IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 38, NO. 7.
JULY I991
Feedback Control of Coronal Plane Hip Angle in
Paraplegic Subjects Using Functional
Neuromuscular Stimulation
James J. Abbas, Student Member, IEEE, and Howard J. Chizeck, Senior Member, IEEE
Abstract-This paper reports on an investigation of feedback
control of coronal plane posture in paraplegic subjects who
stand using functional neuromuscular stimulation (FNS). A
feedback control system directed at regulating coronal plane
hip angle in neutral position was designed, implemented, and
evaluated in two paraplegic subjects. The control system in-
cluded sensor mounting and signal processing techniques, a
two-stage feedback controller, stimulation hardware, and a set
of percutaneous intramuscular electrodes. The feedback con-
troller consisted of two-stages in cascade: a modified discrete-
time proportional-integral-derivative (PID) stage and a nonlin-
ear single-input, multiple-output stage to determine the stim-
ulation to be sent to several muscles. The focus of this work
was on evaluating the performance of the feedback controller
by comparing the response of the feedback-eontrolled system
to that of an open-loop stimulation system. In an evaluation
based on temporal response characteristics the controlled sys-
tem exhibited a 41% reduction in root-meamsquared (rms) er-
ror (where error is defined as the deviation from the desired
angle), a 52% reduction in steady-state error, and a 22% re-
duction in hip compliance. In addition, the feedback-controlled
system exhibited significant reductions in variability of these
measures on several days. These results demonstrate the ability
of the feedback controller to improve the temporal response
characteristics of the FNS control system.
INTRODUCTION
AND BACKGROUND
I N recent years, researchers have investigated the use of
functional neuromuscular stimulation (FNS) as a tool
in the rehabilitation of patients with spinal cord injury,
stroke, and other neurological disorders. This technique
employs electrical pulses to activate paralyzed muscle for
the purpose of achieving functional movements. It has
been used to restore or enhance lower and upper extremity
functional movements as well as a variety of other phys-
iological functions [9], [ 151, [22], [28]. For individuals
with neurological impairments affecting the lower extrem-
Manuscript received July 20, 1989; revised January 29, 1991. This work
was supported by the Rehabilitation Research and Development Service of
the Department of Veterans Affairs.
J . J. Abbas is with the Department of Biomedical Engineering, Case
Western Reserve University, Cleveland, OH 44106 and the Motion Study
Laboratory, Cleveland Veterans Affairs Medical Center, Cleveland, OH
44106.
H. J . Chizeck is with the Department of Systems Engineering, Case
Westem Reserve University, CLeveland, OH 44106 and the Motion Study
Laboratory, Cleveland Veterans Affairs Medical Center, Cleveland, OH
44106.
IEEE Log Number 9100509.
00 18-9294/9 I /0700-06887$01.00 0 1991 IEEE
687
ity, FNS has been used in the laboratory for standing,
walking and stair climbing. Although feasibility has been
demonstrated [20], [22], [24], [25], [32], current lower
extremity FNS technology is deficient in ways which have
delayed and limited its clinical use. In general, FNS sys-
tems need to be easier to use, more reliable, and safer;
they also must provide a greater level of function to the
user. The use of feedback control in lower extremity FNS
systems has been proposed as a means to overcome these
limitations [9], [30].
Various stimulation controllers have been developed
and tested either in computer simulation, in animal ex-
periments, or in human experiments. These control sys-
tems modulate stimulus parameters in order to regulate
one or more system outputs (e.g., joint angle or angular
velocity, joint torque, contact force). Control systems for
FNS act on sets of nonlinear actuators. Controllers con-
sisting of two stages in cascade have often been used: one
stage to control the system dynamics and a second to ef-
fect co-stimulation and compensate for nonlinearities [26].
Both fixed-parameter feedback controllers [lo], [29],
[30], [33] and adaptive controllers [3], [6] have been in-
vestigated. Proportional [30], PID [ 131, pole-placement
[ 101, and adaptive [6] controllers have been used for the
first stage.
Discrete-time proportional-integral-derivative (PID)
controllers have been utilized during stance at the knee
[5], [12] and at the knee and ankle [ l l ] . These earlier
attempts demonstrated disturbance resistance and the abil-
ity to stabilize a particular joint, but did not directly result
in improved stance for the user. Upper body movements
during stance caused unwanted motion at the hip and trunk
in both the coronal and sagittal planes. This suggested
that feedback control of the hip and trunk was also needed.
Initial attempts at using PID control of coronal plane
hip angle were made on subjects who wore braces which
restricted all motion at the ankle, knee, hip, and trunk
except for coronal plane motion at the hip [ 131. Feedback
of coronal plane hip angle was provided by goniometers
mounted on the braces. These preliminary experiments
demonstrated the feasibility of the approach [ 131, but the
practicality of this implementation was limited by the ex-
tensive bracing used. Comparative trials with and without
feedback control were not performed.
688 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING. VOL. 38. NO. 7. JULY 1991

One purpose of the work presented here was to imple-

ment the coronal plane hip angle controller without the
use of such extensive bracing, thus making the system
more suitable for eventual clinical use. A second purpose
was to compare the response of the closed-loop system
with that of the open-loop system, based on standard con-
trol system performance criteria. The coronal plane hip
angle subsystem controller is intended to be a component
of a more general postural and locomotor control system
[9] currently being developed at the Cleveland Veterans
Affairs Medical Center (CVAMC) as part of a lower ex-
tremity neural prosthesis [25]. The application of this
controller in isolation is not expected to restore normal
standing function or to provide a level of function greater
than that of other rehabilitative techniques (such as con- (b)
ventional or advanced bracing). This work explores the Fig. 1 . (a) Model of human posture in the sagittal plane. The four seg-
use of feedback control as a tool for providing improve- ments are a foot, shank, thigh, and head-arms-trunk (HAT). (b) Model of
human posture in the coronal plane. The four segments are two legs, a
ments to a lower extremity FNS system. This work was pelvis and HAT. With the assumption that both feet are on the ground and
not intended to compare the performance of the FNS con- the legs are parallel, the hip angle can be defined as the angle that the thigh
trol system to either that of neurologically intact individ- makes with the vertical. Note that the single inverted pendulum model as-
sumes that the HAT segment remains vertical.
uals or that of other rehabilitative techniques; such an
evaluation should await further developments of FNS
technology. external bracing. Barring the application of auxiliary sag-
ittal plane forces, motion in this plane would be minimal.
Coronal plane posture has most often been described
BIOMECHANICAL
SYSTEMDESCRIPTION using a four-link model [Fig. l(b)] consisting of two legs,
pelvis, and the HAT [16]. The equations describing the
The system to be controlled involves complex interac-
motion of this general four-link system can be simplified
tions among several joints in a multi-joint skeleton. Each
by imposing certain constraints. If both feet are assumed
of these joints may have several degrees of freedom and
to be on the ground and the legs are assumed to be par-
certain constraints on its motion. The complexity of the
allel, the equations reduce to those of a double inverted
system poses a formidable control problem, but the sys-
pendulum. Furthermore, activation of the trunk extensor
tem can be described in a simplified manner by a set of
muscles stiffens the trunk. Under these conditions, the
two planar models. This approach is limited in its ability
HAT segment can be assumed to remain vertical; the set
to describe motions which are not confined to either plane,
of equations then reduces to those of a single inverted
but greatly simplifies the description and thus assists in
pendulum. That is, motion in the coronal plane is consid-
developing a control strategy. In this study, a sagittal
ered to occur only at the hip. The hip angle is defined as
plane model was used to devise a method of maintaining
the angle formed by lines of the femurs, which are parallel
upright sagittal plane posture, and a coronal plane model
to each other, and the vertical. The joint is characterized
was used in the development of the hip controller.
by a passive stiffness; motion is generated by muscle
In the sagittal plane, a four-link model [Fig. l(a)] con-
stimulation. The control of this simplified system has been
sisting of a foot, shank, thigh, and head-arms-trunk
previously considered in simulation studies [ 161 and in
(HAT) has most often been used to study human stance
preliminary experimental trials [13]. In this study, co-
[4], [17], [19], [21]. Extensor moments at the hip or knee,
ronal plane hip angle was monitored and controlled by
whether provided passively by the posture or actively by
adjusting the level of stimulation sent to the abductor-
muscle forces, are countered by ligaments to restrict mo-
adductor pairs.
tion at either joint in full extension. Passive torques at the
ankle are relatively insignificant within the range of mo-
tion seen during normal stance. A fixed-ankle, ankle-foot- CONTROL SYSTEMSTRUCTURE
orthosis (AFO) can be used to restrict both plantar flexion In this work, the first stage of the two-stage FNS con-
and dorsiflexion at the ankle. In addition, when the weight troller [Fig. 2(a)] was a modified discrete-time PID al-
of the body is positioned such that it exerts a dorsiflexion gorithm. It consisted of a weighted linear combination of
moment at the ankle, the counteracting plantar flexion three terms; the error signal, a weighted sum of past er-
moment provided by the orthosis acts to provide an ex- rors (an integral approximation), and the difference be-
tension moment at the knee. Thus, sagittal plane motion tween the last two error measurements (a derivative ap-
of the four-link body is restricted by a combination of proximation). Thus, the control signal varied with the
passive moments provided by the postural configuration, error signal, with the accumulation of past errors and with
muscular activation of the hip and knee extensors, and the rate of change in error. To apply this type of control-
ABBAS A N D CHIZECK: FEEDBACK CONTROL OF HIP ANGLE IN PARAPLEGIC SUBJECTS 689

TABLE I
MODIFIED
DIGITAL PID CONTROLLER EQUATIONS

This implementation of a PID controller uses joint angle 8(r) to calculate

its output c(t):
PW I c'(r) K,,* e(t) + K, * ff * esum ( t ) + K.,* ( e @ )- e(( - I))/T
if (c'(t) > 1.05 * cmax) c(t) 1.05 * cmax
+

else if (c'(f)< - 1.05 * cmax) r(t) - 1.05 * cmax

+

else c(t) + c'(t)

(b)
Fig. 2. (a) Two stage subsystem controller. A digital implementation of a
PID controller in cascade with a pulsewidth map. (b) An example of a
pulsewidth map. The output of the first stage, c(r), was used to determine
the pulsewidth (PW) sent to the various muscles being driven by the con-
troller. In the figure, r, are threshold pulsewidth values and s, are saturation
pulsewidth values, et, and cs, are the controller output values which would
result in threshold or saturation pulsewidths, respectively. Within a region
near the set point both muscle groups are stimulated. As c(t) moves away
from zero the stimulation sent to one muscle group is increased, while
stimulation sent to its antagonist is decreased, then eventually turned off.
On each experiment day, the initial settings of the parameters was taken
as:
CSI = cs2 = loo, csz = cs4 = - loo,
Ctl = -20, Ctz = -30, Ct3 = 20, = 30,
f, = threshold pulsewidth for the ith electrode,
s, = saturation pulsewidth for the ith electrode,
ler, a good model of the system dynamics is not needed;
only knowledge of the direction in which the system re-
sponds to an input and the input-output time delay is re-
quired. PID controllers are known to be relatively robust
and insensitive to model uncertainties. One concern is in-
tegrator windup: if the error signal is continually of the
same sign, the integral term would grow, thus compro-
mising the ability of the controller to correct for setpoint
changes or disturbances that change the error sign. To
avoid this problem, the integral term is scaled by a vari-
able forgetting factor and the accumulated term was
clipped at a maximum of 105% of the value that would
fully activate the muscles. The equations for the PID con-
troller used in this work are shown in Table I.
The second stage of the controller has been designed to
compensate for the nonlinearity of the actuators and to use
the output of the first stage to determine the stimulation
sent to several muscles. As shown in Fig. 2(b), a piece-
wise linear mapping has been used to describe the rela-
tionship between the output of the first controller stage
c(t) and the pulsewidth (PW) sent to each of the muscles.
Defining these curves such that both sets of an agonist-
antagonist pair were stimulated for small values of c(t)
results in co-stimulation [13], [26].This can serve to in-
crease the stiffness at the joint and diminish the effect of
the threshold nonlinearity. Note that this mapping makes
no attempt to perfectly invert the recruitment character-
istic (the relationship between PW and force), or to ac-
count for any time variations in the system.
where
e(r) = 8" - 8(r)
esum ( t ) ff * esum ( t
+ - 1) + e(t) * T
8" is the setpoint
T is the sampling period
K,,. K,,K,, are arbitrary constants
ff is a forgetting factor, the value o f which depends on the
magnitude of the error signal: for errors > 20 pma, ff =
0.95; for errors < 20 pma, ff = 0.99
cmax is the value of controller output which would saturate the
actuators
EXPERIMENTAL
METHODS
Control System Hardware and Sofware
The controller software [2] was designed to implement
bi-level control systems of the form described in [9]. The
software allows for the specification of various system
states, the events which mark state transitions, and the set
of subsystem controllers to be active. Several subsystem
controller types are available for use in any of the speci-
fied states. One of these is a two-stage PID as described
above. In this bi-level structure, feedback signals can be
used by the upper level controller to trigger state transi-
tions, or by the subsystem controllers to determine the
stimulation parameters. In addition to performing the con-
trol functions, the software also allows for sampling and
storage of up to 32 analog input channels.
A block diagram of the control system hardware and
software is given in Fig. 3. The feedback controller has
been implemented on a MicroVax I1 laboratory minicom-
puter (Digital Equipment Corp.). It has been designed and
built around the open-loop stimulation system described
in [7], which is based on a V40 microprocessor (NEC).
Communication between the two processors is executed
via a dual-port RAM (DPR). The stimulator is capable of
providing biphasic, asymmetrical, balanced-charge, cur-
rent regulated (20 mA) pulses to a maximum of 48 elec-
trodes. Pulses are delivered to each of the channels in a
sequential manner. Sequences of pulsewidth values (0-
255 p s ) and stimulus period values (0-255 ms) for each .
of the channels are specified in the software.
For operation of the open-loop system [7], stimulation
sequences are first generated on the VAX and transferred
via the DPR to RAM while the stimulator is off-line. The
subject then uses the command processor via a finger
switch mounted on a ring to control the stimulator. It reads
the stored stimulation pulse parameters from RAM (or
from EPROM) and delivers the appropriate stimulation to
690 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING. VOL. 38. NO. 7. JULY 1991

Wmaa

Fig. 3. Feedback control system implementation. This diagram illustrates the various components o f the feedback control sys-
tem and their interaction; functional units are enclosed in solid line boxes and physical devices are indicated by the shaded
boxes. The feedback controller calculations are performed by a MicroVAX I1 laboratory minicomputer (DEC). The stimulator
and command processor components of the system are contained in a V40 microprocessor (NEC) based unit. Communication
between the feedback controller and the stimulator/command processor is executed via a dual-port RAM (DPR). Note that the
open-loop control system utilizes only the V40 and the EPROM components of the system.

the muscles. The system-to-patient interface displays sys-
tem status information and menu selections for the user.
In the closed-loop system, the stimulus phase parame-
ters are read from tables on the DPR, rather than from
RAM. The VAX-based feedback controller generates the
stimulation parameters based on sensor measurements. It
then sends stimulation parameters to the stimulator via the
DPR in real-time. Also, real-time communication be-
tween the V40 and the VAX via the message board of the
DPR is enabled to allow for upper level control actions,
such as switching between control modes.
Sensors and Signal Processing
The liquid-metal strain gage (Whitney Gage, Park
Medical Electronics) consists of a silastic tube (outer di-
ameter = 0.04 in) filled with liquid mercury. As the tube
is elongated, the diameter of the liquid-metal capillary is
reduced and its length increased, resulting in an increase
in electrical resistance. These gages can be used in a stan-
dard modification of a Wheatstone bridge circuit (as typ-
ically used with low resistance strain gages) to obtain a
voltage output. In static tests the gages have been shown
to generate outputs linearly proportional to strain up to
levels of 40%; in dynamic tests they have been shown to
be frequency-independent with no phase-shift up to 50 Hz
[8]. The sensors can be easily mounted on the skin using
Tegaderm" (3M), a stretchable medical adhesive dress-
ing. The size, shape, and elasticity of the sensors are such
that they are nonrestricting and cosmetically acceptable.
There are several examples of biomedical applications of
these gages [31].
The accuracy of these sensors is compromised by sev-
eral factors. When mounted on the skin, they directly
measure skin stretch, not joint angle. Also, as motion at
the joint is transduced through the skin, spatially-distrib-
uted noise is added and the signal is filtered. Comparison
of measurements of skin stretch at locations about the joint
center of rotation with measurements of joint angle ob-
tained using a strobe photographic technique exhibited a
velocity-dependent hystersis [ 11. The viscoelastic prop-
erties bf skin which could be responsible for this observed
hysteresis have been documented elsewhere [23].
A mounting and signal processing procedure was de-
veloped [Fig. 4(a)] to measure the coronal plane hip angle
while the subject is standing with both feet touching the
ground. A sensor pair was mounted on each side of the
frontal aspect of the pelvis such that the line formed by
the sensor was parallel to the femur and passes just lateral
to the anterior superior iliac spine (ASIS). This mounting
location was adequate, but not necessarily optimal; the
effect of different mounting locations was not exhaus-
tively explored. Using circuitry and processing for the set
of sensor signals [Fig. 4(b)], the accuracy of the mea-
surement was improved to within 3.2". This noisy mea-
surement was adequate, however, for contro1,purposes and
for discerning the differences between the two control
strategies compared in this study, as is demonstrated be-
low.
Subject Description-Electrodes and Muscles
The evaluation of the coronal plane hip controller was
performed on two adult male subjects with complete tho-
racic-level lesions of the spinal cord. The subjects are
long-term participants in the lower extremity FNS re-
search and development project at the Motion Study Lab-
oratory at the CVAMC [24]. One subject (CG), level T7,
was 32-years-old, three years post-injury , and had been
in the program for seven months. The other subject (RL),
level T9, was 42-years-old, nine years post-injury , and
had been in the program for four years.
As a part of their participation in the research program,
both subjects were equipped with a set of functioning per-
cutaneous, intramuscular (IM) electrodes implanted in
several muscles of the lower extremities. The electrodes
were made from 76 pm 10-strand, stainless-steel, Teflon-
coated wire; with each strand 25 pm in diameter. Details
of the electrode design and implantation procedure was
given in [24]. In this study, a subset of those electrodes
was used for muscular activation. In particular, IM elec-
trodes were used bilaterally for activation of the vasti of
quadriceps for knee extension, gluteus maximus for hip
extension, gluteus medius for hip abduction, and the pos-
terior portion of adductor magnus for hip adduction-hip
extension. To supplement the set of percutaneous elec-
ABBAS A N D CHIZECK: FEEDBACK CONTROL OF HIP ANGLE IN PARAPLEGIC SUBJECTS 69 I

I I

Fig. 4. (a) Four stages of sensor signal processing. First, a coordinate transformation converts measurements of skin stretch to
joint angles. This was done by differentially mounting pairs of sensors about the joint center. Second, spatially distributed noise
was reduced by averaging the outputs of several pairs of sensors. Third. high-frequency noise was reduced by smoothing.
Finally, the velocity-dependent hysteresis was reduced by the addition of a derivative-dependent term. (b) Sensor circuitry and
processing for estimating joint angle. The two sensors on the left side (R1 and R2) were placed in series in one arm of a
Wheatstone bridge (also in series with a fixed resistance), and the two on the right (R3 and R4) were placed in series in the other
arm. The coordinate transformation and spatial averaging were done in the circuitry. The outputs of the bridge were differentially
amplified (IOOOX). low-pass filtered ( A = 25 Hz).and sampled at a rate of 50 Hz.The signal was then smoothed using a five-
point rectangular window ( J = 6 Hz),the difference approximation to the derivative was calculated, scaled, and added to the
smoothed signal.

trodes, surface electrodes placed on the lower back were disturboncc

used to activate erector spinae for trunk extension. In some ext hip 0%
O Loddd system

ztL*2anqt
cases, surface electrodes placed on the posterior aspect of
the thigh were used to activate hamstrings for additional
diitubonce
hip extension. a
-fix!

Systems to be Evaluated
PW mop
The objective of the coronal plane hip controller was to
maintain neutral upright hip angle position in the coronal Fig. 5 . Diagrams of the OPen-looP (OL)and closed-loop (CL)control SYs-
tem compared in this study.
plane. A set of experiments was designed to compare its
performance with the response of an open-loop stimula-
tion system. Block diagram representations of the systems
tested are given in Fig. 5 . The first system (OL) uses open-
loop stimulation of extensors at the knee, hip, and trunk,
and of hip abductors and adductors. The second system
(CL) adds the two-stage .subsystem controller to control
coronal plane hip angle. Note that the OL system was
equivalent to the CL system with the feedback loop cut.
That is, the OL system utilized stimulation levels for all
muscles that were the same as those of the CL system
under a condition of zero error. When using either the OL
or CL system, the subject stood with his hands on an in-
strumented horizontal bar for auxiliary support.

Application of the Disturbance
The two controllers were evaluated by comparing their
performance in maintaining upright coronal plane posture
as the subject stood wiFh both feet on the ground and with
both hands on a horizontal support bar. Disturbances were
applied in the form of ap impulse-like force which moved
the pelvis laterally, thus causing the subject to bend in the
coronal plane at the -hip. Application of the disturbance
was done such that the applied force was measurable and
the region of application was restricted to areas of &e skin
Fig. 6. Sketch of experimental setup illustrating the subject and instru-
.mentation used in the experiments.
that would not corrupt the skin stretch sensor measure-
ments. A rectangular frame (24 X 15 in) made of light-
weight aluminum was placed around the subject's waist
(Fig. 6 ) . The frame was held in place by two bolts, each
of which passed through the frame on either side and ter-
minated at a pad which was placed on the lateral aspect
of the pelvis just below the iliac spine. With proper place-
692 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING. VOL. 38, NO. 7. JULY 1991
ment of the pads, the disturbance force was applied in the
region of the bony landmark, thus limiting the deforma-
tion of the skin to a small area. The disturbance was ap-
plied by tugging on a rope attached to one side of the
aluminum frame. Although this type of disturbance is not
perfectly repeatable, the applied disturbance force was
measured using a load cell (Model 3167, Lebow Assoc.
Inc.) placed in series with the rope (Fig. 6).
Data Collection
For the purposes of evaluation, the joint angle data was
supplemented with data collected from other laboratory
instruments. Force platforms (model OR6-5- 1 , Advanced
Medical Technology, Inc .) were used to monitor the
forces acting at the subjects feet. The output of the load
cell was recorded to measure the disturbance forces ap-
plied to the pelvis. Video records of both the frontal and
side views were kept to allow visual review of the exper-
iments. The subject stood with his hands on a horizontal
bar which was sqpported by two instrumented vertical
posts [18] (Fig. 6). The measurements obtained from these
vertical support posts do not provide measures of the
forces acting on each hand; they do provide the informa-
tion needed to determine the components of the moment
exerted at the hip by the hands. With the use of the co-
ronal plane model of the system (Fig. l), it can be shown
that the coronal plane hip moment due to the action of the
hands is the weighted sum of two terms: the sum of the
coronal plane forces measured on the support posts
(Mhh,c),and the difference between the vertical plane
forces measured on the support posts (Mhh,,,). Further de-
tails are given in Table 11.
Controller Tuning
The controller was tuned by adjusting the PID param-
eters and the parameters of the pulsewidth map. A two-
step tuning procedure was used: working ranges for pa-
rameters of both stages were determined in preliminary
experiments; then minor adjustments were made as nec-
essary.
The PW map was first set so that the full range of ac-
tivation of all muscles would be utilized over the range of
controller outputs c(r) = -100 to 100. For small con-
troller outputs (-30 < c(t) < 30), both muscle groups
would be activated. For large controller outputs, only one
muscle group would be activated. The values for PW
thresholds and saturation were obtained from laboratory
records based on biweekly muscle tests. Example values
of the initial settings are presented in Fig. 2(b). Over the
course of the experiments, certain parameters of the PW
map were adjusted as necessary. For example, when a
consistent offset was noticed, the slope of either muscle
group was adjusted to alter the levels of activation near
the setpoint. It should be noted that the structure and tun-
ing of the PW maps were ad hoc, and were by no means
optimal.
The PID parameters were also tuned in a two-step pro-
TABLE I1
DESCRIPTION
OF AUXILIARY
SUPPORT BARMEASUREMENTS
A static, planar double inverted pendulum model with arms added as
rigid segments was used to study the moments acting at the hip due to the
hands. Assuming that any deviation from upright does not affect the
moment arm significantly, the following equations describe the moment
at the hip due to the hands (Mhh), the sum of the forces acting on the
horizontal bar in the coronal and vertical directions (Fhh.,.
Fhh.;),and the
sum of the moments about right support point of the horizontal bar (MI):
Mhh == (FLX + FRx) * /I + (FLZ + FRZ) * w/2
Fhb., Fix + F2x + FLX+ FRX= 0
Fhh.; = FIZ+ F2z + FLZ+ FRZ= 0
MI = -Fzz * (2d + S) - FLZ * (d + S) - FRZ * (d) = 0
where
FR, FL are the forces acting on the horizontal bar at the right and left
hands,
F,, F2 are the forces measured at support points 1, 2 of the horizontal
bar,
h, w are the height and weight of the HAT segment,
s is the distance between the two hands,
d is the distance from a hand to the nearest support bar (assumed
to be the same for each hand),
and subscripts x, 2, on forces indicate coronal and vertical components,
respectively, with positive x defined to the subjects left and positive z
downward. Solving for M h h in terms of the measured forces on the
horizontal bar yields
Mht, = (FIX+ F ~ x*) ( - h ) + (Fzz - FIT.)* ( - ( d w /S) - (w/2))
cedure. Initial tuning was performed using a standard
Zeigler-Nichols method [ 141. This standard procedure of
control engineering uses the gain at which a proportional
controller results in sustained oscillations (which is found
experimentally) to determine the PID parameters. Sec-
ondary tuning based on measures of rms error and visual
observation was performed in the course of the experi-
ment. For example, when the controllers response ap-
peared sluggish (i.e., the response was comparable to
OL), the three controller gains were increased; when a
steady-state error was observed, only the integral gain was
increased; when a large overshoot was observed (e.g.,
> 25 % peak), only the derivative gain was increased. This
retuning was performed for the purposes of the evalua-
tion, but it is impractical for everyday use. As a practical
matter, automated rule-based or adaptive tuning proce-
dures may be required in order to implement this feedback
controller outside of a laboratory setting.
Experimental Protocol
Experiments were done on five days: two days with
subject no. 1, three days with subject no. 2. At the begin-
ning of each experiment day, the sensor gains were de-
termined using a static two-port calibration procedure.
The sensors were calibrated in units of percent-maximum
abduction (pma). With the subject standing erect, the pel-
vis was pushed to the right and the trunk bent to the left,
thus providing a sensor reading for 100%abduction to the
left. Then the pelvis and trunk were moved in the opposite
direction and a sensor reading for - 100%abduction was
taken. These readings were used to calculate the sensor
 ~

ABBAS A N D CHIZECK: FEEDBACK CONTROL OF HIP ANGLE IN PARAPLEGIC SUBJECTS 693

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bod
2
,J
2.5

hi0 onole vortlcal suooort torcoo

Fig. 7. Example traces showing the applied disturbance, the resulting hip angle trajectories, and the two components of the
Support force measurements. The top plot displays example disturbance force tracings for an OL (solid line) and a CL (dashed
line) trial. The observed difference in the traces was due to the trial-to-trial variation in the application of the disturbances; in
general, there was no significant difference between the OL and CL disturbances. The second plot displays the resulting coronal
plane hip angle trajectories for each system. While the observed reduction in peak angular excursion and increase in natural
frequency were typical, the improvement in steady-state error was, in general, greater than that which was observed in the
+
example. The third and fourth plots display the coronal plane support forces ( F , x F z x ) and the difference in the vertical plane
support forces (Flz - Fzz) measured on the horizontal support bar. Also note here that the observed differences in the traces
were due to trial-to-trial variations; there were no consistently significant differences between the support force measurements
of the OL and CL trials.

gain, which was then used throughout that day. To ac-
count for any changes in sensor offset, the sensor offset
was recalibrated at the beginning of each run with the sub-
ject standing. For the subjects used in this study, 100%
abduction corresponded to approximately 20".
Each day of experimentatiod consisted of four to eight
runs. In a run, either the OL or the CL system was tested;
the order in which the systems were tested was varied and
the subject was not aware of which system was being
tested. Each run lasted approximately three minutes with
six to eight minutes of rest between runs. In each run the
subject first stood up using prespecified stimulation se-
quences. The frame used for application of the distur-
bance was then secured about his waist and his feet placed
on markers Axed on the force plates. Upon a trigger from
the subject, either CL or OL operation was initiated. If
the CL system was being tested, the real-time controller
was then activated. The subject was instructed to look
straight ahead and to use his arms as little as possible for
support. Disturbances were then applied repeatedly (every
5-10 s) for the duration of the run. A trial was defined as
a 3-s segment of data which was triggered by the appli-
cation of the disturbance. The results reported below were
based on 448 such trials over five days. When the subject
signalled the termination of a run the feedback controller,
if active, was deactivated. A fixed level of stimulation to
the extensors was maintained while the frame was re-
moved; the subject then sat down using pre-specified
stimulation sequences.
Temporal Response Measures
Sample tracings of input disturbance force, hip angle
trajectory, and auxiliary support forces for an OL and a
CL trial are given in Fig. 7. Two different types of quan-
tities were calculated for each trial. First, three pei$or-
mance measures were used to compare the responses of
the two control systems: rms error, steady-state error and
compliance. The error was defined as the deviation from
the desired hip angle (0'). The root-mean-squared ( h S )
error provided an overall measure of system output track-
ing. This has often been used as the primary measure of
performance for FNS control systems, as well as other
types of control systems. Steady-state error was calcu-
lated as the mean value of hip angle over the last half-
second of the trial. The ratio of initial peak angular ex-
cursion of the hip to the peak disturbance force was used
as a measure of compliance.
Secondly, four other response attributes were calcu-
lated, each with respect to the steady-state value for that
trial (Fig. 8). Rms-wrt-ss was calculated as the square
root of the mean squared deviation from the steady-state
value. Overshoot, return time, and setting time were cal-
culated as described in Fig. 8. Together, they characterize
the transient response of the system.
RESU LTS
Pei$ormance Measures
The purpose of the evaluation was to compare the re-
sponse of the CL system with that of the OL system. The
first objective was to determine if, on any given day, the
action of the controller resulted in significant changes in
the performance measures. For each trial, the values of
each of the measures were calculated; then the values ob-
tained on each day were grouped by controller type. The
data for each of the measures for the OL and the CL
694 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 38. NO. 7. JULY 1991

TABLE 111
COMPARISON OF OL AND CL SYSTEM PERFORMANCE A N D ATTRIBUTES

experiment day 1 2 3 4 5
subject # I 1 2 2 2
# OL trials 12 26 21 23 69
# CL trials 38 34 60 56 43
Performance measures
r m s error X X X X X
S . S . error X X X X X
compliance X X X X
Fig. 8. Diagrammatic representation of the temporal response character- System attributes (with respect to steady-state value)
istics used for the control system evaluation. The quantities shown are de- rms-wrt-ss X X X
fined as follows: overshoot = l(p2 - s ~ ) \ return
, time = irlO% - rpl. return time X X
settling time = is 10%- t p l . where pl = initial peak of the angular tra- settling time 0 0
jectory (positive or negative), p? = second peak of the angular trajectory overshoot 0 0
(positive or negative), fpl = time at which p l occurred, ss = steady-state ~~ ~ ~

value of hip angle, dh = 10%* I(pl - ss)J trlO% = time at which the
angle had returned to within ss f dh, is 10% = time at which the angle
had settled to within ss f dh.
groups were tested for normality of distribution using the
chi-square test. For some df the measures the normality
of the distribution could not be confirmed on some days.
Therefore, statistical significance of the difference be-
tween the OL and the CL data was evaluated using the
Kmskal-Wallis nonparametric test (see Table 111) [27].
Differences were considered significant for P < 0.05.
Mean values and standard error bars for each of the tem-
poral measures on each day are shown in Fig. 9. Note that
on all five days the CL controller resulted in a statistically
significant reductiorl in fms error. Although this improve-
ment was primarily a reflection of the reduction in steady-
state error, it was also influenced by the transient char-
acteristics of the response. The CL controller resulted in
a significantly reducedLcompliance on four days.
In addition to comparing daily performance of the two
controllers, the overall performance with regard to each
measure was evaluated. The daily mean values of each
performance measure were normalized with respect to the
OL mean value for that day. For each day, the percent
reduction for each measure due to the action of the con-
troller was calculated as 100 * (1 - (CL measure/OL
measure)). A paired t-test was used to determine the sig-
nificance of the changes in the absolute measures over the
set of all days. Results indicate that the CL controller gen-
erated significant reductions in each of the performance
measures: a 41 % reduction in rms error, a 52% reduction
in steady-state error, and a 22% reduction in compliance.
System Attributes (Calculated with Respect to Steady-
State)
The quantities of rms-wrt-ss, return time, settling time,
and overshoot were all calculated with respect to the
steady-state value for each trial. The influence of the
steady-state error must be considered in interpreting these
results. For example, a fast return to an incorrect steady-
state position may result in a faster return or settling time
or a smaller Overshoot than the same controller would
achieve if it did not have the steady-state error. This said,
we note that the CL controller reduced rms-wrt-ss on three
The top four rows indicate the experiment day, subject, and the number
of OL and CL trials performed on that day. The middle three rows denote
statistically significant differences ( P < 0.05 using the Kurskal-Wallis
nonparametric test) between the OL and CL performance measyes on each
of the five experiment days. X indicates that the CL values for that day
were significantly less than the OL values, 0indicates that the OL val-
ues were significantly less than the CL. An empty slot in the table indicates
that there was no significant difference between the two groups. Similarly,
the bottom four rows indicate statistically significant differences for the
system attributes calculated with respect to the steady-state value.
days, reduced return time on two days, increased settling
time on two days, and increased overshoot on two days.
Disturbance Forces
As indicated earlier, the disturbances for each trial were
not precisely identical, but they were measured for each
trial. The possibility that differences in disturbance rms
value, peak value, energy, or rate of application might
have influenced the system response was tested via cor-
relation analysis. On all days, all of the performance
measures were found to be poorly correlated with the dis-
turbance measures ( p << 0.5); none of the correlation
coefficients were consistently different from zero. Thus,
the disturbances for each trial were treated as being iden-
tical, i.e., the data were not normalized.
Support Forces
The measurements of auxiliary support force were used
to determine whether or not the observed differences in
performance were due to differences in support force used
by the subjects. Recall that the hip moment due to the
action of the hands is the weighted sum of two terms: the
sum of the coronal plane forces measured on the support
posts (Mhh,c),and the difference between the vertical plane
forces measured on the support posts (Mhhqt,).The rms
value, rms kalculated with respect to the initial value, and
the peak value of the force component of each of these
two terms, and of their weighted sum were calculated for
each trial. These data were then analyzed to determine if
there were significant differences between the OL and CL
trials. Results indicated that, for any given measure, there
was no consistent difference across the five days. The rms
value of cpronal plane force was lower for the CL trials
on three days, lower for the OL trials on one day, and
ABBAS A N D CHIZECK: FEEDBACK CONTROL OF HIP ANGLE IN PARAPLEGIC SUBJECTS 695

ruI hip angle steady-state error cowliance

4

240
0
0
D
I
m 4
%a 4
Y * m
0
*
1 2 3 4 5 1 2 3 4 5 1 2 7 4 5
mxperiment day experiment day experiment day

(b) (C)
rma-m-t-ss return ti-

o h

::::p]
1 2 3 4 5 1 2 3 4 5
experimnt day experiment day

+
;;11;.1-
0.5

- 0
0
1

1 2 3
( 4
r e t t l i n g time

4 5
10

ot *. . . . .
0
1 1
(e)
overshoot

3 4 5
experimnt day experiment day

(f) ( g)
Fig. 9. Mean values of the performance measures and system attributes versus experiment day for both the OL and CL systems.
Subject no. 1 was used on days 1. 2 and subject no. 2 was used on days 3, 4, and 5 . (a) Displays the mean value of rms error
for the OL system (0) and for the CL system (X) versus experiment day. Vertical bars indicate f one standard error;
the units of the y-axis are given in percent-maximum-abduction (pma) as described in the text. Similar plots for steady-state
error, compliance, rms-wrt-ss, return time, settling time and overshoot are shown in (b)-( g), respectively.

showed no difference on one day. This was the most con-
sistent of the measures; no other.measure was higher or
lower for one group on more than two days. The lack of
observed consistent differences in the measures of the mo-
ments exerted by the hands during the OL and CL trials
suggests that the differences observed in the OL and CL
system responses cannot be attributed to the action of the
hands. Tracings of the time course of the forces contrib-
uting to each component of the moment exerted by the
hands for the sample trials are given in Fig. 7(c) and (d).
Although in these trials the CL system required less upper
body support this was not a general trend.
In the course of the experiments, an additional differ-
ence between the OL and CL systems was observed. Fol-
lowing the disturbances, the CL system often resulted in
larger weight shifts between the two legs than the OL sys-
tem. To quantify this observation, the rms values of the
difference in the vertical component of the two ground
reaction force vectors were calculated. On three days this
measure was lower for the OL system, which reflects the
higher compliance of that system. In some situations, this
result may be undesirable, thus weight distribution on the
feet may be a useful feedback signal for the controller.
System Response Variability
The variance of the performance measures and system
attributes was used to evaluate the effect of the controller
on system variability. Results of this analysis are pre-
sented in Table IV. The chi-square test was used to eval-
uate the normality of the distribution of each group. If the
distribution of the data for either the OL or CL group was
determined not to be normal for a given day, comparison
of the variances would not be valid. These cases are in-
diated in the table with a + . For the remaining entries
in the table, Bartletts test [27] was used to test the equal-
ity of the variances. As indicated in Table IV, in several
instances the CL controller brought about significant re-
ductions of the variance of the performance measures. The
reduction in variance brought about by the CL controller
was seen most clearly on days 1, 2, and 5.
DISCUSSION
Performance Measures
Lower extremity FNS systems which provide stance
currently have two primary deficiencies: the high level of
energy expenditure and the limited ability to respond to
-

696 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING. VOL. 38. NO. 7. JULY 1991

TABLE IV room for improvement. Analysis of these measures indi-

COMPARISON
OF OL A N D CL SYSTEM
VARIABILITY
~
experiment day 1 2 3 4
subject # I I 2 2
# OL trials 12 26 21 23 69
# CL trials 38 34 60 56 43
Variability of performance measures
rms error X X X the steady-state value. This suggests that, on these days,
S.S. error + X + +
compliance X X
Variability of system attributes
rms-wrt-ss X X
return time + + + +
settling time + X
overshoot + X X 0
Entries in the table indicate statistically significant differences (P < 0.05
using Bartletts test) between the variances of the OL and CL quantities
reported in Table 111. X indicates that the CL variance for that day was
significantly less than the OL variance, 0 indicates that the OL variance
was significantlyless than the CL, and an empty slot indicates that there
was no significant difference between the two groups. A + in the table
indicates that a chi-square test determined that either the OL or CL measure
was not normally distributed, thus making a comparison of the variances
invalid.
disturbances. The former limits the duration of standing,
while the latter limits the users ability to use the hands
to perform various tasks. This work addresses the latter
of these issues. The demonstrated reductions in rms error,
steady-state error, and compliance provided by the CL
controller suggest an improvement in the disturbance re-
jection capability. This would be a desirable characteris-
tic of an FNS control system that is active during func-
tional standing, i.e., when the user stands while
performing activities with the hands.
This evaluation focused on three performance meas-
ures: rms error, steady-state error, and compliance. These
measures were chosen because rms error provides an
overall measure of the system response to a disturbance;
compliance provides a measure of the ability of the sys-
tem to resist an impact; and steady-state error provides a
measure of the ability of the system to return to an upright
position. It should be noted, however, that these improve-
ments afforded by the CL controller do not guarantee that
its use will enhance the clinical utility of the FNS system.
Clinical testing is required to evaluate the relevance of
these measures, to develop definitions of clinically desir-
able characteristics, and to compare the performance of
these systems to normal function. Such testing is beyond
the scope of this study. However, this study does dem-
onstrate the ability of the CL controller to favorably mod-
ify the system response characteristics.
System Attributes (Calculated with Respect to Steady
State)
These measures (rms-wrt-ss, return time, settling time,
and overshoot) are of limited use in evaluating system
performance because they are calculated with respect to
very different steady-state errors. However, they do in-
dicate which characteristics of the system response have
been affected by the controller, and where there may be
cates that the CL controller affected the transient response
5 of the system. The instances of reductions in return time
2 indicate improvements in the initial return towards the
steady-state value. The instances of increases in settling
time and in overshoot indicate increased oscillations about
X one effect of the CL controller was to decrease the damp-
X ing ratio of the system response. This type of behavior
could be avoided by a more appropriate controller tuning
X
procedure. Future trials with this and other FNS feedback
controllers may benefit from a consideration of these
measures in the tuning protocol.
System Response Variability
The data presented in this study exhibit two types of
variability which are discussed below: variability within
a population of performance measures on a given day and
variability of the mean value of a population across sev-
eral days. Analysis revealed two important aspects of the
performance of the CL control system. First, on four of
five days, the variability of the CL system was signifi-
cantly lower than that of the OL system for several of the
measures used. Second, although there was day-to-day
variability, the CL controller consistently performed bet-
ter than the OL controller with regards to the three per-
formance measures used in the study. This ability to pro-
vide improvements under varied conditions is an important
aspect of any biomedical control system, and attests to the
robustness of the control strategy used here.
The variability of the data observed on a given day may
have had several causes. First, the base of postural sup-
port in the coronal plane is broad and stiffness at the hip
joint in that plane provides stability in quiet stance over a
wide range of joint positions. Thus, the system is tolerant
to some level of deviations about the erect position. Such
changes in position, although acceptable to the subject,
could significantly affect the systems response to a dis-
turbance. That is, changes in initial starting position may
account for some of the variability exhibited in the data
presented here. Other sources of response variability could
be sagittal plane movements, the actions of hands in ex-
erting auxiliary support forces, sensor measurement noise,
changes in muscle response, and variations in the trajec-
tory of disturbance force. Throughout the experiments at-
tempts were made to minimize these effects, but it was
not possible to eliminate them. It should be noted that the
statistical analysis indicated that in many instances a
straightforward difference between the two groups was
discernible, despite the observed variability in the data.
Such variability, however, may limit the usefulness of an
FNS standing system.
The observed day-to-day variability was probably due
to several factors. The experiments were run on two dif-
ferent subjects. There were several days (sometimes
weeks) between experiments. Occasionally different elec-
trodes were used on consecutive experiment days. The
ABBAS A N D CHIZECK: FEEDBACK CONTROL OF HIP ANGLE IN PARAPLEGIC SUBJECTS
amount of weight supported by the arms varied from day
to day. The difference in system responses of the two sub-
jects was most apparent in the measure of compliance
(Fig. 9). Subject no. 1joined the program three years post-
injury; at the time of the first day of trials he had been in
the program for only a few months. The strength of the
implanted muscles had not yet fully redeveloped, as was
evidenced by a high compliance and minimal ability to
withstand disturbances. The second day of experimenta-
tion with this subject took place one month later. An in-
crease in muscle strength during this time was apparent,
as indicated by reductions in compliance, return time and
settling time. Subject no. 2 had been in the program for
several years and thus had greater muscle development
than subject no. 1. The effect of the greater muscle
strength and passive stiffness was seen in lower values of
hip compliance and return time, and a greater ability to
withstand disturbances.
CONCLUSIONS
A feedback controller of coronal plane hip angle has
been implemented in paraplegic subjects using FNS. The
performance of the feedback-controlled system has been
quantitatively compared to that of an open-loop control
system. In the comparison, the feedback controller dem-
onstrated a 41 % reduction in rms error, a 52 % reduction
in steady-state error, and a 22 % reduction in compliance.
The observed changes in these performance measures
suggest that the feedback-controlled system provided a
greater level of disturbance rejection than the open-loop
system. This improvement may allow the user of the FNS
system to have greater use of the hands during stance. The
feedback controller also resulted in a reduction in the
variance of these performance measures on some of the
experiment days. This type of improvement in the repeat-
ability of the system response may help to make the FNS
system easier to learn to use and easier to use.
ACKNOWLEDGMENT
The authors thank E. B. Marsolais and R. Kobetic for
their assistance and collaboration and R. Shepheard for
the illustration presented in Fig. 6.
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James J. Abbas (S88) was born in Lawrence,
MA in 1961. He received the Sc.B. degree in
bioelectrical engineering from Brown University,
Providence, RI, in 1982 and the M.S. degree in
biomedical engineering from Case Western Re-
serve University, Cleveland, OH in 1989. He is
currently working towards the Ph.D. degree in
Biomedical Engineering at Case Westem Reserve
University.
From 1982 to 1984 he taught secondary school
mathematics in Mzuzu, Malawi. Since 1986 he has
been employed as a Biomedical Engineer at the Motion Study Laboratory
at the Cleveland Veterans Affairs Medical Center in Cleveland, OH. His
research interests include neuromotor prostheses, control and analysis of
biomechanical systems, and the design of neural network controllers for
dynamic systems.
Howard Jay Chizeck (S74-M79) was born on
March 27, 1952 in Columbus, OH. He received
the B.S. and M.S. degrees in systems and control
Engineering from Case Western Reserve Univer-
sity, Cleveland, OH. in 1974 and 1976, respec-
tively, and the Sc.D. degree in Electrical Engi-
neering and Computer Science from the
Massachusetts Institute of Technology, Cam-
bridge, in 1982.
He is an associate professor in the Systems En-
gineering and Biomedical Engineering Depart-
ments at Case Western Reserve University. His research interests involve
applications of control engineering to biomedical problems. Current proj-
ects include the design and analysis of controllers for the electrical stimu-
lation of paralyzed muscle, adaptive control of drug delivery, identification
and control of cerebral ventricle volume dynamics for hydrocephalus man-
agement, algebraic modelling of DNA sequence-geometry relationships and
applications of algebraic systems theory to coding.
Dr. Chizeck is a member of the AAAS, Sigma Xi, the Rehabilitation
Society of North America (RESNA), and the International Federation of
Automatic Control (IFAC) Technical Committee on Biomedical Engineer-
ing.