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Posture shifting after spinal cord injury using functional neuromuscular stimulation--a computer simulation study.

Musa L Audu1, Raviraj Nataraj, Steven J Gartman

  • 1Department of Biomedical Engineering and Orthopedics, Case Western Reserve University, Cleveland, OH 44106, USA. musa@case.edu

Journal of Biomechanics
|May 4, 2011
PubMed
Summary

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Spinal cord injury (SCI) patients can improve standing posture control using functional neuromuscular stimulation (FNS). Targeted muscle activation in the trunk and lower extremities (LE) minimizes upper extremity (UE) effort, enhancing reach and work volume.

Area of Science:

  • Biomechanics
  • Neurorehabilitation
  • Computational Modeling

Background:

  • Individuals with spinal cord injury (SCI) often face challenges maintaining stable standing posture.
  • Functional neuromuscular stimulation (FNS) offers a potential avenue for restoring motor function in SCI.
  • Understanding the biomechanical requirements for postural control is crucial for developing effective FNS strategies.

Purpose of the Study:

  • To explore the ability of individuals with SCI to alter standing posture using FNS.
  • To identify optimal muscle activation patterns for postural control with minimal upper extremity (UE) support.
  • To investigate the role of trunk and lower extremity (LE) muscles in enabling postural shifts.

Main Methods:

  • Anatomically inspired musculoskeletal model of the trunk, pelvis, and LE was utilized.

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  • Dynamic optimization determined muscle excitations for anterior and lateral postural shifts.
  • UE forces simulating assistive device interaction were incorporated (<10% body-weight).
  • Nine different muscle activation sets were evaluated.

    • Main Results:

    • Activating the Psoas and External Obliques bilaterally minimized UE effort for anterior shifts (5.4% BW).
    • Activating the Psoas and Latissimus Dorsi bilaterally optimized performance for lateral shifts (3.3% BW).
    • Psoas activation alone bilaterally showed favorable overall performance across both maneuvers.

    Conclusions:

    • Targeted FNS of specific trunk and LE muscles can enable SCI individuals to modify standing posture.
    • Minimal upper body effort is achievable, potentially increasing functional reach and standing work capacity.
    • This approach holds promise for improving independence and quality of life for individuals with SCI.