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Biomedical subjects

F M Barr

Publications and source records attributed to F M Barr.

6 recordsLinked to original sources
PubMed1998

Selecting candidates for a lower limb stimulator implant programme: a patient-centred method.

OBJECTIVE: To develop an effective selection procedure for lower limb functional neurostimulation (LLFNS) for standing in paraplegia. DESIGN: The selection procedure and exclusion criteria were based on the previous experience for two clinical centres with experience of LLFNS. SETTING: Two Regional Spinal Injuries units in southern England. SUBJECTS: 254 fully rehabilitated paraplegics living in the community. INTERVENTION: Patients were invited to participate in the programme, and if suitable to subject themselves to a rigorous staged selection procedure from which they could withdraw at any time. OUTCOME MEASURE: Functionally successful home standing using closed-loop surface electrical stimulation. RESULTS: 57/254 patients were suitable on paper and were accessible. 19 of these (CI = 10-28) were interested in the project and attended one of the spinal centres for details. Twelve (CI = 5-19) of these fulfilled the selection criteria and started on the training programme; and 10 of them completed the muscle training programme successfully. Seven patients (CI = 2-12) achieved closed-loop standing in the laboratory and four patients (CI = 1-8) did so at home.

Adult↗
PubMed1998

Investigation of the Hammerstein hypothesis in the modeling of electrically stimulated muscle.

To restore functional use of paralyzed muscles by automatically controlled stimulation, an accurate quantitative model of the stimulated muscles is desirable. The most commonly used model for isometric muscle has had a Hammerstein structure, in which a linear dynamic block is preceded by a static nonlinear function. To investigate the accuracy of the Hammerstein model, the responses to a pseudo-random binary sequence (PRBS) excitation of normal human plantarflexors, stimulated with surface electrodes, were used to identify a Hammerstein model but also four local models which describe the responses to small signals at different mean levels of activation. Comparison of the local models with the linearized Hammerstein model showed that the Hammerstein model concealed a fivefold variation in the speed of response. Also, the small-signal gain of the Hammerstein model was in error by factors up to three. We conclude that, despite the past widespread use of the Hammerstein model, it is not an accurate representation of isometric muscle. On the other hand, local models, which are more accurate predictors, can be identified from the responses to short PRBS sequences. The utility of local models for controller design is discussed.

Adult↗
PubMed1997

Feedback control of unsupported standing in paraplegia--part II: experimental results.

This is the second of a pair of papers which describe an investigation into the feasibility of providing artificial balance to paraplegics using electrical stimulation of the paralyzed muscles. By bracing the body above the shanks, only stimulation of the plantar flexors is necessary. This arrangement prevents any influence from the intact neuromuscular system above the spinal cord lesion. In this paper, we present experimental results from intact and paraplegic subjects.

Adult↗
PubMed1997

Lumbar root stimulation for restoring leg function: results in paraplegia.

We have implanted an intradural array of 12 tripolar electrodes on the anterior roots L2-S2, left and right, at cauda equina level, in a 33-year-old woman with a complete T9 cord lesion of 3 years' duration. They are driven by an implanted multiplexed stimulator system using radio frequency (RF) power and control signals. All channels generate movements, in patterns that might be predicted from the known anatomy of the cauda equina. In particular, stimulation of L2 and L3 gives hip adduction; L3, L4, and L5 gives quadriceps femoris movements; L5, S1, and S2 gives hamstrings movement; and S1 and S2 give plantar flexion. Stimulation of L5 gives mixed movements at the ankle. Surprisingly, stimulation of the L2 roots has not given strong hip flexion. Responses have been stable. Some thresholds have varied, probably as a result of tissue encapsulation. The moment generated within each degree of freedom of the legs has been measured for each root, using a specially designed multimoment measurement apparatus. For several roots, a movement of lower threshold may be accompanied by a second movement of higher electrical threshold, suggesting that different muscles may have fiber populations that differ in their diameter or their location in the root. The use of stimulus forms that enable selective anodal block may, in the future, enable separation of two distinct movements from a single motor root.

Adult↗
PubMed1993

Fibre areas and histochemical fibre types in the quadriceps muscle of paraplegic subjects.

With the advent of functional electrical stimulation (FES) there is the possibility of paraplegic patients regaining some degree of locomotor activity. It is of interest to document the changes in composition histochemistry and size of muscle fibres in such patients both before and after such therapy. We have examined biopsy specimens from quadriceps muscles obtained from 7 male patients, age range 24-47 years, who had been paraplegic for times ranging from 11 months to 9 years and we report the histochemical appearance of the muscle the fibre type composition and the mean fibre areas. In 5 of the 7 subjects there was a marked or complete predominance of fibres which stained as type 2 with the ATPase reaction at pH 9.4. At acid pH these fibres were seen to be predominantly 2B (fast fatigable). The 2 subjects who had been paralysed for the shortest periods had proportions of type 1 fibres which were relatively well preserved. The mean fibre areas of type 2 fibres were below the normal range (2500-7500 microns 2) in every case as were the type 1 fibres in the 4 patients in which these were still present. There was no relationship between the length of time the patient had been paralysed and the mean fibre areas which suggests that atrophy occurs fairly quickly following loss of voluntary control and precedes the loss of type 1 characteristics. Our findings provide an explanation for the rapid onset of fatigue in paraplegic patients taking part in FES programmes since muscles deficient in type 1 fibres will be unable to maintain force for any length of time.

Adult↗