Simulating the restoration of standing balance at leaning postures with functional neuromuscular stimulation following spinal cord injury. 2016

Raviraj Nataraj, and Musa L Audu, and Ronald J Triolo
Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA. raviraj.nataraj@gmail.com.

In this simulation study, we present and examine methods to develop a feedback controller for a neuroprosthesis that restores forward and side leaning function during standing following complete thoracic-level spinal cord injury. Achieving leaning postures away from erect stance with functional neuromuscular stimulation (FNS) would allow users to extend their reaching capabilities. Utilizing a 3-D computer model of human stance, an FNS control system based on total-body center of mass (CoM) kinematics (position, acceleration) is developed and tested in simulation. CoM kinematics drive an artificial neural network to modulate muscle excitations and reduce the upper extremity loading, presumably against a walker or similar support surface, required to resist the effects of postural perturbations. Furthermore, a novel method to robustly estimate the feedback kinematics for standing applications is also presented while assuming 3-D accelerometer signals at locations consistent with a proposed implantable networked neuroprosthesis system. For shifting and balance at leaning postures, respectively, center of mass position and acceleration could be approximated to within 20% of the maximum value, with strong correlations (R > 0.9) between values estimated by the proposed method and the true values derived from model dynamics. When utilizing the estimated feedback kinematics for FNS control, standing performance in terms of maximum upper extremity loading was still significantly reduced (p < 0.001) compared to conventionally applying constant and maximal stimulation. In the future, these simulation-based methods will be employed to develop experimental approaches for restoring leaning standing function by FNS.

UI MeSH Term Description Entries
D008954 Models, Biological Theoretical representations that simulate the behavior or activity of biological processes or diseases. For disease models in living animals, DISEASE MODELS, ANIMAL is available. Biological models include the use of mathematical equations, computers, and other electronic equipment. Biological Model,Biological Models,Model, Biological,Models, Biologic,Biologic Model,Biologic Models,Model, Biologic
D011187 Posture The position or physical attitude of the body. Postures
D004599 Electric Stimulation Therapy Application of electric current in treatment without the generation of perceptible heat. It includes electric stimulation of nerves or muscles, passage of current into the body, or use of interrupted current of low intensity to raise the detection threshold of the skin to pain. Electrotherapy,Electrical Stimulation Therapy,Interferential Current Electrotherapy,Therapeutic Electric Stimulation,Therapeutic Electrical Stimulation,Therapy, Electric Stimulation,Electric Stimulation, Therapeutic,Electrical Stimulation, Therapeutic,Electrotherapy, Interferential Current,Stimulation Therapy, Electric,Stimulation Therapy, Electrical,Stimulation, Therapeutic Electric,Stimulation, Therapeutic Electrical,Therapy, Electrical Stimulation
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001696 Biomechanical Phenomena The properties, processes, and behavior of biological systems under the action of mechanical forces. Biomechanics,Kinematics,Biomechanic Phenomena,Mechanobiological Phenomena,Biomechanic,Biomechanic Phenomenas,Phenomena, Biomechanic,Phenomena, Biomechanical,Phenomena, Mechanobiological,Phenomenas, Biomechanic
D013119 Spinal Cord Injuries Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., WOUNDS, GUNSHOT; WHIPLASH INJURIES; etc.). Myelopathy, Traumatic,Injuries, Spinal Cord,Post-Traumatic Myelopathy,Spinal Cord Contusion,Spinal Cord Laceration,Spinal Cord Transection,Spinal Cord Trauma,Contusion, Spinal Cord,Contusions, Spinal Cord,Cord Contusion, Spinal,Cord Contusions, Spinal,Cord Injuries, Spinal,Cord Injury, Spinal,Cord Laceration, Spinal,Cord Lacerations, Spinal,Cord Transection, Spinal,Cord Transections, Spinal,Cord Trauma, Spinal,Cord Traumas, Spinal,Injury, Spinal Cord,Laceration, Spinal Cord,Lacerations, Spinal Cord,Myelopathies, Post-Traumatic,Myelopathies, Traumatic,Myelopathy, Post-Traumatic,Post Traumatic Myelopathy,Post-Traumatic Myelopathies,Spinal Cord Contusions,Spinal Cord Injury,Spinal Cord Lacerations,Spinal Cord Transections,Spinal Cord Traumas,Transection, Spinal Cord,Transections, Spinal Cord,Trauma, Spinal Cord,Traumas, Spinal Cord,Traumatic Myelopathies,Traumatic Myelopathy

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