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Biomedical subjects

H B Boom

Publications and source records attributed to H B Boom.

At least 19 recordsLinked to original sources

The step response of left ventricular pressure to ejection flow: a system oriented approach.

Left ventricular pressure is dependent on both ventricular volume and ventricular ejection flow. These dependencies are usually expressed by ventricular elastance, and resistance, respectively. Resistance is a one-valued effect only, when ejection flow either is constant or increases. Decreasing ejection flow elicits a third effect: a decrease of elastance. The effects of elastance, resistance and elastance depression were modeled in a three-compartment model consisting of a dead-volume compartment, an elastance compartment, and a second series-elastance compartment connected to the elastance compartment by a resistance. This model was identified with the pressure response determined experimentally by imposing pumped constant-flow ejection epochs on isolated rabbit hearts. The experimental flow epochs consisted of two phases of constant flow separated by an increasing or decreasing flow step. It was found that elastance is not changed after the flow step if this is positive or zero. Negative flow steps induced a deactivation of elastance that is linearly dependent on the difference between isovolumic pressure that would be developed at the volume existing at the time of measurement and actual pressure. The parameters found from the identification procedure are ventricular active volume, nondepressed elastance, series-elastance, resistance, and the elastance deactivation factor. The first four parameter values were found in agreement with other results reported in literature. The elastance depression factor is a new parameter that could be of physiological or clinical significance since it may be related to the inability of the force generators in the heart muscle to be restored to their full number, after being inactivated or decoupled by filament sliding associated with ejection. On the basis of the results, an alinear state-model of the ventricle, for arbitrary, including physiological flow patterns is proposed.

Animals

On/off control in FES-induced standing up: a model study and experiments.

Control of paraplegic standing up was studied with respect to the limitation of the end-velocity of the knee joint when the patient reaches the upright position. Closed-loop on/off control of knee extensor muscle was compared with open-loop controlled standing up both in a model study and in paraplegic patients in a controlled model situation. Criteria were knee-end-velocity and knee extensor muscle activation time. Sensitivity of the system to additional arm support and (in the model study) to the dynamics of knee extensor muscle was studied. It is concluded that the control scheme may reduce knee-end velocity to about 40 per cent and knee extensor activation time to near 70 per cent of the respective open-loop values.

Biomechanical Phenomena

Potential distribution and single-fibre action potentials in a radially bounded muscle model.

In modelling the electrical behaviour of muscle tissue, we used to employ a frequency-dependent volume conductor network model, which was infinitely extended in all directions. Equations in this model could be solved using a finite-difference approach. The most important restriction of this model was the fact that no boundary effects could be incorporated. Analytical models of muscle tissue normally do not have this disadvantage, but in those models the microscopic structure of muscle tissue cannot be taken into account. In the paper, we present a combined numerical/analytical approach, which enables the study of potential distributions and SFAPs in simulated microscopic muscle tissue in which the influence of the muscle boundary has been considered. We considered muscle models with radii of 1.5 mm and 10 mm. Both models were compared with an unbounded network model. In the model with a radius of 1.5 mm we varied the position of the active fibre relative to the muscle surface. It appeared that in most cases the presence of a boundary had a considerable effect on the potential distribution. An increase in the peak-to-peak value of the SFAP amplitude up to 300 per cent was noticed when the active fibre was positioned 500 microns beneath the muscle surface in a model with a radius of 1.5 mm.

Action Potentials

Low-level finite state control of knee joint in paraplegic standing.

Low-level finite state (locked-unlocked) control is compared with open-loop stimulation of the knee extensor muscles in functional electrical stimulation (FES) induced paraplegic standing. The parameters were: duration of standing, relative torque loss in knee extensor muscles, knee angle stability, average stimulus output and average arm effort during standing. To investigate the impact of external mechanical conditions on controller performance, experiments were performed both under the condition of a freely moving ankle joint and of a mechanically stabilized ankle joint. Finite state control resulted in a 2.5 to 12 times increase of standing duration or in a 1.5 to 5 times decrease of relative torque loss in comparison with open-loop stimulation. Finite state control induced a limit cycle oscillation in the knee joint. Average maximum knee flexion was 6.2 degrees without ankle bracing, and half that value with ankle bracing. Average arm support was 13.9 and 7.5% of the body weight without and with ankle bracing respectively.

Adult

Simulation of multipolar fiber selective neural stimulation using intrafascicular electrodes.

A realistic, quantitative model is presented for the excitation of myelinated nerve fibers by intrafascicular electrodes. It predicts the stimulatory regions of any configuration of any number of electrodes, positioned anywhere inside the fascicle. The model has two parts. First, the nerve fiber is represented by a lumped electrical network and its response to an arbitrary extracellular potential field is calculated. Second, assuming a cylindrical geometry of the nerve bundle and its surroundings, an analytical expression for this field is derived. With realistic parameters, the model is applied to two cases: monopolar stimulation by a single cathode and stimulation by a specific tripolar configuration. It is shown that tripolar stimulation has the better spatial selectivity. Also tripolar stimulation is less sensitive to the conductivity of the medium surrounding the nerve and yields a more natural recruitment order.

Electric Conductivity

Recruitment of dorsal column fibers in spinal cord stimulation: influence of collateral branching.

An electrical network model of myelinated dorsal column nerve fibers is presented. The effect of electrical stimulation was investigated using both a homogeneous volume conductor and a more realistic model of the spinal cord. An important feature of dorsal column nerve fibers is the presence of myelinated collaterals perpendicular to the rostro-caudal fibers. It was found that transmembrane potentials, due to external monopolar stimulation, at the node at which a collateral is attached, is significantly influenced by the presence of the collateral. It is concluded that both excitation threshold and blocking threshold of dorsal column fibers are decreased up to 50% compared to unbranched fibers.

Action Potentials

Modelling the optimal control of cyclical leg movements induced by functional electrical stimulation.

An optimal control strategy for FES-induced cyclical leg movements in paraplegics is proposed. The control of the cyclical movement of a freely swinging leg is considered as an example. Quadriceps and the flexion withdrawal reflex are stimulated in order to generate a cyclical movement, of which the forward swing resembles the swing phase of gait. Optimal stimulation patterns are determined on the basis of an optimization criterion and a dynamic model of the system. The criterion is based on desired movement parameters and a minimal duration of the stimulation bursts. The movement parameters should ensure the generation of the desired cyclical movement: a desired hip angle range, sufficient foot clearance during the forward swing and knee extension at the beginning of the backward swing. Minimal duration of the stimulation bursts is assumed to yield minimal fatigue. A dynamic model, describing the dynamics of the neural system, the muscles and the leg, was constructed and its parameters identified on the basis of preliminary experiments and literature. Optimal timing of the quadriceps and flexion reflex stimulation bursts was determined by means of computer simulation. These simulations predicted that the flexion reflex should be stimulated in a short burst approximately 150 ms before the start of the forward swing. The quadriceps should be stimulated approximately starting 200 ms before the end of the forward swing in order to ensure knee extension at the beginning of the backward swing. The duration of one cycle of the movement was between 1300 and 1500 ms in these simulations. These results predict that the movement specified by the functional objectives can be realised using only two channels of stimulation. On the basis of the optimal timing, an adaptive control strategy can be designed, which varies the stimulation burst width when muscles fatigue.

Biomechanical Phenomena

Lower extremity angle measurement with accelerometers--error and sensitivity analysis.

Closed-loop control techniques for the restoration of locomotion of paraplegic subjects are expected to improve the quality of functional neuromuscular stimulation (FNS). We investigated the use of accelerometers for the assessment of feedback parameters. Previously, the possibility of angle assessment of the lower extremities using accelerometers, but without integration, was demonstrated. The current paper evaluates and assesses this method by an error and sensitivity analysis using healthy subject data. Of three potential error sources, the reference system, the accelerometers, and the model assumptions, the last was found to be the most important. Model calculations based on data obtained by the Elite video motion analysis system showed the rigid-body assumption error to be dominant for high frequencies (greater than 10 Hz), with vibrations in the order of 1 mm resulting in errors of one radial or more. For low frequencies (less than 5 Hz), the imperfect fixation of the accelerometers combined with a nonhinge type knee joint gave an error contribution of +/- 0.03 rad. The walking pattern was assumed to be two-dimensional which was shown to result in an error of +/- 0.04 rad. Accelerations due to rotations of the segments could be neglected. The total error computed for low frequencies (+/- 0.07 rad) was comparable to the experimental difference between the current and the reference system.

Acceleration

Left-ventricular dynamic model based on constant ejection flow periods.

Experiments with constant ejection flow periods on the rabbit left ventricle suggest that left ventricular pressure can be described by a time varying three-element model consisting of elastance Ee(t), resistance R(t), and series-elastance Es(t). Previous experiments demonstrated the existence of a "deactivation effect" after the cessation of a constant ejection flow period, which could be described by a decrease of elastance Ee(t). This paper presents a simulation model based on findings of constant ejection flow experiments, and tested on measured pressure and volume data. The results show that when the model is fitted on one single beat, left ventricular pressure can satisfactorily be described by a three-element model without deactivation. However, the model does not predict isovolumic pressure at end-ejection volume. When isovolumic pressure has to be described by the model as well, introduction of deactivation is necessary. The quality of the model was further tested by fitting it to two beats with different ejection parameters. Deactivation again was necessary for a good fit. Only with a deactivation effect in the model, the component values found are close to the normal range found with CFP experiments in the rabbit left ventricles. From the simulation results it can be concluded that (at least for constant ejection flow periods) elastance, resistance, series-elastance, and deactivation effects all are necessary in describing (and predicting) left ventricular pressure.

Animals

Epidural spinal cord stimulation: calculation of field potentials with special reference to dorsal column nerve fibers.

The effect of electrical stimulation with several electrode combinations on nerve fibers with different orientations in the spinal cord was investigated by computing the steady-state field potentials and activating functions. At first an infinite homogeneous model was used while secondly the spinal cord and its surrounding tissues were modeled as an inhomogeneous anisotropic volume conductor. The effect of mediodorsal epidural stimulation was calculated. It was concluded that with cathodal stimulation, mediodorsally in the epidural space, longitudinal fibers are depolarized, but dorsoventral ones are hyperpolarized. With anodal stimulation the opposite will occur. It was found that parameters substantially affecting the potential distribution in the dorsal columns are the conductivity of the white matter and the width and the conductivity of the csf layer.

Action Potentials

Artificial-reflex stimulation for FES-induced standing with minimum quadriceps force.

A control strategy is proposed to decrease quadriceps activity during standing. Modified on/off (or artificial reflex) control is used: a non-numerical or finite-state control scheme based on feedback of knee angle and angular velocity. The control strategy is evaluated in paraplegic patients in an experimental setup using transcutaneous stimulation. The stability of the system and its sensitivity to various control parameters are determined. It is concluded that the control scheme will enable reduction of muscle force independent of additional mechanical bracing or specific posture, and may result in continuous dynamic activation of muscle.

Electric Stimulation Therapy

Real-time gait assessment utilizing a new way of accelerometry.

Real-time registration of body segment angles is essential in artificial body position control. A new method is presented for the real-time calculation of the lower extremity angles using data obtained from pairs of two one-dimensional accelerometers. It is shown that, assuming rigid-body dynamics and simple hinge joints, relative angles (i.e. angles between segments) can be calculated without integration, thereby solving the problem of integration drift normally associated with accelerometry. During the stance phase of walking, the relative angles can be transformed to absolute angles (i.e. relative to the gravitational field direction) for the different leg segments. The feasibility of relative angle calculation is demonstrated by calculation of the knee angle of a healthy subject. Stability and resolution were demonstrated with measurements during standing. Measurements during standing up, sitting down and walking showed that shock (heel-strike) and skin movements, due to movements of the underlying muscle tissue, are the main error sources. Additional signal processing, e.g. low-pass filtering, can be used to diminish this error. The accuracy of the knee angle found is shown to be high enough to be used in a feedback controller for functional electrostimulation of the lower extremities.

Biomechanical Phenomena

Automatic stance-swing phase detection from accelerometer data for peroneal nerve stimulation.

The development of implantable peroneal nerve stimulators has increased interest in sensors which can detect the different phases of walking (stance and swing). Accelerometers, having a potential for implantation, are studied as detectors for the swing phase of walking to replace footswitches. Theoretically, we could show that accelerometers can be used to distinguish between stance and swing phase. Attaching accelerometers between ankle and knee joint the equivalent acceleration of the ankle joint was calculated. This resulted in a typical and reproducible signal in which the different walking phases were identified. Automatic detection algorithms, based on cross correlation calculation were developed and tested. Measurements from four healthy and four hemiplegic subjects resulted in a total of 317 and 272 steps, respectively. One of the hemiplegic subjects was considered to be a failure due to large disturbances in the acceleration signal during the swing phase of walking, which may be related to the use of crutches. Taking part of the data as a learning set and the other part as an evaluation set we found two errors in the push-off detection for both the healthy subjects and the remaining three hemiplegic subjects, out of 152 and 106 steps, respectively. In addition, we showed that when using one accelerometer closely below the knee joint almost identical results can be achieved. This could lead to a combination of sensor and stimulator into one implantable device.

Algorithms

Left ventricular active stiffness: dependency on time and inotropic state.

Left ventricular systolic stiffness was measured by rapidly changing ventricular volume (within 7 ms) of isovolumically contracting isolated rabbit hearts. Instantaneous pressure-volume relations were found to be linear with slopes that depended upon the moment during contraction at which the volume change was induced. These slopes were proportional to the total pressure developed in the ventricle just prior to the volume change. The same was found when the time course of pressure was influenced by changing the Ca++ content of the perfusate. An influence, however, also could be detected when end-diastolic volume was changed. At the same pre-release pressure a greater volume caused a decrease of active stiffness. The results indicate the possibility of an active component in ventricular systolic stiffness.

Animals

The combined influence of the stimulus frequency of the vagal nerves and the atrial stimulus interval on the atrioventricular conduction time.

The way in which the A-V node adapts its conduction time to stepwise alterations of atrial stimulation rates was studied under different conditions of vagal nerve activity (open chest, anaesthetised rabbit). Increase of stimulation rate induced oscillatory adaptation to a longer conduction time. Decrease caused shorter conduction times without oscillation. The time constant did not differ. Oscillation amplitude and time constants were markedly influenced by vagal activity. The observed phenomena can be explained on the basis of a time and voltage dependent K+ conductance.

Animals

A note on the phase-plane technique representation of cardiac action potentials.

In this study the applicability of the phase-plane technique for interpreting membrane properties of cardiac cells in a two-dimensional structure is discussed. The conditions are derived for which the effects of two-dimensionality of a sheet can be neglected and for which the one-dimensional phase-plane technique for estimation of the membrane current densities remains valid. The usual phase-plane technique appears to be applicable to nodal and atrial tissue.

Action Potentials