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Individuals with paraplegia spend their time on the wheelchair for life. Adapting to prolonged wheelchair seating for almost all activities of daily living is challenging. The loss of abilities to sense any pain or excessive seating pressure cause them to remain seated on the wheelchair without any pressure relief activities. This situation leads to secondary complications including pressure ulcer which further degrades the individual’s health. To overcome this, a wheelchair seating pressure relief training system (WSETs) was developed. Optimal placement of the force sensitive resistors (FSR) as seating pressure sensors on the cushion were determined, and their responses were investigated with 5 paraplegics. Two different FSR orientations, A and B, were compared. Each paraplegic sat in resting position and then performed pressure relief activities (PRA) which included whole body push-up, left and right lean and forward lean, before returning to resting position. Orientation B, with more forward positioned FSRs, showed higher sensitivity, implying better capture of high-risk area of pressure ulcer development. The FSR sensor readings were significantly different among pressure relief activities in all subjects (p < 0.05) indicating the validity of FSR measures for the intended application. In conclusion, the WSETs system was proven suitable as a training tool for new paraplegics to habituate themselves in performing PRA.
Norhani Md Nadzri; Nur Azah Hamzaid; Tze Yang Chung. Design and development of a wheelchair seating pressure relief reminder system for pressure ulcer prevention among paraplegics. Journal of Medical Engineering & Technology 2021, 1 -8.
AMA StyleNorhani Md Nadzri, Nur Azah Hamzaid, Tze Yang Chung. Design and development of a wheelchair seating pressure relief reminder system for pressure ulcer prevention among paraplegics. Journal of Medical Engineering & Technology. 2021; ():1-8.
Chicago/Turabian StyleNorhani Md Nadzri; Nur Azah Hamzaid; Tze Yang Chung. 2021. "Design and development of a wheelchair seating pressure relief reminder system for pressure ulcer prevention among paraplegics." Journal of Medical Engineering & Technology , no. : 1-8.
Due to its clinically proven safety and health benefits, functional electrical stimulation (FES) cycling has become a popular exercise modality for individuals with spinal cord injury (SCI). Since its inception in 2013, the Cybathlon championship has been a platform for publicizing the potential of FES cycling in rehabilitation and exercise for individuals with SCI. This study aimed to evaluate the contribution of the Cybathlon championship to the literature on FES cycling for individuals with SCI 3 years pre and post the staging of the Cybathlon championship in 2016. Web of Science, Scopus, ScienceDirect, IEEE Xplore, and Google Scholar databases were searched for relevant studies published between January 2013 and July 2019. The quality of the included studies was objectively evaluated using the Downs and Black checklist. A total of 129 articles on FES cycling were retained for analysis. A total of 51 articles related to Cybathlon were reviewed, and 14 articles were ultimately evaluated for the quality. In 2017, the year following the Cybathlon championship, Web of Science cited 23 published studies on the championship, which was almost 5-fold more than were published in 2016 (n = 5). Training was most often reported as a topic of interest in these studies, which mostly (76.7%) highlighted the training parameters of interest to participating teams in their effort to maximize their FES cycling performance during the Cybathlon championship. The present study indicates that the Cybathlon championship in 2016 contributed to the number of literature published in 2017 on FES cycling for individuals with SCI. This finding may contribute to the lessons that can be learned from participation in the Cybathlon and potentially provide additional insights into research in the field of race-based FES cycling.
Puteri Nur Farhana Hamdan; Nur Azah Hamzaid; Nasrul Anuar Abd Razak; Nazirah Hasnan. Contributions of the Cybathlon championship to the literature on functional electrical stimulation cycling among individuals with spinal cord injury: A bibliometric review. Journal of Sport and Health Science 2020, 1 .
AMA StylePuteri Nur Farhana Hamdan, Nur Azah Hamzaid, Nasrul Anuar Abd Razak, Nazirah Hasnan. Contributions of the Cybathlon championship to the literature on functional electrical stimulation cycling among individuals with spinal cord injury: A bibliometric review. Journal of Sport and Health Science. 2020; ():1.
Chicago/Turabian StylePuteri Nur Farhana Hamdan; Nur Azah Hamzaid; Nasrul Anuar Abd Razak; Nazirah Hasnan. 2020. "Contributions of the Cybathlon championship to the literature on functional electrical stimulation cycling among individuals with spinal cord injury: A bibliometric review." Journal of Sport and Health Science , no. : 1.
A transfemoral prosthesis is required to assist amputees to perform the activity of daily living (ADL). The passive prosthesis has some drawbacks such as utilization of high metabolic energy. In contrast, the active prosthesis consumes less metabolic energy and offers better performance. However, the recent active prosthesis uses surface electromyography as its sensory system which has weak signals with microvolt-level intensity and requires a lot of computation to extract features. This paper focuses on recognizing different phases of sitting and standing of a transfemoral amputee using in-socket piezoelectric-based sensors. 15 piezoelectric film sensors were embedded in the inner socket wall adjacent to the most active regions of the agonist and antagonist knee extensor and flexor muscles, i. e. region with the highest level of muscle contractions of the quadriceps and hamstring. A male transfemoral amputee wore the instrumented socket and was instructed to perform several sitting and standing phases using an armless chair. Data was collected from the 15 embedded sensors and went through signal conditioning circuits. The overlapping analysis window technique was used to segment the data using different window lengths. Fifteen time-domain and frequency-domain features were extracted and new feature sets were obtained based on the feature performance. Eight of the common pattern recognition multiclass classifiers were evaluated and compared. Regression analysis was used to investigate the impact of the number of features and the window lengths on the classifiers’ accuracies, and Analysis of Variance (ANOVA) was used to test significant differences in the classifiers’ performances. The classification accuracy was calculated using k-fold cross-validation method, and 20% of the data set was held out for testing the optimal classifier. The results showed that the feature set (FS-5) consisting of the root mean square (RMS) and the number of peaks (NP) achieved the highest classification accuracy in five classifiers. Support vector machine (SVM) with cubic kernel proved to be the optimal classifier, and it achieved a classification accuracy of 98.33 % using the test data set. Obtaining high classification accuracy using only two time-domain features would significantly reduce the processing time of controlling a prosthesis and eliminate substantial delay. The proposed in-socket sensors used to detect sit-to-stand and stand-to-sit movements could be further integrated with an active knee joint actuation system to produce powered assistance during energy-demanding activities such as sit-to-stand and stair climbing. In future, the system could also be used to accurately predict the intended movement based on their residual limb’s muscle and mechanical behaviour as detected by the in-socket sensory system.
Tawfik Yahya; Nur Azah Hamzaid; Sadeeq Ali; Farahiyah Jasni; Hanie Nadia Shasmin. Classification of standing and sitting phases based on in-socket piezoelectric sensors in a transfemoral amputee. Biomedical Engineering / Biomedizinische Technik 2020, 1 .
AMA StyleTawfik Yahya, Nur Azah Hamzaid, Sadeeq Ali, Farahiyah Jasni, Hanie Nadia Shasmin. Classification of standing and sitting phases based on in-socket piezoelectric sensors in a transfemoral amputee. Biomedical Engineering / Biomedizinische Technik. 2020; ():1.
Chicago/Turabian StyleTawfik Yahya; Nur Azah Hamzaid; Sadeeq Ali; Farahiyah Jasni; Hanie Nadia Shasmin. 2020. "Classification of standing and sitting phases based on in-socket piezoelectric sensors in a transfemoral amputee." Biomedical Engineering / Biomedizinische Technik , no. : 1.
Functional electrical stimulation (FES) has been used to produce force-related activities on the paralyzed muscle among spinal cord injury (SCI) individuals. Early muscle fatigue is an issue in all FES applications. If not properly monitored, overstimulation can occur, which can lead to muscle damage. A real-time mechanomyography (MMG)-based FES system was implemented on the quadriceps muscles of three individuals with SCI to generate an isometric force on both legs. Three threshold drop levels of MMG-root mean square (MMG-RMS) feature (thr50, thr60, and thr70; representing 50%, 60%, and 70% drop from initial MMG-RMS values, respectively) were used to terminate the stimulation session. The mean stimulation time increased when the MMG-RMS drop threshold increased (thr50: 22.7 s, thr60: 25.7 s, and thr70: 27.3 s), indicating longer sessions when lower performance drop was allowed. Moreover, at thr70, the torque dropped below 50% from the initial value in 14 trials, more than at thr50 and thr60. This is a clear indication of muscle fatigue detection using the MMG-RMS value. The stimulation time at thr70 was significantly longer (p = 0.013) than that at thr50. The results demonstrated that a real-time MMG-based FES monitoring system has the potential to prevent the onset of critical muscle fatigue in individuals with SCI in prolonged FES sessions.
Jannatul Naeem; Nur Azah Hamzaid; Amelia Wong Azman; Manfred Bijak. Electrical stimulator with mechanomyography-based real-time monitoring, muscle fatigue detection, and safety shut-off: a pilot study. Biomedical Engineering / Biomedizinische Technik 2020, 65, 461 -468.
AMA StyleJannatul Naeem, Nur Azah Hamzaid, Amelia Wong Azman, Manfred Bijak. Electrical stimulator with mechanomyography-based real-time monitoring, muscle fatigue detection, and safety shut-off: a pilot study. Biomedical Engineering / Biomedizinische Technik. 2020; 65 (4):461-468.
Chicago/Turabian StyleJannatul Naeem; Nur Azah Hamzaid; Amelia Wong Azman; Manfred Bijak. 2020. "Electrical stimulator with mechanomyography-based real-time monitoring, muscle fatigue detection, and safety shut-off: a pilot study." Biomedical Engineering / Biomedizinische Technik 65, no. 4: 461-468.
Using traditional regression modelling, we have previously demonstrated a positive and strong relationship between paralyzed knee extensors' mechanomyographic (MMG) signals and neuromuscular electrical stimulation (NMES)-assisted knee torque in persons with spinal cord injuries. In the present study, a method of estimating NMES-evoked knee torque from the knee extensors’ MMG signals using support vector regression (SVR) modelling is introduced and performed in eight persons with chronic and motor complete spinal lesions. The model was developed to estimate knee torque from experimentally derived MMG signals and other parameters related to torque production, including the knee angle and stimulation intensity, during NMES-assisted knee extension. When the relationship between the actual and predicted torques was quantified using the coefficient of determination (R2), with a Gaussian support vector kernel, the R2 value indicated an estimation accuracy of 95% for the training subset and 94% for the testing subset while the polynomial support vector kernel indicated an accuracy of 92% for the training subset and 91% for the testing subset. For the Gaussian kernel, the root mean square error of the model was 6.28 for the training set and 8.19 for testing set, while the polynomial kernels for the training and testing sets were 7.99 and 9.82, respectively. These results showed good predictive accuracy for SVR modelling, which can be generalized, and suggested that the MMG signals from paralyzed knee extensors are a suitable proxy for the NMES-assisted torque produced during repeated bouts of isometric knee extension tasks. This finding has potential implications for using MMG signals as torque sensors in NMES closed-loop systems and provides valuable information for implementing this method in research and clinical settings.
Morufu Olusola Ibitoye; Nur Azah Hamzaid; Ahmad Khairi Abdul Wahab; Nazirah Hasnan; Sunday Olusanya Olatunji; Glen M. Davis. SVR modelling of mechanomyographic signals predicts neuromuscular stimulation-evoked knee torque in paralyzed quadriceps muscles undergoing knee extension exercise. Computers in Biology and Medicine 2020, 117, 103614 .
AMA StyleMorufu Olusola Ibitoye, Nur Azah Hamzaid, Ahmad Khairi Abdul Wahab, Nazirah Hasnan, Sunday Olusanya Olatunji, Glen M. Davis. SVR modelling of mechanomyographic signals predicts neuromuscular stimulation-evoked knee torque in paralyzed quadriceps muscles undergoing knee extension exercise. Computers in Biology and Medicine. 2020; 117 ():103614.
Chicago/Turabian StyleMorufu Olusola Ibitoye; Nur Azah Hamzaid; Ahmad Khairi Abdul Wahab; Nazirah Hasnan; Sunday Olusanya Olatunji; Glen M. Davis. 2020. "SVR modelling of mechanomyographic signals predicts neuromuscular stimulation-evoked knee torque in paralyzed quadriceps muscles undergoing knee extension exercise." Computers in Biology and Medicine 117, no. : 103614.
Micro-processor controlled prosthetic legs (MPCPL) offer better functionality than conventional prosthetic legs as they use actuators to replace missing joint function. This potentially reduces the user’s metabolic energy consumption and normal walking gait can be mimicked as closely as possible. However, MPCPL require a good control system to perform efficiently, and one of the essential components is the system of sensors. The sensory system must satisfy two important criteria; the practicality in donning and doffing the prosthesis, i.e. the process of putting on and taking off the prosthesis by the amputee user, and the quality in the information provided. In this paper, a comprehensive review was conducted on studies related to the state of the art of sensory system adopted in MPCPL. The publications were searched using four electronics databases within the last 13 years. A total of 31 papers were reviewed. The articles were classified into three main categories: prosthetic-device oriented, user’sbiological-input oriented and neuro-mechanical fusion sensory system. Types of sensors used and their application to the prosthetic system were analyzed. This review indicates that the sensors technology reported in the literature still does not fulfil the criteria of an efficient sensory system. Hence, a sensory system that eases the don and doff process of the prosthesis, yet informative in terms of providing enough useful data to effectively control the prosthesis, is needed for a successful MPCPL.
Nur Azah Hamzaid; Nur Hidayah Mohd Yusof; Farahiyah Jasni. Sensory Systems in Micro-Processor Controlled Prosthetic Leg: A Review. IEEE Sensors Journal 2019, 20, 4544 -4554.
AMA StyleNur Azah Hamzaid, Nur Hidayah Mohd Yusof, Farahiyah Jasni. Sensory Systems in Micro-Processor Controlled Prosthetic Leg: A Review. IEEE Sensors Journal. 2019; 20 (9):4544-4554.
Chicago/Turabian StyleNur Azah Hamzaid; Nur Hidayah Mohd Yusof; Farahiyah Jasni. 2019. "Sensory Systems in Micro-Processor Controlled Prosthetic Leg: A Review." IEEE Sensors Journal 20, no. 9: 4544-4554.
This study investigates whether mechanomyography (MMG) produced from contracting muscles as a measure of their performance could be a proxy of muscle fatigue during a sustained functional electrical stimulation (FES)-supported standing-to-failure task. Bilateral FES-evoked contractions of quadriceps and glutei muscles, of four adults with motor-complete spinal cord injury (SCI), were used to maintain upright stance using two different FES frequencies: high frequency (HF – 35 Hz) and low frequency (LF – 20 Hz). The time at 30° knee angle reduction was taken as the point of critical “fatigue failure”, while the generated MMG characteristics were used to track the pattern of force development during stance. Quadriceps fatigue, which was primarily responsible for the knee buckle, was characterized using MMG-root mean square (RMS) amplitude. A double exponential decay model fitted the MMG fatigue data with good accuracy [R2 = 0.85–0.99; root mean square error (RMSE) = 2.12–8.10] implying changes in the mechanical activity performance of the muscle’s motor units. Although the standing duration was generally longer for the LF strategy (31–246 s), except in one participant, when compared to the HF strategy, such differences were not significant (p > 0.05) but suggested a faster muscle fatigue onset during HF stimulation. As MMG could discriminate between different stimulation frequencies, we speculate that this signal can quantify muscle fatigue characteristics during prolonged FES applications.
Morufu Olusola Ibitoye; Nur Azah Hamzaid; Ahmad Khairi Abdul Wahab; Nazirah Hasnan; Glen M. Davis. Quadriceps mechanomyography reflects muscle fatigue during electrical stimulus-sustained standing in adults with spinal cord injury – a proof of concept. Biomedical Engineering / Biomedizinische Technik 2019, 65, 165 -174.
AMA StyleMorufu Olusola Ibitoye, Nur Azah Hamzaid, Ahmad Khairi Abdul Wahab, Nazirah Hasnan, Glen M. Davis. Quadriceps mechanomyography reflects muscle fatigue during electrical stimulus-sustained standing in adults with spinal cord injury – a proof of concept. Biomedical Engineering / Biomedizinische Technik. 2019; 65 (2):165-174.
Chicago/Turabian StyleMorufu Olusola Ibitoye; Nur Azah Hamzaid; Ahmad Khairi Abdul Wahab; Nazirah Hasnan; Glen M. Davis. 2019. "Quadriceps mechanomyography reflects muscle fatigue during electrical stimulus-sustained standing in adults with spinal cord injury – a proof of concept." Biomedical Engineering / Biomedizinische Technik 65, no. 2: 165-174.
The aim of this study was to investigate the performance of mechanomyography (MMG) and electromyography (EMG) in monitoring the sternocleidomastoid (SCM) as accessory respiratory muscles when breathing during singing. MMG and EMG were used to record the activity of the SCM in 32 untrained singers reciting a monotonous text and a standard folk song. Their voices were recorded and their pitch, or fundamental frequency (FF), and intensity were derived using Praat software. Instants of inhale and exhales were identified during singing from their voice recordings and the corresponding SCM MMG and EMG activities were analysed. The SCM MMG, and EMG signals during breathing while singing were significantly different than breathing at rest (p < 0.001). On the other hand, MMG was relatively better correlated to voice intensity in both reading and singing than EMG. EMG was better, but not significantly, correlated with FF in both reading and singing as compared to MMG. This study established MMG and EMG as the quantitative measurement tool to monitor breathing activities during singing. This is useful for applications related to singing therapy performance measure including potentially pathologically effected population. While the MMG and EMG could not distinguish FF and intensity significantly, it is useful to serve as a proxy of inhalation and exhalation levels throughout a particular singing session. Further studies are required to determine its efficacy in a therapeutic setting.
Muhammad Imran Ramli; Nur Azah Hamzaid; Julia Patrick Engkasan. Monitoring Breathing Muscle Performance During Singing Noninvasively Using Mechanomyography and Electromyography. Journal of Voice 2019, 34, 862 -869.
AMA StyleMuhammad Imran Ramli, Nur Azah Hamzaid, Julia Patrick Engkasan. Monitoring Breathing Muscle Performance During Singing Noninvasively Using Mechanomyography and Electromyography. Journal of Voice. 2019; 34 (6):862-869.
Chicago/Turabian StyleMuhammad Imran Ramli; Nur Azah Hamzaid; Julia Patrick Engkasan. 2019. "Monitoring Breathing Muscle Performance During Singing Noninvasively Using Mechanomyography and Electromyography." Journal of Voice 34, no. 6: 862-869.
Gait detection is crucial especially in active prosthetic leg control mechanism. Vision system, floor sensors, and wearable sensors are the popular methods proposed to collect data for gait detection. However, in active prosthetic leg control, a tool that is practical in its implementation and is able to provide rich gait information is important for effective manipulation of the prosthetic leg. This paper aims to ascertain the feasibility of the piezoelectric-based in-socket sensory system that is hypothesized to be practical in implementation and provide sufficient information as a wearable gait detection tool for transfemoral prosthetic users. Fifteen sensors were instrumented to the anterior and posterior internal wall of a quadrilateral socket. One transfemoral amputee subject donned the instrumented socket and performed two walking routines; single stride and continuous walking. The sensors’ responses from both routines were analyzed with respect to the gait phases. The results suggested that the sensors output signal corresponds to the force components behavior of the stump while performing gait. All sensors were seen active during the first double support period (DS1). The anterior sensors were prominent during the initial swing (Sw), while posterior sensors were active during terminal Sw. These findings correspond with the muscle activity during the respective phases. Besides, the sensors also show significant pattern during single support and the second double support (DS2) phase. Thus, it can be deduced that the proposed sensory system is feasible to be used as a gait phase identification tool.
Farahiyah Jasni; Nur Azah Hamzaid; Tawfik Yahya Al-Nusairi; Nur Hidayah Mohd Yusof; Hanie Nadia Shasmin; Siew-Cheok Ng. Feasibility of a Gait Phase Identification Tool for Transfemoral Amputees Using Piezoelectric- Based In-Socket Sensory System. IEEE Sensors Journal 2019, 19, 6437 -6444.
AMA StyleFarahiyah Jasni, Nur Azah Hamzaid, Tawfik Yahya Al-Nusairi, Nur Hidayah Mohd Yusof, Hanie Nadia Shasmin, Siew-Cheok Ng. Feasibility of a Gait Phase Identification Tool for Transfemoral Amputees Using Piezoelectric- Based In-Socket Sensory System. IEEE Sensors Journal. 2019; 19 (15):6437-6444.
Chicago/Turabian StyleFarahiyah Jasni; Nur Azah Hamzaid; Tawfik Yahya Al-Nusairi; Nur Hidayah Mohd Yusof; Hanie Nadia Shasmin; Siew-Cheok Ng. 2019. "Feasibility of a Gait Phase Identification Tool for Transfemoral Amputees Using Piezoelectric- Based In-Socket Sensory System." IEEE Sensors Journal 19, no. 15: 6437-6444.
This study assessed electrically-evoked sustained muscle contractions with real-time changes in near-infrared spectroscopy and mechanomyography signals. Twenty healthy volunteers performed electrical-evoked wrist extension for 10 min. Root mean square derived from MMG (%RMS-MMG) and tissue oxygen saturation (%StO2) from NIRS of the extensor carpi radialis (ECR) muscle were monitored throughout the sessions. The correlated responses of these two measures comprised of 7 consecutive sets of 10 contractions each. %StO2 revealed an initial decline from muscle contraction 1 to 10 and then an increase from contraction 11 to 70. For %RMS-MMG, a significant decrease was observed from contraction 1 to 10 as well as from contraction 41 to 60 while an increase was seen from contraction 11 to 40 and from contraction 61 to 70. Positive low-order correlations were found between %StO2 and %RMS-MMG during the start of the exercise while later on, the two variables were negatively correlated. As the number of contractions increased over time, increased %StO2 revealed good oxygen saturation aligned with decreased %RMS-MMG values, suggesting decreased muscle fiber activation and strength. In this study, the physiological muscle responses were associated with its mechanical characteristics.
Nurul Salwani Mohamad Saadon; Nur Azah Hamzaid; Nazirah Hasnan; Muhammad Afiq Dzulkifli; Mira Teoh; Kok Beng Gan; Glen M. Davis. Muscle Oxygen Saturation Correlates with Muscle Mechanomyography During Prolonged Electrical Stimulation-Evoked Wrist Extension Exercise. Lecture Notes in Electrical Engineering 2019, 101 -107.
AMA StyleNurul Salwani Mohamad Saadon, Nur Azah Hamzaid, Nazirah Hasnan, Muhammad Afiq Dzulkifli, Mira Teoh, Kok Beng Gan, Glen M. Davis. Muscle Oxygen Saturation Correlates with Muscle Mechanomyography During Prolonged Electrical Stimulation-Evoked Wrist Extension Exercise. Lecture Notes in Electrical Engineering. 2019; ():101-107.
Chicago/Turabian StyleNurul Salwani Mohamad Saadon; Nur Azah Hamzaid; Nazirah Hasnan; Muhammad Afiq Dzulkifli; Mira Teoh; Kok Beng Gan; Glen M. Davis. 2019. "Muscle Oxygen Saturation Correlates with Muscle Mechanomyography During Prolonged Electrical Stimulation-Evoked Wrist Extension Exercise." Lecture Notes in Electrical Engineering , no. : 101-107.
Patients with spinal cord injury (SCI) benefit from muscle training with functional electrical stimulation (FES). For safety reasons and to optimize training outcome, the fatigue state of the target muscle must be monitored. Detection of muscle fatigue from mel frequency cepstral coefficient (MFCC) feature of mechanomyographic (MMG) signal using support vector machine (SVM) classifier is a promising new approach. Five individuals with SCI performed FES cycling exercises for 30 min. MMG signals were recorded on the quadriceps muscle group (rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM)) and categorized into non-fatigued and fatigued muscle contractions for the first and last 10 min of the cycling session. For each subject, a total of 1800 contraction-related MMG signals were used to train the SVM classifier and another 300 signals were used for testing. The average classification accuracy (4-fold) of non-fatigued and fatigued state was 90.7% using MFCC feature, 74.5% using root mean square (RMS), and 88.8% with combined MFCC and RMS features. Inter-subject prediction accuracy suggested training and testing data to be based on a particular subject or large collection of subjects to improve fatigue prediction capacity.
Jannatul Naeem; Nur Azah Hamzaid; Anamul Islam; Amelia Wong Azman; Manfred Bijak. Mechanomyography-based muscle fatigue detection during electrically elicited cycling in patients with spinal cord injury. Medical & Biological Engineering & Computing 2019, 57, 1199 -1211.
AMA StyleJannatul Naeem, Nur Azah Hamzaid, Anamul Islam, Amelia Wong Azman, Manfred Bijak. Mechanomyography-based muscle fatigue detection during electrically elicited cycling in patients with spinal cord injury. Medical & Biological Engineering & Computing. 2019; 57 (6):1199-1211.
Chicago/Turabian StyleJannatul Naeem; Nur Azah Hamzaid; Anamul Islam; Amelia Wong Azman; Manfred Bijak. 2019. "Mechanomyography-based muscle fatigue detection during electrically elicited cycling in patients with spinal cord injury." Medical & Biological Engineering & Computing 57, no. 6: 1199-1211.
Functional Electrical Stimulation (FES) technologies can facilitate standing in persons with spinal cord injury (SCI), and prolonged standing elicited via FES may offer both functional and therapeutic benefits to users. However, the current attainable FES-evoked standing duration is typically short and below the threshold for clinical efficacy. To promote the objective selection of suitable control strategies to restore prolonged and higher-quality standing duration, this study summarised current and emerging approaches to FES standing. PubMed, IEEE Xplore,Web of Science and Google Scholar databases were searched for relevant studies on FES-evoked standing after SCI between the earliest return date and December 2017. Thereafter, the quality of all included studies was objectively evaluated using the Downs and Black methodological assessment checklist. Twenty-five full-length articles, with mean methodological quality score of 56%, met the inclusion criteria and were retained for analysis. Recent advancements to promote prolonged standing relied greatly on the use of voluntary upper extremities for balancing with arm engaged or disengaged. Some widely-reported constraints were issues of unpredictable postural sway, and unusual muscle responses and perturbations, such as spasm or spasticity, which diminished the reliability of the standing control sensors and algorithms. Closed-loop control of FES-supported standing with arms-free modality and voluntary upper extremity balancing promoted the “longest” standing duration and “highest” efficacy among the reported methods, albeit with a limited successful transfer of the technology into the routine clinical practice or community deployment. However, open-loop control of FES standing appeared popular, particularly for its therapeutic gains, simplicity of use and other health and psychological benefits associated with weight bearing through the legs. The information from this study could stimulate useful knowledge that may promote clinically significant FES-supported standing duration.
Morufu Olusola Ibitoye; Nur Azah Hamzaid; Mitsuhiro Hayashibe; Nazirah Hasnan; Glen M. Davis. Restoring prolonged standing via functional electrical stimulation after spinal cord injury: A systematic review of control strategies. Biomedical Signal Processing and Control 2018, 49, 34 -47.
AMA StyleMorufu Olusola Ibitoye, Nur Azah Hamzaid, Mitsuhiro Hayashibe, Nazirah Hasnan, Glen M. Davis. Restoring prolonged standing via functional electrical stimulation after spinal cord injury: A systematic review of control strategies. Biomedical Signal Processing and Control. 2018; 49 ():34-47.
Chicago/Turabian StyleMorufu Olusola Ibitoye; Nur Azah Hamzaid; Mitsuhiro Hayashibe; Nazirah Hasnan; Glen M. Davis. 2018. "Restoring prolonged standing via functional electrical stimulation after spinal cord injury: A systematic review of control strategies." Biomedical Signal Processing and Control 49, no. : 34-47.
Repetitive electrically-evoked muscle contraction leads to accelerated muscle fatigue. This study assessed electrically-evoked fatiguing muscle with changes to mechanomyography root mean square percentage (%RMS-MMG) and tissue saturation index (%TSI) in extensor carpi radialis. Forty healthy volunteers (n=40) performed repetitive electrical-evoked wrist extension to fatigue and results were analyzed pre- and post-fatigue, i.e. 50% power output (%PO) drop. Responses of %PO, %TSI and %RMS-MMG were correlated while the relationships between %RMS-MMG and %TSI were investigated using linear regression. The %TSI for both groups were negatively correlated with declining %PO as the ability of the muscle to take up oxygen became limited due to fatigued muscle. The %RMS-MMG behaved in two different patterns post-fatigue against declining %PO whereby; (i) group A showed positive correlation (%RMS-MMG decreased) throughout the session and (ii) group B demonstrated negative correlation (%RMS-MMG increased) with declining %PO until the end of the session. Regression analysis showed %TSI was inversely proportional to %RMS-MMG during post-fatigue in group A. Small gradients in both groups suggested that %TSI was not sensitive to the changes in %RMS-MMG and they were mutually exclusive. Most correlation and regression changed significantly post-fatigue indicating that after fatigue, the condition of muscle had changed mechanically and physiologically.
Nurul Salwani Mohamad Saadon; Nur Azah Hamzaid; Nazirah Hasnan; Muhammad Afiq Dzulkifli; Glen M. Davis. Electrically evoked wrist extensor muscle fatigue throughout repetitive motion as measured by mechanomyography and near-infrared spectroscopy. Biomedical Engineering / Biomedizinische Technik 2018, 64, 439 -448.
AMA StyleNurul Salwani Mohamad Saadon, Nur Azah Hamzaid, Nazirah Hasnan, Muhammad Afiq Dzulkifli, Glen M. Davis. Electrically evoked wrist extensor muscle fatigue throughout repetitive motion as measured by mechanomyography and near-infrared spectroscopy. Biomedical Engineering / Biomedizinische Technik. 2018; 64 (4):439-448.
Chicago/Turabian StyleNurul Salwani Mohamad Saadon; Nur Azah Hamzaid; Nazirah Hasnan; Muhammad Afiq Dzulkifli; Glen M. Davis. 2018. "Electrically evoked wrist extensor muscle fatigue throughout repetitive motion as measured by mechanomyography and near-infrared spectroscopy." Biomedical Engineering / Biomedizinische Technik 64, no. 4: 439-448.
This study sought to design and deploy a torque monitoring system using an artificial neural network (ANN) with mechanomyography (MMG) for situations where muscle torque cannot be independently quantified. The MMG signals from the quadriceps were used to derive knee torque during prolonged functional electrical stimulation (FES)-assisted isometric knee extensions and during standing in spinal cord injured (SCI) individuals. Three individuals with motor-complete SCI performed FES-evoked isometric quadriceps contractions on a Biodex dynamometer at 30° knee angle and at a fixed stimulation current, until the torque had declined to a minimum required for ANN model development. Two ANN models were developed based on different inputs; Root mean square (RMS) MMG and RMS-Zero crossing (ZC) which were derived from MMG. The performance of the ANN was evaluated by comparing model predicted torque against the actual torque derived from the dynamometer. MMG data from 5 other individuals with SCI who performed FES-evoked standing to fatigue-failure were used to validate the RMS and RMS-ZC ANN models. RMS and RMS-ZC of the MMG obtained from the FES standing experiments were then provided as inputs to the developed ANN models to calculate the predicted torque during the FES-evoked standing. The average correlation between the knee extension-predicted torque and the actual torque outputs were 0.87 ± 0.11 for RMS and 0.84 ± 0.13 for RMS-ZC. The average accuracy was 79 ± 14% for RMS and 86 ± 11% for RMS-ZC. The two models revealed significant trends in torque decrease, both suggesting a critical point around 50% torque drop where there were significant changes observed in RMS and RMS-ZC patterns. Based on these findings, both RMS and RMS-ZC ANN models performed similarly well in predicting FES-evoked knee extension torques in this population. However, interference was observed in the RMS-ZC values at a time around knee buckling. The developed ANN models could be used to estimate muscle torque in real-time, thereby providing safer automated FES control of standing in persons with motor-complete SCI.
Muhammad Afiq Dzulkifli; Nur Azah Hamzaid; Glen M. Davis; Nazirah Hasnan. Neural Network-Based Muscle Torque Estimation Using Mechanomyography During Electrically-Evoked Knee Extension and Standing in Spinal Cord Injury. Frontiers in Neurorobotics 2018, 12, 1 .
AMA StyleMuhammad Afiq Dzulkifli, Nur Azah Hamzaid, Glen M. Davis, Nazirah Hasnan. Neural Network-Based Muscle Torque Estimation Using Mechanomyography During Electrically-Evoked Knee Extension and Standing in Spinal Cord Injury. Frontiers in Neurorobotics. 2018; 12 ():1.
Chicago/Turabian StyleMuhammad Afiq Dzulkifli; Nur Azah Hamzaid; Glen M. Davis; Nazirah Hasnan. 2018. "Neural Network-Based Muscle Torque Estimation Using Mechanomyography During Electrically-Evoked Knee Extension and Standing in Spinal Cord Injury." Frontiers in Neurorobotics 12, no. : 1.
Investigation of muscle fatigue during functional electrical stimulation (FES)-evoked exercise in individuals with spinal cord injury using dynamometry has limited capability to characterize the fatigue state of individual muscles. Mechanomyography has the potential to represent the state of muscle function at the muscle level. This study sought to investigate surface mechanomyographic responses evoked from quadriceps muscles during FES-cycling, and to quantify its changes between pre- and post-fatiguing conditions in individuals with spinal cord injury. Six individuals with chronic motor-complete spinal cord injury performed 30-min of sustained FES-leg cycling exercise on two days to induce muscle fatigue. Each participant performed maximum FES-evoked isometric knee extensions before and after the 30-min cycling to determine pre- and post- extension peak torque concomitant with mechanomyography changes. Similar to extension peak torque, normalized root mean squared (RMS) and mean power frequency (MPF) of the mechanomyography signal significantly differed in muscle activities between pre- and post-FES-cycling for each quadriceps muscle (extension peak torque up to 69%; RMS up to 80%, and MPF up to 19%). Mechanomyographic-RMS showed significant reduction during cycling with acceptable between-days consistency (intra-class correlation coefficients, ICC = 0.51–0.91). The normalized MPF showed a weak association with FES-cycling duration (ICC = 0.08–0.23). During FES-cycling, the mechanomyographic-RMS revealed greater fatigue rate for rectus femoris and greater fatigue resistance for vastus medialis in spinal cord injured individuals. Mechanomyographic-RMS may be a useful tool for examining real time muscle function of specific muscles during FES-evoked cycling in individuals with spinal cord injury.
Anamul Islam; Nur Azah Hamzaid; Morufu Olusola Ibitoye; Nazirah Hasnan; Ahmad Khairi Abdul Wahab; Glen M. Davis. Mechanomyography responses characterize altered muscle function during electrical stimulation-evoked cycling in individuals with spinal cord injury. Clinical Biomechanics 2018, 58, 21 -27.
AMA StyleAnamul Islam, Nur Azah Hamzaid, Morufu Olusola Ibitoye, Nazirah Hasnan, Ahmad Khairi Abdul Wahab, Glen M. Davis. Mechanomyography responses characterize altered muscle function during electrical stimulation-evoked cycling in individuals with spinal cord injury. Clinical Biomechanics. 2018; 58 ():21-27.
Chicago/Turabian StyleAnamul Islam; Nur Azah Hamzaid; Morufu Olusola Ibitoye; Nazirah Hasnan; Ahmad Khairi Abdul Wahab; Glen M. Davis. 2018. "Mechanomyography responses characterize altered muscle function during electrical stimulation-evoked cycling in individuals with spinal cord injury." Clinical Biomechanics 58, no. : 21-27.
Functional Electrical Stimulation (FES) has been widely used as part of physiotherapy for spinal cord injury (SCI) patients. The ability to do sit to stand (STS) manoeuvre is an important and practical indicator of functional independence in SCI individuals. One of the factors that contributes to STS movement is arm support. The objective of this study is to instrument an arm support with pressure sensors, and to analyse the impact of using standing frame during FES-assisted STS movement to the SCI patients’ stability and rate of fatigue throughout multiple STS movements. FlexiForce sensors were used to analyse the force exerted on the frame’s handle. Experiments on STS activity with two SCI subjects were completed in two consecutive days (with and without assistance of FES) in a motion analysis laboratory. The instrumented standing frame (SF) was calibrated via a series of hanging test with ten healthy subjects with different body weights to provide an insight on the weight distribution along the SF. This test demonstrates the instrumented standing frame’s ability to measure the force exerted on the frame with minimum accuracy of 85% to total body weight. Both SCI subjects showed shorter time taken to complete a STS cycle without the assistance of FES. They showed early stage of fatigue with assistance of FES thus longer time taken recorded in performing STS activity. SCI subjects’ centre of force slightly inclined to the right side of the standing frame in both sessions without and with FES to compensate several conditions of lower limb joint contractures.
Musfirah Abd Aziz; Nur Azah Hamzaid. FES Standing: The Effect of Arm Support on Stability and Fatigue During Sit-to-Stand Manoeuvres in SCI Individuals. 8th European Medical and Biological Engineering Conference 2017, 67 -72.
AMA StyleMusfirah Abd Aziz, Nur Azah Hamzaid. FES Standing: The Effect of Arm Support on Stability and Fatigue During Sit-to-Stand Manoeuvres in SCI Individuals. 8th European Medical and Biological Engineering Conference. 2017; ():67-72.
Chicago/Turabian StyleMusfirah Abd Aziz; Nur Azah Hamzaid. 2017. "FES Standing: The Effect of Arm Support on Stability and Fatigue During Sit-to-Stand Manoeuvres in SCI Individuals." 8th European Medical and Biological Engineering Conference , no. : 67-72.
Previous research investigated recumbent cycle power output (PO) from the perspective of knee and hip joint biomechanics. However, ankle-foot biomechanics and, in particular, the effect of ankle-foot orthosis (AFO)-constrained movements on cycle PO has not been widely explored. Therefore, the purpose of this study was to determine whether AFOs of a fixed position (FP) and in dorsi-plantarflexion (DPF)-, dorsiflexion (DF)- and plantarflexion (PF)-constrained movements might influence PO during voluntary recumbent cycling exercises. Twenty-five healthy individuals participated in this study. All underwent 1-min cycling at a fixed cadence for each of the AFOs. The peak and average PO of each condition were analyzed. The peak and average PO were 27.2±12.0 W (range 6–60) and 17.2±9.0 W (range 2–36), respectively, during voluntary cycling. There were no significant differences in the peak PO generated by the AFOs (p=0.083). There were also no significant differences in the average PO generated using different AFOs (p=0.063). There were no significant differences in the changes of the hip and knee joint angles with different AFOs (p=0.974 and p=1.00, respectively). However, there was a significant difference in the changes of the ankle joint angle (p
Puteri N.F. Hamdan; Nur Azah Hamzaid; Juliana Usman; Anamul Islam; Victor S.P. Kean; Ahmad K. Abdul Wahab; Nazirah Hasnan; Glen M. Davis. Variations of ankle-foot orthosis-constrained movements increase ankle range of movement while maintaining power output of recumbent cycling. Biomedical Engineering / Biomedizinische Technik 2017, 63, 691 -697.
AMA StylePuteri N.F. Hamdan, Nur Azah Hamzaid, Juliana Usman, Anamul Islam, Victor S.P. Kean, Ahmad K. Abdul Wahab, Nazirah Hasnan, Glen M. Davis. Variations of ankle-foot orthosis-constrained movements increase ankle range of movement while maintaining power output of recumbent cycling. Biomedical Engineering / Biomedizinische Technik. 2017; 63 (6):691-697.
Chicago/Turabian StylePuteri N.F. Hamdan; Nur Azah Hamzaid; Juliana Usman; Anamul Islam; Victor S.P. Kean; Ahmad K. Abdul Wahab; Nazirah Hasnan; Glen M. Davis. 2017. "Variations of ankle-foot orthosis-constrained movements increase ankle range of movement while maintaining power output of recumbent cycling." Biomedical Engineering / Biomedizinische Technik 63, no. 6: 691-697.
A mechanomyography muscle contraction (MC) sensor, affixed to the skin surface, was used to quantify muscle tension during repetitive functional electrical stimulation (FES)-evoked isometric rectus femoris contractions to fatigue in individuals with spinal cord injury (SCI). Nine persons with motor complete SCI were seated on a commercial muscle dynamometer that quantified peak torque and average torque outputs, while measurements from the MC sensor were simultaneously recorded. MC-sensor-predicted measures of dynamometer torques, including the signal peak (SP) and signal average (SA), were highly associated with isometric knee extension peak torque (SP: r = 0.91, p < 0.0001), and average torque (SA: r = 0.89, p < 0.0001), respectively. Bland-Altman (BA) analyses with Lin’s concordance (ρC) revealed good association between MC-sensor-predicted peak muscle torques (SP; ρC = 0.91) and average muscle torques (SA; ρC = 0.89) with the equivalent dynamometer measures, over a range of FES current amplitudes. The relationship of dynamometer torques and predicted MC torques during repetitive FES-evoked muscle contraction to fatigue were moderately associated (SP: r = 0.80, p < 0.0001; SA: r = 0.77; p < 0.0001), with BA associations between the two devices fair-moderate (SP; ρC = 0.70: SA; ρC = 0.30). These findings demonstrated that a skin-surface muscle mechanomyography sensor was an accurate proxy for electrically-evoked muscle contraction torques when directly measured during isometric dynamometry in individuals with SCI. The novel application of the MC sensor during FES-evoked muscle contractions suggested its possible application for real-world tasks (e.g., prolonged sit-to-stand, stepping,) where muscle forces during fatiguing activities cannot be directly measured.
Nor Zainah Mohamad; Nur Azah Hamzaid; Glen M. Davis; Ahmad Khairi Abdul Wahab; Nazirah Hasnan. Mechanomyography and Torque during FES-Evoked Muscle Contractions to Fatigue in Individuals with Spinal Cord Injury. Sensors 2017, 17, 1627 .
AMA StyleNor Zainah Mohamad, Nur Azah Hamzaid, Glen M. Davis, Ahmad Khairi Abdul Wahab, Nazirah Hasnan. Mechanomyography and Torque during FES-Evoked Muscle Contractions to Fatigue in Individuals with Spinal Cord Injury. Sensors. 2017; 17 (7):1627.
Chicago/Turabian StyleNor Zainah Mohamad; Nur Azah Hamzaid; Glen M. Davis; Ahmad Khairi Abdul Wahab; Nazirah Hasnan. 2017. "Mechanomyography and Torque during FES-Evoked Muscle Contractions to Fatigue in Individuals with Spinal Cord Injury." Sensors 17, no. 7: 1627.
The walking mechanism of a prosthetic leg user is a tightly coordinated movement of several joints and limb segments. The interaction among the voluntary and mechanical joints and segments requires particular biomechanical insight. This study aims to analyze the inter-relationship between amputees’ voluntary and mechanical coupled leg joints variables using cyclograms. From this analysis, the critical gait parameters in each gait phase were determined and analysed if they contribute to a better powered prosthetic knee control design. To develop the cyclogram model, twenty healthy able-bodied subjects and twenty-five prosthesis and orthosis users (10 transtibial amputees, 5 transfemoral amputees and 10 different pathological profiles of orthosis users) walked at their comfortable speed in a 3D motion analysis lab setting. The gait parameters (i.e.angle, moment and power for ankle, knee and hip joints) were coupled to form thirty-six cyclograms relationship. The model was validated by quantifying the gait disparities by analyzing each cyclograms pairs using feed-forward neural network. Subsequently, the cyclogram pairs that contributed to the highest gait disparity of each gait phase were manipulated by replacing it with normal values and re-analyzed. The manipulated cyclograms relationship that showed highest improvement in terms of gait disparity calculation suggested that they are the most dominant parameters in powered-knee control. In case of transfemoral amputee, it was identified using this approach that at each gait sub-phase, the knee variables most responsible for closest to normal walking were: knee power during loading response and mid-stance, knee moment and angle during terminal stance phase, knee angle and power during pre-swing, knee angle at initial swing, and knee power at terminal swing. No variable was dominant during mid-swing phase implying natural pendulum effect of the lower limb between the initial and terminal swing phases. The outcome of this cyclogram approach proposed an insight into the method of determining the causal effect of manipulating a particular joint’s mechanical properties towards the joint behavior in an amputee’s gait by determining the curve closeness, C, of the modified cyclogram curve to the normal conventional curve, to enable quantitative judgment of the effect of changing a particular parameter to the gait.
Farahiyah Jasni; Nur Azah Hamzaid; Nor Elleeiana Mohd Syah; Tze Y. Chung; Noor Azuan Abu Osman. Analysis of Interrelationships among Voluntary and Prosthetic Leg Joint Parameters Using Cyclograms. Frontiers in Neuroscience 2017, 11, 230 .
AMA StyleFarahiyah Jasni, Nur Azah Hamzaid, Nor Elleeiana Mohd Syah, Tze Y. Chung, Noor Azuan Abu Osman. Analysis of Interrelationships among Voluntary and Prosthetic Leg Joint Parameters Using Cyclograms. Frontiers in Neuroscience. 2017; 11 ():230.
Chicago/Turabian StyleFarahiyah Jasni; Nur Azah Hamzaid; Nor Elleeiana Mohd Syah; Tze Y. Chung; Noor Azuan Abu Osman. 2017. "Analysis of Interrelationships among Voluntary and Prosthetic Leg Joint Parameters Using Cyclograms." Frontiers in Neuroscience 11, no. : 230.
Previous research has investigated functional electrical stimulation (FES) cycle force and power output (PO) from the perspective of knee and hip joint biomechanics. However, ankle-foot biomechanics and, in particular, the effect of releasing the ankle joint on cycle pedal force and PO during FES cycling in paraplegics has not been widely explored. Therefore, the purpose of this study is to determine whether releasing the ankle joint might influence the peak pedal force and PO during FES cycling in paraplegics. Three complete paraplegics (C7 – T4) participated in this study. All participants performed two sessions of cycling in randomized order. Session 1 and 2 required the participants to cycle in fixed and free-ankle setup, respectively. For each session, the participants performed two sub-sessions of FES cycling. During sub-session 1, the muscles stimulated were upper leg muscles [quadriceps (QUAD) and hamstrings (HAM)]. In sub-session 2, both upper and lower leg muscles [QUAD, HAM, tibialis anterior (TA) and triceps surae (TS)] were stimulated. The normalized peak pedal force and PO of each condition were analyzed. Overall, the normalized peak pedal force and PO during fixed-ankle FES cycling is higher than free-ankle FES cycling. Stimulation of both upper and lower leg muscles during FES cycling provided higher normalized peak pedal force and PO compared to the upper leg muscles stimulated alone. The present pilot study revealed that fixed-ankle FES cycling produced higher normalized peak pedal force and PO than free-ankle FES cycling. Future work involving more paraplegics will be investigated. This finding might serve as a reference for future rehabilitative cycling protocols.
P. N. F. Hamdan; K. Teo; N. A. Hamzaid; J. Usman; R. Razman. The Effects of Releasing Ankle Joint on Pedal Force and Power Production during Electrically Stimulated Cycling in Paraplegic Individuals: A Pilot Study. VI Latin American Congress on Biomedical Engineering CLAIB 2014, Paraná, Argentina 29, 30 & 31 October 2014 2017, 129 -132.
AMA StyleP. N. F. Hamdan, K. Teo, N. A. Hamzaid, J. Usman, R. Razman. The Effects of Releasing Ankle Joint on Pedal Force and Power Production during Electrically Stimulated Cycling in Paraplegic Individuals: A Pilot Study. VI Latin American Congress on Biomedical Engineering CLAIB 2014, Paraná, Argentina 29, 30 & 31 October 2014. 2017; ():129-132.
Chicago/Turabian StyleP. N. F. Hamdan; K. Teo; N. A. Hamzaid; J. Usman; R. Razman. 2017. "The Effects of Releasing Ankle Joint on Pedal Force and Power Production during Electrically Stimulated Cycling in Paraplegic Individuals: A Pilot Study." VI Latin American Congress on Biomedical Engineering CLAIB 2014, Paraná, Argentina 29, 30 & 31 October 2014 , no. : 129-132.