Modulation of pain processing in hyperalgesia by cognitive demand.

The relationship between pain and cognitive function is of theoretical and clinical interest, exemplified by observations that attention-demanding activities reduce pain in chronically afflicted patients. Previous studies have concentrated on phasic pain, which bears little correspondence to clinical pain conditions. Indeed, phasic pain is often associated with differential or opposing effects to tonic pain in behavioral, lesion, and pharmacological studies. To address how cognitive engagement interacts with tonic pain, we assessed the influence of an attention-demanding cognitive task on pain-evoked neural responses in an experimental model of chronic pain, the capsaicin-induced heat hyperalgesia model. Using functional magnetic resonance imaging (fMRI), we show that activity in the orbitofrontal and medial prefrontal cortices, insula, and cerebellum correlates with the intensity of tonic pain. This pain-related activity in medial prefrontal cortex and cerebellum was modulated by the demand level of the cognitive task. Our findings highlight a role for these structures in the integration of motivational and cognitive functions associated with a physiological state of injury. Within the limitations of an experimental model of pain, we suggest that the findings are relevant to understanding both the neurobiology and pathophysiology of chronic pain and its amelioration by cognitive strategies.

Empathy for pain involves the affective but not sensory components of pain.

Our ability to have an experience of another's pain is characteristic of empathy. Using functional imaging, we assessed brain activity while volunteers experienced a painful stimulus and compared it to that elicited when they observed a signal indicating that their loved one--present in the same room--was receiving a similar pain stimulus. Bilateral anterior insula (AI), rostral anterior cingulate cortex (ACC), brainstem, and cerebellum were activated when subjects received pain and also by a signal that a loved one experienced pain. AI and ACC activation correlated with individual empathy scores. Activity in the posterior insula/secondary somatosensory cortex, the sensorimotor cortex (SI/MI), and the caudal ACC was specific to receiving pain. Thus, a neural response in AI and rostral ACC, activated in common for "self" and "other" conditions, suggests that the neural substrate for empathic experience does not involve the entire "pain matrix." We conclude that only that part of the pain network associated with its affective qualities, but not its sensory qualities, mediates empathy.

Dread and the disvalue of future pain.

Standard theories of decision-making involving delayed outcomes predict that people should defer a punishment, whilst advancing a reward. In some cases, such as pain, people seem to prefer to expedite punishment, implying that its anticipation carries a cost, often conceptualized as 'dread'. Despite empirical support for the existence of dread, whether and how it depends on prospective delay is unknown. Furthermore, it is unclear whether dread represents a stable component of value, or is modulated by biases such as framing effects. Here, we examine choices made between different numbers of painful shocks to be delivered faithfully at different time points up to 15 minutes in the future, as well as choices between hypothetical painful dental appointments at time points of up to approximately eight months in the future, to test alternative models for how future pain is disvalued. We show that future pain initially becomes increasingly aversive with increasing delay, but does so at a decreasing rate. This is consistent with a value model in which moment-by-moment dread increases up to the time of expected pain, such that dread becomes equivalent to the discounted expectation of pain. For a minority of individuals pain has maximum negative value at intermediate delay, suggesting that the dread function may itself be prospectively discounted in time. Framing an outcome as relief reduces the overall preference to expedite pain, which can be parameterized by reducing the rate of the dread-discounting function. Our data support an account of disvaluation for primary punishments such as pain, which differs fundamentally from existing models applied to financial punishments, in which dread exerts a powerful but time-dependent influence over choice.

Toward a human-like biped robot with compliant legs

Conventional models of bipedal walking generally assume rigid body structures, while elastic material properties seem to play an essential role in nature. On the basis of a novel theoretical model of bipedal walking, this paper investigates a model of biped robot which makes use of minimum control and elastic passive joints inspired from the structures of biological systems. The model is evaluated in simulation and a physical robotic platform by analyzing the kinematics and ground reaction force. The experimental results show that, with a proper leg design of passive dynamics and elasticity, an attractor state of human-like walking gait patterns can be achieved through extremely simple control without sensory feedback. The detailed analysis also explains how the dynamic human-like gait can contribute to adaptive biped walking. © 2007 Elsevier B.V. All rights reserved.

Enlarging regions of stable running with segmented legs

In human and animal running spring-like leg behavior is found, and similar concepts have been demonstrated by various robotic systems in the past. In general, a spring-mass model provides self-stabilizing characteristics against external perturbations originated in leg-ground interactions and motor control. Although most of these systems made use of linear spring-like legs. The question addressed in this paper is the influence of leg segmentation (i.e. the use of rotational joint and two limb-segments) to the self-stability of running, as it appears to be a common design principle in nature. This paper shows that, with the leg segmentation, the system is able to perform self-stable running behavior in significantly broader ranges of running speed and control parameters (e.g. control of angle of attack at touchdown, and adjustment of spring stiffness) by exploiting a nonlinear relationship between leg force and leg compression. The concept is investigated by using a two-segment leg model and a robotic platform, which demonstrate the plausibility in the real world. ©2008 IEEE.

Bipedal walking and running with compliant legs

Passive dynamics plays an important role in legged locomotion of the biological systems. The use of passive dynamics provides a number of advantages in legged locomotion such as energy efficiency, self-stabilization against disturbances, and generating gait patterns and behavioral diversity. Inspired from the theoretical and experimental studies in biomechanics, this paper presents a novel bipedal locomotion model for walking and running behavior which uses compliant legs. This model consists of three-segment legs, two servomotors, and four passive joints that are constrained by eight tension springs. The self-organization of two gait patterns (walking and running) is demonstrated in simulation and in a real-world robot. The analysis of joint kinematics and ground reaction force explains how a minimalistic control architecture can exploit the particular leg design for generating different gait patterns. Moreover, it is shown how the proposed model can be extended for controlling locomotion velocity and gait patterns with the simplest control architecture. © 2007 IEEE.

Toward a human-like biped robot with compliant legs

Conventional models of bipedal walking generally assume rigid body structures, while elastic material properties seem to play an essential role in nature. On the basis of a novel theoretical model of bipedal walking, this paper investigates a model of biped robot which makes use of minimum control and elastic passive joints inspired from the structures of biological systems. The model is evaluated in simulation and a physical robotic platform with respect to the kinematics and the ground reaction force. The experimental results show that the behavior of this simple locomotion model shows a considerable similarity to that of human walking. © 2006 The authors.

Running and walking with compliant legs

It has long been the dream to build robots which could walk and run with ease. To date, the stance phase of walking robots has been characterized by the use of either straight, rigid legs, as is the case of passive walkers, or by the use of articulated, kinematically-driven legs. In contrast, the design of most hopping or running robots is based on compliant legs which exhibit quite natural behavior during locomotion. © 2006 Springer.

Optimal Fuzzy PID Controller with Incomplete Derivation and Its Simulation Research on Application of Intelligent Artificial Legs

提出了一种新的最优模糊PID控制器，它由两部分组成，即在线模糊推理机构和带有不完全微分的常规PID控制器，在模糊推理机构中，引入了三个可调节因子xp,xi和xd，其作用是进一步修改和优化模糊推理的结果，以使控制器对一个给定对象具有最优的控制效果，可调节因子的最优值采用ITAE准则及Nelder和Mead提出的柔性多面体最优搜索算法加以确定，这种PID控制器被用来控制由作者设计的智能人工腿中的一个直流电机，仿真结果表明该控制器的设计是非常有效的，它可被用于控制各种不同的对象和过程。

Development of process control methodology for tracking the quality and safety of pain, agitation and sedation management in critical care units

Objective: To develop sedation, pain, and agitation quality measures using process control methodology and evaluate their properties in clinical practice. Design: A Sedation Quality Assessment Tool was developed and validated to capture data for 12-hour periods of nursing care. Domains included pain/discomfort and sedation-agitation behaviors; sedative, analgesic, and neuromuscular blocking drug administration; ventilation status; and conditions potentially justifying deep sedation. Predefined sedation-related adverse events were recorded daily. Using an iterative process, algorithms were developed to describe the proportion of care periods with poor limb relaxation, poor ventilator synchronization, unnecessary deep sedation, agitation, and an overall optimum sedation metric. Proportion charts described processes over time (2 monthly intervals) for each ICU. The numbers of patients treated between sedation-related adverse events were described with G charts. Automated algorithms generated charts for 12 months of sequential data. Mean values for each process were calculated, and variation within and between ICUs explored qualitatively. Setting: Eight Scottish ICUs over a 12-month period. Patients: Mechanically ventilated patients. Interventions: None. Measurements and Main Results: The Sedation Quality Assessment Tool agitation-sedation domains correlated with the Richmond Sedation Agitation Scale score (Spearman [rho] = 0.75) and were reliable in clinician-clinician (weighted kappa; [kappa] = 0.66) and clinician-researcher ([kappa] = 0.82) comparisons. The limb movement domain had fair correlation with Behavioral Pain Scale ([rho] = 0.24) and was reliable in clinician-clinician ([kappa] = 0.58) and clinician-researcher ([kappa] = 0.45) comparisons. Ventilator synchronization correlated with Behavioral Pain Scale ([rho] = 0.54), and reliability in clinician-clinician ([kappa] = 0.29) and clinician-researcher ([kappa] = 0.42) comparisons was fair-moderate. Eight hundred twenty-five patients were enrolled (range, 59-235 across ICUs), providing 12,385 care periods for evaluation (range 655-3,481 across ICUs). The mean proportion of care periods with each quality metric varied between ICUs: excessive sedation 12-38%; agitation 4-17%; poor relaxation 13-21%; poor ventilator synchronization 8-17%; and overall optimum sedation 45-70%. Mean adverse event intervals ranged from 1.5 to 10.3 patients treated. The quality measures appeared relatively stable during the observation period. Conclusions: Process control methodology can be used to simultaneously monitor multiple aspects of pain-sedation-agitation management within ICUs. Variation within and between ICUs could be used as triggers to explore practice variation, improve quality, and monitor this over time

Mapping the gene for autosomal dominant restless legs syndrome in an Irish family

Restless Legs Syndrome (RLS) is a common neurological disorder affecting nearly 15% of the general population. Ironically, RLS can be described as the most common condition one has never heard of. It is usually characterised by uncomfortable, unpleasant sensations in the lower limbs inducing an uncontrollable desire to move the legs. RLS exhibits a circadian pattern with symptoms present predominantly in the evening or at night, thus leading to sleep disruption and daytime somnolence. RLS is generally classified into primary (idiopathic) and secondary (symptomatic) forms. Primary RLS includes sporadic and familial cases of which the age of onset is usually less than 45 years and progresses slowly with a female to male ratio of 2:1. Secondary forms often occur as a complication of another health condition, such as iron deficiency or thyroid dysfunction. The age of onset is usually over 45 years, with an equal male to female ratio and more rapid progression. Ekbom described the familial component of the disorder in 1945 and since then many studies have been published on the familial forms of the disorder. Molecular genetic studies have so far identified ten loci (5q, 12q, 14p, 9p, 20p, 16p, 19p, 4q, 17p). No specific gene within these loci has been identified thus far. Association mapping has highlighted a further five areas of interest. RLS6 has been found to be associated with SNPs in the BTBD9 gene. Four other variants were found within intronic and intergenic regions of MEIS1, MAP2K5/LBXCOR1, PTPRD and NOS1. The pathophysiology of RLS is complex and remains to be fully elucidated. Conditions associated with secondary RLS, such as pregnancy or end-stage renal disease, are characterised by iron deficiency, which suggests that disturbed iron homeostasis plays a role. Dopaminergic dysfunction in subcortical systems also appears to play a central role. An ongoing study within the Department of Pathology (University College Cork) is investigating the genetic characteristics of RLS in Irish families. A three generation RLS pedigree RLS3002 consisting of 11 affected and 7 unaffected living family members was recruited. The family had been examined for four of the known loci (5q, 12q, 14p and 9p) (Abdulrahim 2008). The aim of this study was to continue examining this Irish RLS pedigree for possible linkage to the previously described loci and associated regions. Using informative microsatellite markers linkage was excluded to the loci on 5q, 12q, 14p, 9p, 20p, 16p, 19p, 4q, 17p and also within the regions reported to be associated with RLS. This suggested the presence of a new unidentified locus. A genome-wide scan was performed using two microsatellite marker screening sets (Research Genetics Inc. Mapping set and the Applied Biosystems Linkage mapping set version 2.5). Linkage analysis was conducted under an autosomal dominant model with a penetrance of 95% and an allele frequency of 0.01. A maximum LOD score of 3.59 at θ=0.00 for marker D19S878 indicated significant linkage on chromosome 19p. Haplotype analysis defined a genetic region of 6.57 cM on chromosome 19p13.3, corresponding to 2.5 Mb. There are approximately 100 genes annotated within the critical region. Sequencing of two candidate genes, KLF16 and GAMT, selected on the assumed pathophysiology of RLS, did not identify any sequence variant. This study provides evidence of a novel RLS locus in an Irish pedigree, thus supporting the picture of RLS as a genetically heterogeneous trait.