Automatic application of neural stimulation during wheelchair propulsion after SCI enhances recovery of upright sitting from destabilizing events

Armstrong, Kiley; Lombardo, Lisa M.; Foglyano, Kevin M.; Audu, Musa L.; Triolo, Ronald J.

doi:10.1186/s12984-018-0362-2

Cited by 15 publications

(9 citation statements)

References 37 publications

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“…Returning the subject to an upright stable posture faster after a reach will reduce the length of time in an unstable posture. In instances with possible falls it is also crucial to restore upright sitting as fast as possible [ 21 , 42 ]. The return to upright movements are likely a combination of eccentric and concentric contractions.…”

Section: Discussionmentioning

confidence: 99%

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

Friederich

Bao

Triolo

et al. 2022

J NeuroEngineering Rehabil

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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.

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Section: Discussionmentioning

confidence: 99%

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

Friederich

Bao

Triolo

et al. 2022

J NeuroEngineering Rehabil

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“…Subjects had received 8-channel implanted receiver stimulators 23 or 16-channel implanted stimulator telemeters 24 for ongoing studies in our laboratory of seated trunk control, [5][6][7] standing balance, 25 or new nerve cuff electrodes. 26 The implanted neuroprostheses were approved for experimental use by Investigational Device Exemptions from the US Food and Drug Administration, and all study procedures were approved by the institutional review board of the Louis Stokes Cleveland VA Medical Center with written consent obtained from all subjects (Clinical Trial Registry Number: NCT01474148).…”

Section: Participantsmentioning

confidence: 99%

“…Chronic MWC users with SCI have high prevalence of shoulder pathology, 2,3 and wheelchair propulsion can contribute to lower quality of life because of back pain. 4 Neural stimulation to the hips and spine can provide seated stability, 5 restore an upright position from forward leaning postures, 6,7 and make upper limb movements more efficient. 8,9 Constant low-level activation of the hip and trunk extensors can reduce peak resultant pushrim forces of up to 26% and improved efficiency up to 22% 10 at preferred speed on level ground.…”

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confidence: 99%

Effect of Context-Dependent Modulation of Trunk Muscle Activity on Manual Wheelchair Propulsion

Bailey

Foglyano

Bean

et al. 2021

Am J Phys Med Rehabil

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Objective The aims of the study were to reliably determine the two main phases of manual wheelchair propulsion via a simple wearable sensor and to evaluate the effects of modulated trunk and hip stimulation on manual wheelchair propulsion during the challenging tasks of ramp assent and level sprint. Design An offline tool was created to identify common features between wrist acceleration signals for all subjects who corresponded to the transitions between the contact and recovery phases of manual wheelchair propulsion. For one individual, the acceleration rules and thresholds were implemented for real-time phase-change event detection and modulation of stimulation. Results When pushing with phase-dependent modulated stimulation, there was a significant (P < 0.05) increase in the primary speed variable (5%–6%) and the subject rated pushing as “moderately or very easy.” In the offline analysis, the average phase-change event detection success rate was 79% at the end of contact and 71% at the end of recovery across the group. Conclusions Signals from simple, wrist-mounted accelerometers can detect the phase transitions during manual wheelchair propulsion instead of elaborate and expensive, instrumented systems. Appropriately timing changes in muscle activation with the propulsion cycle can result in a significant increase in speed, and the system was consistently perceived to be significantly easier to use.

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“…Application of NMES has been successfully used to generate trunk muscle contractions, as well as to improve spinal alignment, sitting posture, trunk stability, and reaching ability in individuals with spinal cord injury (Kukke and Triolo 2004 ; Triolo et al 2009 ). Moreover, NMES applications were used to stabilize the trunk during wheelchair perturbations, which can also prevent falls and injuries (Patel et al 2017 ; Armstrong et al 2018 ). While prosthetic NMES application has been applied successfully in clinical settings, it remains unclear how short-duration (< 20 min) NMES of the trunk muscles affects the intact central nervous system excitability.…”

Section: Introductionmentioning

confidence: 99%

Effects of trunk neuromuscular electrical stimulation on the motor circuits of able-bodied individuals

et al. 2023

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Upper- and lower-limb neuromuscular electrical stimulation (NMES) is known to modulate the excitability of the neural motor circuits. However, it remains unclear whether short-duration trunk muscle NMES could achieve similar neuromodulation effects. We assessed motor evoked potentials (MEPs) elicited through transcranial magnetic stimulation of the primary motor cortex representation of the trunk extensor muscles to evaluate corticospinal excitability. Moreover, cervicomedullary motor evoked potentials (CMEPs) were assessed through cervicomedullary junction magnetic stimulation to evaluate subcortical excitability. Twelve able-bodied individuals participated in the MEP study, and another twelve in the CMEP study. During the interventions, NMES was applied bilaterally to activate the erector spinae muscle and produce intermittent contractions (20 s ON/20 s OFF) for a total of 20 min while participants remained seated. Assessments were performed: (i) before; (ii) during (in brief periods when NMES was OFF); and (iii) immediately after the interventions to compare MEP or CMEP excitability. Our results showed that MEP responses were not affected by trunk NMES, while CMEP responses were facilitated for approximately 8 min during the intervention, and returned to baseline before the end of the 20 min stimulating period. Our findings therefore suggest that short-duration NMES of the trunk extensor muscles likely does not affect the corticospinal excitability, but it has a potential to facilitate subcortical neural circuits immediately after starting the intervention. These findings indicate that short-duration application of NEMS may be helpful in rehabilitation to enhance neuromodulation of the trunk subcortical neural motor circuits.

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Automatic application of neural stimulation during wheelchair propulsion after SCI enhances recovery of upright sitting from destabilizing events

Cited by 15 publications

References 37 publications

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

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

Effect of Context-Dependent Modulation of Trunk Muscle Activity on Manual Wheelchair Propulsion

Effects of trunk neuromuscular electrical stimulation on the motor circuits of able-bodied individuals

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