Use of the Case Western Reserve/Veterans Administration neuroprosthesis for exercise, standing and transfers by a paraplegic subject

Experimental Implementation of Automatic Control of Posture-Dependent Stimulation in an Implanted Standing Neuroprosthesis

Knowledge of the upper extremity (UE) effort exerted under real-world conditions is important for understanding how persons with motor or sensory disorders perform the postural shifts necessary to complete many activities of daily living while standing. To this end, a feedback controller, named the “Posture Follower Controller”, was developed to aid in task-dependent posture shifting by individuals with spinal cord injury standing with functional neuromuscular stimulation. In this experimental feasibility study, the controller modulated activation to the paralyzed lower extremity muscles as a function of the position of overall center of pressure (CoP), which was prescribed to move in a straight line in forward and diagonal directions. Posture-dependent control of stimulation enabled leaning movements that translated the CoP up to 48 mm away from the nominal position during quiet standing. The mean 95% prediction ellipse area, a measure of the CoP dispersion in the forward, forward-right, and forward-left directions, was 951.0 ± 341.1 mm², 1095.9 ± 251.2 mm², and 1364.5 ± 688.2 mm², respectively. The average width of the prediction ellipses across the three directions was 15.1 mm, indicating that the CoP deviated from the prescribed path as task-dependent postures were assumed. The average maximal UE effort required to adjust posture across all leaning directions was 24.1% body weight, which is only slightly more than twice of what is required to maintain balance in an erect standing posture. These preliminary findings suggest that stimulation can be modulated to effectively assume user-specified, task-dependent leaning postures characterized by the CoP shifts that deviate away from the nominal position and which require moderate UE effort to execute.