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Friederich ARW, Lombardo LM, Foglyano KM, Audu ML, Triolo RJ. Stabilizing leaning postures with feedback controlled functional neuromuscular stimulation after trunk paralysis. Front Rehabil Sci 2023; 4:1222174. [PMID: 37841066 PMCID: PMC10568131 DOI: 10.3389/fresc.2023.1222174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/28/2023] [Indexed: 10/17/2023]
Abstract
Spinal cord injury (SCI) can cause paralysis of trunk and hip musculature that negatively impacts seated balance and ability to lean away from an upright posture and interact fully with the environment. Constant levels of electrical stimulation of peripheral nerves can activate typically paralyzed muscles and aid in maintaining a single upright seated posture. However, in the absence of a feedback controller, such seated postures and leaning motions are inherently unstable and unable to respond to perturbations. Three individuals with motor complete SCI who had previously received a neuroprosthesis capable of activating the hip and trunk musculature volunteered for this study. Subject-specific muscle synergies were identified through system identification of the lumbar moments produced via neural stimulation. Synergy-based calculations determined the real-time stimulation parameters required to assume leaning postures. When combined with a proportional, integral, derivative (PID) feedback controller and an accelerometer to infer trunk orientation, all individuals were able to assume non-erect postures of 30-40° flexion and 15° lateral bending. Leaning postures increased forward reaching capabilities by 10.2, 46.7, and 16 cm respectively for each subject when compared with no stimulation. Additionally, the leaning controllers were able to resist perturbations of up to 90 N, and all subjects perceived the leaning postures as moderately to very stable. Implementation of leaning controllers for neuroprostheses have the potential of expanding workspaces, increasing independence, and facilitating activities of daily living for individuals with paralysis.
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Affiliation(s)
- Aidan R. W. Friederich
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Lisa M. Lombardo
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Kevin M. Foglyano
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Musa L. Audu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Ronald J. Triolo
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
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Williams AMM, Chisholm AE, Lynn A, Malik RN, Eginyan G, Lam T. Arm crank ergometer "spin" training improves seated balance and aerobic capacity in people with spinal cord injury. Scand J Med Sci Sports 2019; 30:361-369. [PMID: 31621945 DOI: 10.1111/sms.13580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/16/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is some evidence that upper-body training modalities can improve not only aerobic capacity but also seated balance in people with spinal cord injury (SCI), even in those classified with motor-complete paralysis above T6. Here, we evaluated the effect of arm crank ergometry (ACE) "spin" training on trunk muscle recruitment and its effects on seated balance and aerobic capacity. METHODS Eight individuals with high-level complete and 6 with either a low-level complete or a motor-incomplete SCI participated in this study. Participants completed 5 weeks of a group ACE "spin" training protocol which featured modulations in cadence and resistance as well as back-supported and unsupported bouts. Surface electromyography was used to confirm trunk muscle recruitment during unsupported ACE. Changes in aerobic capacity (peak oxygen consumption) and seated balance control (center of pressure parameters) were assessed at pre- and post-intervention. RESULTS Unsupported ACE was effective for eliciting trunk muscle activity (P < .05). Following training, peak oxygen consumption significantly improved by an average of 16% (P = .005). Static sitting balance significantly improved from pre- to post-intervention, but only when tested with eyes closed as measured by a reduction in area (P = .047) and velocity of center of pressure (P = .013). No significant changes were observed in static sitting balance with eyes open or in dynamic sitting balance. CONCLUSION Group ACE "spin" classes may benefit not only aerobic fitness but also static seated balance control in people with SCI.
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Affiliation(s)
- Alison M M Williams
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Amanda E Chisholm
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Andrea Lynn
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Raza N Malik
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Gevorg Eginyan
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.,Physical Activity Research Centre (PARC), International Collaboration On Repair Discoveries, Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
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Audu ML, Lombardo LM, Schnellenberger JR, Foglyano KM, Miller ME, Triolo RJ. A neuroprosthesis for control of seated balance after spinal cord injury. J Neuroeng Rehabil 2015; 12:8. [PMID: 25608888 PMCID: PMC4326199 DOI: 10.1186/1743-0003-12-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/13/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A major desire of individuals with spinal cord injury (SCI) is the ability to maintain a stable trunk while in a seated position. Such stability is invaluable during many activities of daily living (ADL) such as regular work in the home and office environments, wheelchair propulsion and driving a vehicle. Functional neuromuscular stimulation (FNS) has the ability to restore function to paralyzed muscles by application of measured low-level currents to the nerves serving those muscles. METHODS A feedback control system for maintaining seated balance under external perturbations was designed and tested in individuals with thoracic and cervical level spinal cord injuries. The control system relied on a signal related to the tilt of the trunk from the vertical position (which varied between 1.0 ≡ erect posture and 0.0 ≡ most forward flexed posture) derived from a sensor fixed to the sternum to activate the user's own hip and trunk extensor muscles via an implanted neuroprosthesis. A proportional-derivative controller modulated stimulation between trunk tilt values indicating deviation from the erect posture and maximum desired forward flexion. Tests were carried out with external perturbation forces set at 35%, 40% and 45% body-weight (BW) and maximal forward trunk tilt flexion thresholds set at 0.85, 0.75 and 0.70. RESULTS Preliminary tests in a case series of five subjects show that the controller could maintain trunk stability in the sagittal plane for perturbations up to 45% of body weight and for flexion thresholds as low as 0.7. The mean settling time varied across subjects from 0.5(±0.4) and 2.0 (±1.1) seconds. Mean response time of the feedback control system varied from 393(±38) ms and 536(±84) ms across the cohort. CONCLUSIONS The results show the high potential for robust control of seated balance against nominal perturbations in individuals with spinal cord injury and indicates that trunk control with FNS is a promising intervention for individuals with SCI.
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Affiliation(s)
- Musa L Audu
- />Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA
| | - Lisa M Lombardo
- />Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH USA
| | - John R Schnellenberger
- />Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH USA
| | - Kevin M Foglyano
- />Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH USA
| | - Michael E Miller
- />Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH USA
| | - Ronald J Triolo
- />Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA
- />Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH USA
- />Department of Orthopedics, Case Western Reserve University, Cleveland, OH USA
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