Restoring standing capabilities with feedback control of functional neuromuscular stimulation following spinal cord injury. 2017

Raviraj Nataraj, and Musa L Audu, and Ronald J Triolo
Department of Orthopaedics, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA; Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, USA; Department of Biomedical Engineering, Chemistry and Biological Sciences, Stevens Institute of Technology, 1 Castle Point Terrace, Hoboken, NJ 07030, USA. Electronic address: raviraj.nataraj@gmail.com.

This paper reviews the field of feedback control for neuroprosthesis systems that restore advanced standing function to individuals with spinal cord injury. Investigations into closed-loop control of standing by functional neuromuscular stimulation (FNS) have spanned three decades. The ultimate goal for FNS standing control systems is to facilitate hands free standing and enabling the user to perform manual functions at self-selected leaning positions. However, most clinical systems for home usage currently only provide basic upright standing using preprogrammed stimulation patterns. To date, online modulation of stimulation to produce advanced standing functions such as balance against postural disturbances or the ability to assume leaning postures have been limited to simulation and laboratory investigations. While great technological advances have been made in biomechanical sensing and interfaces for neuromuscular stimulation, further progress is still required for finer motor control by FNS. Another major challenge is the development of sophisticated control schemes that produce the necessary postural adjustments, adapt against accelerating muscle fatigue, and consider volitional actions of the intact upper-body of the user. Model-based development for novel control schemes are proven and sensible approaches to prototype and test the basic operating efficacy of potentially complex and multi-faceted control systems. The major considerations for further innovation of such systems are summarized in this paper prior to describing the evolution of closed-loop FNS control of standing from previous works. Finally, necessary emerging technologies to for implementing FNS feedback control systems for standing are identified. These technological advancements include novel electrodes that more completely and selectively activate paralyzed musculature and implantable sensors and stimulation modules for flexible neuroprosthesis system deployment.

UI MeSH Term Description Entries
D009132 Muscles Contractile tissue that produces movement in animals. Muscle Tissue,Muscle,Muscle Tissues,Tissue, Muscle,Tissues, Muscle
D004856 Postural Balance A POSTURE in which an ideal body mass distribution is achieved. Postural balance provides the body carriage stability and conditions for normal functions in stationary position or in movement, such as sitting, standing, or walking. Postural Control,Posture Balance,Posture Control,Posture Equilibrium,Balance, Postural,Musculoskeletal Equilibrium,Postural Equilibrium,Balance, Posture,Control, Postural,Control, Posture,Equilibrium, Musculoskeletal,Equilibrium, Postural,Equilibrium, Posture,Postural Controls,Posture Balances,Posture Controls,Posture Equilibriums
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
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
D058765 Neurofeedback A technique to self-regulate brain activities provided as a feedback in order to better control or enhance one's own performance, control or function. This is done by trying to bring brain activities into a range associated with a desired brain function or status. Alpha Biofeedback,Alpha Feedback,Brainwave Biofeedback,Brainwave Feedback,EEG Feedback,Electroencephalography Biofeedback,Electromyography Feedback,Alpha Biofeedbacks,Alpha Feedbacks,Biofeedback, Alpha,Biofeedback, Brainwave,Biofeedback, Electroencephalography,Biofeedbacks, Alpha,Biofeedbacks, Brainwave,Biofeedbacks, Electroencephalography,Brainwave Biofeedbacks,Brainwave Feedbacks,EEG Feedbacks,Electroencephalography Biofeedbacks,Feedback, Alpha,Feedback, Brainwave,Feedback, EEG,Feedbacks, Alpha,Feedbacks, Brainwave,Feedbacks, EEG,Neurofeedbacks
D019736 Prostheses and Implants Artificial substitutes for body parts, and materials inserted into tissue for functional, cosmetic, or therapeutic purposes. Prostheses can be functional, as in the case of artificial arms and legs, or cosmetic, as in the case of an artificial eye. Implants, all surgically inserted or grafted into the body, tend to be used therapeutically. IMPLANTS, EXPERIMENTAL is available for those used experimentally. Implants, Artificial,Prostheses and Implant,Prosthesis,Prosthetic Implant,Endoprostheses,Endoprosthesis,Prostheses,Prosthetic Implants,Artificial Implant,Artificial Implants,Implant and Prostheses,Implant, Artificial,Implant, Prosthetic,Implants and Prostheses,Implants, Prosthetic

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