title: Comparing joint kinematics and center of mass acceleration as feedback for control of standing balance by functional neuromuscular stimulation.
abstract: BACKGROUND
  The purpose of this study was to determine the comparative effectiveness of feedback control systems for maintaining standing balance based on joint kinematics or total body center of mass (COM) acceleration, and assess their clinical practicality for standing neuroprostheses after spinal cord injury (SCI).
  
  
  METHODS
  In simulation, controller performance was measured according to the upper extremity effort required to stabilize a three-dimensional model of bipedal standing against a variety of postural disturbances. Three cases were investigated: proportional-derivative control based on joint kinematics alone, COM acceleration feedback alone, and combined joint kinematics and COM acceleration feedback. Additionally, pilot data was collected during external perturbations of an individual with SCI standing with functional neuromuscular stimulation (FNS), and the resulting joint kinematics and COM acceleration data was analyzed.
  
  
  RESULTS
  Compared to the baseline case of maximal constant muscle excitations, the three control systems reduced the mean upper extremity loading by 51%, 43% and 56%, respectively against external force-pulse perturbations. Controller robustness was defined as the degradation in performance with increasing levels of input errors expected with clinical deployment of sensor-based feedback. At error levels typical for body-mounted inertial sensors, performance degradation due to sensor noise and placement were negligible. However, at typical tracking error levels, performance could degrade as much as 86% for joint kinematics feedback and 35% for COM acceleration feedback. Pilot data indicated that COM acceleration could be estimated with a few well-placed sensors and efficiently captures information related to movement synergies observed during perturbed bipedal standing following SCI.
  
  
  CONCLUSIONS
  Overall, COM acceleration feedback may be a more feasible solution for control of standing with FNS given its superior robustness and small number of inputs required.
authors.affiliation: Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA. raviraj.nataraj@gmail.com
authors.forename: Raviraj
authors.initials: R
authors.lastname: Nataraj
authors.forename: Musa L
authors.initials: ML
authors.lastname: Audu
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Triolo
mesh_terms: D000054:Acceleration; D000465:Algorithms; D001676:Biofeedback, Psychology / Q000379:methods*; D001696:Biomechanical Phenomena; D003627:Data Interpretation, Statistical; D004558:Electric Stimulation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007596:Joints / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology; D010865:Pilot Projects; D004856:Postural Balance / Q000502:physiology*; D025341:Principal Component Analysis; D011597:Psychomotor Performance / Q000502:physiology; D015203:Reproducibility of Results; D013119:Spinal Cord Injuries / Q000534:rehabilitation; D034941:Upper Extremity