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

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Abstract

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.

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Acknowledgments

The project described was supported by Grant Number R01NS040547 from NINDS/NIH, and T32AR00750525 from NIAMS/NIH. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIAMS or NIH. The research described here was supported in part by the Department of Veterans Affairs, Veterans Health Administration, Rehabilitation Research and Development Service—Award No. A9259-L. The research was approved by VA IRB #2008-027.

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Authors and Affiliations

  1. Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA

    Raviraj Nataraj & Ronald J. Triolo

  2. Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA

    Musa L. Audu & Ronald J. Triolo

  3. Advanced Platform Technology Center, Cleveland Louis Stokes Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, USA

    Raviraj Nataraj, Musa L. Audu & Ronald J. Triolo

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  1. Raviraj Nataraj
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  2. Musa L. Audu
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  3. Ronald J. Triolo
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Correspondence to Raviraj Nataraj.

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Nataraj, R., Audu, M.L. & Triolo, R.J. Simulating the restoration of standing balance at leaning postures with functional neuromuscular stimulation following spinal cord injury. Med Biol Eng Comput 54, 163–176 (2016). https://doi.org/10.1007/s11517-015-1377-5

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  • DOI: https://doi.org/10.1007/s11517-015-1377-5

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