication number Publication date
ES2222819B1 (es) 2006-03-16
ES2222819A1 (es) 2005-02-01

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