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Zoulias ID, Armengol M, Poulton A, Andrews B, Gibbons R, Harwin WS, Holderbaum W. Novel instrumented frame for standing exercising of users with complete spinal cord injuries. Sci Rep 2019; 9:13003. [PMID: 31506460 PMCID: PMC6736978 DOI: 10.1038/s41598-019-49237-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 08/15/2019] [Indexed: 11/10/2022] Open
Abstract
This paper describes a Functional Electrical Stimulation (FES) standing system for rehabilitation of bone mineral density (BMD) in people with Spinal Cord Injury (SCI). BMD recovery offers an increased quality of life for people with SCI by reducing their risk of fractures. The standing system developed comprises an instrumented frame equipped with force plates and load cells, a motion capture system, and a purpose built 16-channel FES unit. This system can simultaneously record and process a wide range of biomechanical data to produce muscle stimulation which enables users with SCI to safely stand and exercise. An exergame provides visual feedback to the user to assist with upper-body posture control during exercising. To validate the system an alternate weight-shift exercise was used; 3 participants with complete SCI exercised in the system for 1 hour twice-weekly for 6 months. We observed ground reaction forces over 70% of the full body-weight distributed to the supporting leg at each exercising cycle. Exercise performance improved for each participant by an increase of 13.88 percentage points of body-weight in the loading of the supporting leg during the six-month period. Importantly, the observed ground reaction forces are of higher magnitude than other studies which reported positive effects on BMD. This novel instrumentation aims to investigate weight bearing standing therapies aimed at determining the biomechanics of lower limb joint force actions and postural kinematics.
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Affiliation(s)
| | - Monica Armengol
- School of Biological Sciences, University of Reading, Reading, UK
| | - Adrian Poulton
- School of Computing and Communications, Open University, Milton Keynes, UK
| | - Brian Andrews
- Nuffield Department of Surgical Sciences, Oxford, UK.,School of Engineering, University of Warwick, Warwick, UK
| | - Robin Gibbons
- Aspire CREATe, University College London, London, UK
| | - William S Harwin
- School of Biological Sciences, University of Reading, Reading, UK
| | - William Holderbaum
- School of Biological Sciences, University of Reading, Reading, UK.,School of Engineering, Metropolitan University of Manchester, Manchester, UK
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Audu ML, Odle BM, Triolo RJ. Control of standing balance at leaning postures with functional neuromuscular stimulation following spinal cord injury. Med Biol Eng Comput 2017; 56:317-330. [PMID: 28736791 PMCID: PMC5790868 DOI: 10.1007/s11517-017-1687-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Abstract
This study systematically explored the potential of applying feedback control of functional neuromuscular stimulation (FNS) for stabilizing various erect and leaning standing postures after spinal cord injury (SCI). Perturbations ranging from 2 to 6% body weight were applied to two subjects with motor complete thoracic level SCI who were proficient at standing with implanted multichannel neural stimulators to activate the ankle, knee, hip and trunk muscles. The subjects stood with four different postures: erect, forward, forward-right and forward-left. Repeatable and controlled perturbations were applied in the forward, backward, rightward and leftward directions by linear actuators pulling on ropes attached to the subjects via a belt worn just above the waist. Upper extremity (UE) forces exerted on a stationary walker were measured with load cells attached to the handles. A feedback controller based on center of pressure (CoP) varied the stimulation levels to the otherwise paralyzed muscles so as to resist the effects of the perturbations. The effect of the feedback controller was compared to the case where only open-loop baseline stimulation was applied. This was done in terms of: (a) maximum resultant UE force exerted by the subjects on the walker, (b) maximum resultant CoP overshoot and (c) CoP root-mean-square deviation (RMSD). Feedback control resulted in significant reductions in the mean values of the majority of outcome values compared to baseline open-loop stimulation. Maximum resultant UE force was reduced by as much as 50% in one of the postures for one of the subjects. RMSD and maximum CoPs were reduced by as much as 75 and 70%, respectively, with feedback control. These results indicate that feedback control can be used to reject destabilizing disturbances in individuals with SCI using FNS not only for erect postures but also for leaning postures typically adopted during reaching while attempting various activities of daily living.
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Affiliation(s)
- Musa L Audu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA. .,Advanced Platform Technology Center, Cleveland Louis Stokes Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, USA. .,Motion Study Laboratory, C15, VA Medical Center, Cleveland, OH, 44106, USA.
| | - Brooke M Odle
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Advanced Platform Technology Center, Cleveland Louis Stokes Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, USA
| | - Ronald J Triolo
- Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Advanced Platform Technology Center, Cleveland Louis Stokes Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, USA
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Duggan C, Wilson C, DiPonio L, Trumpower B, Meade MA. Resilience and Happiness After Spinal Cord Injury: A Qualitative Study. Top Spinal Cord Inj Rehabil 2016; 22:99-110. [PMID: 29339852 DOI: 10.1310/sci2202-99] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: The purpose of this study was to identify factors associated with resilience among individuals with spinal cord injury (SCI). Methods: Qualitative analyses were conducted of the written comments that were completed as part of a cross-sectional survey of individuals with SCI living in the community. More than 1,800 mail surveys were distributed to individuals identified as having a traumatic SCI through the records and/or membership lists of 4 organizations. Four hundred and seventy-five individuals completed and returned the survey, with approximately half (48.6%; n = 231) of respondents answering the open-ended question "Is there anything else you would like to tell us about your resilience or ability to 'bounce back' when you face a challenge?" Results: Analyses of these responses identified both specific resources and cognitive perspectives that are associated with perceived happiness. Responses fell within 8 general categories: resilience, general outlook on life, social support and social relationships, religion or faith in a higher power, mood, physical health and functioning (including pain), social comparisons, and resources. Nuanced themes within these categories were identified and were generally concordant with self-reported level of happiness. Conclusion: A majority of respondents with SCI identified themselves as happy and explained their adjustment and resilience as related to personality, good social support, and a spiritual connection. In contrast, pain and physical challenges appeared to be associated with limited ability to bounce back.
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Affiliation(s)
| | - Catherine Wilson
- James A. Haley Veterans Hospital, Tampa, Florida.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa DiPonio
- Department of Physical Medicine & Rehabilitation, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Brad Trumpower
- Department of Physical Medicine & Rehabilitation, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Michelle A Meade
- Department of Physical Medicine & Rehabilitation, University of Michigan School of Medicine, Ann Arbor, Michigan
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Ho CH, Triolo RJ, Elias AL, Kilgore KL, DiMarco AF, Bogie K, Vette AH, Audu ML, Kobetic R, Chang SR, Chan KM, Dukelow S, Bourbeau DJ, Brose SW, Gustafson KJ, Kiss ZHT, Mushahwar VK. Functional electrical stimulation and spinal cord injury. Phys Med Rehabil Clin N Am 2015; 25:631-54, ix. [PMID: 25064792 DOI: 10.1016/j.pmr.2014.05.001] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Spinal cord injuries (SCI) can disrupt communications between the brain and the body, resulting in loss of control over otherwise intact neuromuscular systems. Functional electrical stimulation (FES) of the central and peripheral nervous system can use these intact neuromuscular systems to provide therapeutic exercise options to allow functional restoration and to manage medical complications following SCI. The use of FES for the restoration of muscular and organ functions may significantly decrease the morbidity and mortality following SCI. Many FES devices are commercially available and should be considered as part of the lifelong rehabilitation care plan for all eligible persons with SCI.
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Affiliation(s)
- Chester H Ho
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Foothills Medical Centre, Room 1195, 1403-29th Street NW, Calgary, Alberta T2N 2T9, Canada.
| | - Ronald J Triolo
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Orthopaedics, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Anastasia L Elias
- Chemical and Materials Engineering, W7-002 ECERF, University of Alberta, Edmonton, Alberta T6G 2V4, Canada
| | - Kevin L Kilgore
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Anthony F DiMarco
- MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Kath Bogie
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Orthopaedics, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Albert H Vette
- Department of Mechanical Engineering, University of Alberta, 4-9 Mechanical Engineering Building, Edmonton, Alberta T6G 2G8, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 - 111 Avenue, Edmonton, Alberta T5G 0B7, Canada
| | - Musa L Audu
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Rudi Kobetic
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Sarah R Chang
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - K Ming Chan
- Division of Physical Medicine and Rehabilitation, Centre for Neuroscience, University of Alberta, 5005 Katz Group Centre, 11361-87 Avenue, Edmonton, Alberta T6G 2E1, Canada
| | - Sean Dukelow
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Foothills Medical Centre, Room 1195, 1403-29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Dennis J Bourbeau
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Steven W Brose
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA; Ohio University Heritage College of Osteopathic Medicine, Grosvenor Hall, Athens, OH 45701, USA
| | - Kenneth J Gustafson
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Zelma H T Kiss
- Department of Clinical Neurosciences, Foothills Medical Centre, Room 1195, 1403-29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Vivian K Mushahwar
- Division of Physical Medicine and Rehabilitation, Centre for Neuroscience, University of Alberta, 5005 Katz Group Centre, 11361-87 Avenue, Edmonton, Alberta T6G 2E1, Canada
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Nas K, Yazmalar L, Şah V, Aydın A, Öneş K. Rehabilitation of spinal cord injuries. World J Orthop 2015; 6:8-16. [PMID: 25621206 PMCID: PMC4303793 DOI: 10.5312/wjo.v6.i1.8] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/24/2014] [Accepted: 06/16/2014] [Indexed: 02/06/2023] Open
Abstract
Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients’ family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary.
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Schiefer MA, Freeberg M, Pinault GJC, Anderson J, Hoyen H, Tyler DJ, Triolo RJ. Selective activation of the human tibial and common peroneal nerves with a flat interface nerve electrode. J Neural Eng 2013; 10:056006. [PMID: 23918148 DOI: 10.1088/1741-2560/10/5/056006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Electrical stimulation has been shown effective in restoring basic lower extremity motor function in individuals with paralysis. We tested the hypothesis that a flat interface nerve electrode (FINE) placed around the human tibial or common peroneal nerve above the knee can selectively activate each of the most important muscles these nerves innervate for use in a neuroprosthesis to control ankle motion. APPROACH During intraoperative trials involving three subjects, an eight-contact FINE was placed around the tibial and/or common peroneal nerve, proximal to the popliteal fossa. The FINE's ability to selectively recruit muscles innervated by these nerves was assessed. Data were used to estimate the potential to restore active plantarflexion or dorsiflexion while balancing inversion and eversion using a biomechanical simulation. MAIN RESULTS With minimal spillover to non-targets, at least three of the four targets in the tibial nerve, including two of the three muscles constituting the triceps surae, were independently and selectively recruited in all subjects. As acceptable levels of spillover increased, recruitment of the target muscles increased. Selective activation of muscles innervated by the peroneal nerve was more challenging. SIGNIFICANCE Estimated joint moments suggest that plantarflexion sufficient for propulsion during stance phase of gait and dorsiflexion sufficient to prevent foot drop during swing can be achieved, accompanied by a small but tolerable inversion or eversion moment.
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Affiliation(s)
- M A Schiefer
- Louis Stokes Cleveland Department of Veterans' Affairs Medical Center, Cleveland OH, USA. Department of Biomedical Engineering, Case Western Reserve University, Cleveland OH, USA. MetroHealth Medical Center, Cleveland OH, USA
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