Journal Article

Feedback control of upright seating with functional neuromuscular stimulation during a reaching task after spinal cord injury: a feasibility study

Bao, Xuefeng, Friederich, Aidan R. W., Triolo, Ronald J., Audu, Musa L.

2022

Overview

Background Restoring or improving seated stability after spinal cord injury (SCI) can improve the ability to perform activities of daily living by providing a dynamic, yet stable, base for upper extremity motion. Seated stability can be obtained with activation of the otherwise paralyzed trunk and hip musculature with neural stimulation, which has been shown to extend upper limb reach and improve seated posture. Methods We implemented a proportional, integral, derivative (PID) controller to maintain upright seated posture by simultaneously modulating both forward flexion and lateral bending with functional neuromuscular stimulation. The controller was tested with a functional reaching task meant to require trunk movements and impart internal perturbations through rapid changes in inertia due to acquiring, moving, and replacing objects with one upper extremity. Five subjects with SCI at various injury levels who had received implanted stimulators targeting their trunk and hip muscles participated in the study. Each subject was asked to move a weighted jar radially from a center home station to one of three target stations. The task was performed with the controller active, inactive, or with a constant low level of neural stimulation. Trunk pitch (flexion) and roll (lateral bending) angles were measured with motion capture and plotted against each other to generate elliptical movement profiles for each task and condition. Postural sway was quantified by calculating the ellipse area. Additionally, the mean effective reach (distance between the shoulder and wrist) and the time required to return to an upright posture was determined during reaching movements. Results Postural sway was reduced by the controller in two of the subjects, and mean effective reach was increased in three subjects and decreased for one. Analysis of the major direction of motion showed return to upright movements were quickened by 0.17 to 0.32 s. A 15 to 25% improvement over low/no stimulation was observed for four subjects. Conclusion These results suggest that feedback control of neural stimulation is a viable way to maintain upright seated posture by facilitating trunk movements necessary to complete reaching tasks in individuals with SCI. Replication of these findings on a larger number of subjects would be necessary for generalization to the various segments of the SCI population.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Accelerometers / Activities of Daily Living / Biomedical and Life Sciences / Biomedical Engineering and Bioengineering / Biomedicine / Care and treatment / Control systems / Controllers / Dynamic stability / Feasibility Studies / Feedback / Feedback control / Feedback control systems / Functional neuromuscular stimulation / Hip / Humans / Methods / Motion capture / Motion stability / Movement disorders / Muscles / Musculoskeletal / Neural stimulation / Neurology / Neuroprosthesis / Neurosciences / Perturbation / Physical Therapy Modalities / Pitch (inclination) / Posture / Posture - physiology / Proportional integral derivative / Quality of life / Rehabilitation Medicine / Rolling motion / Seated stability / Spinal Cord Injuries / Spinal cord injury / Stimulation / Stimulators / Wheelchairs / Wrist