title: A neuroprosthesis for control of seated balance after spinal cord injury.
abstract: BACKGROUND
  A major desire of individuals with spinal cord injury (SCI) is the ability to maintain a stable trunk while in a seated position. Such stability is invaluable during many activities of daily living (ADL) such as regular work in the home and office environments, wheelchair propulsion and driving a vehicle. Functional neuromuscular stimulation (FNS) has the ability to restore function to paralyzed muscles by application of measured low-level currents to the nerves serving those muscles.
  
  
  METHODS
  A feedback control system for maintaining seated balance under external perturbations was designed and tested in individuals with thoracic and cervical level spinal cord injuries. The control system relied on a signal related to the tilt of the trunk from the vertical position (which varied between 1.0 ≡ erect posture and 0.0 ≡ most forward flexed posture) derived from a sensor fixed to the sternum to activate the user's own hip and trunk extensor muscles via an implanted neuroprosthesis. A proportional-derivative controller modulated stimulation between trunk tilt values indicating deviation from the erect posture and maximum desired forward flexion. Tests were carried out with external perturbation forces set at 35%, 40% and 45% body-weight (BW) and maximal forward trunk tilt flexion thresholds set at 0.85, 0.75 and 0.70.
  
  
  RESULTS
  Preliminary tests in a case series of five subjects show that the controller could maintain trunk stability in the sagittal plane for perturbations up to 45% of body weight and for flexion thresholds as low as 0.7. The mean settling time varied across subjects from 0.5(±0.4) and 2.0 (±1.1) seconds. Mean response time of the feedback control system varied from 393(±38) ms and 536(±84) ms across the cohort.
  
  
  CONCLUSIONS
  The results show the high potential for robust control of seated balance against nominal perturbations in individuals with spinal cord injury and indicates that trunk control with FNS is a promising intervention for individuals with SCI.
authors.affiliation: Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA. mxa93@case.edu.
authors.forename: Musa L
authors.initials: ML
authors.lastname: Audu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lombardo
authors.forename: John R
authors.initials: JR
authors.lastname: Schnellenberger
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Foglyano
authors.forename: Michael E
authors.initials: ME
authors.lastname: Miller
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Triolo
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000465:Algorithms; D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000293:injuries; D004558:Electric Stimulation; D025461:Feedback, Physiological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology; D058117:Neural Prostheses; D010243:Paralysis / Q000503:physiopathology / Q000534:rehabilitation; D004856:Postural Balance; D011930:Reaction Time; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D013904:Thoracic Vertebrae / Q000293:injuries; D060726:Torso / Q000503:physiopathology