Above- and below-lesion EMG pattern mapping for controlling electrical stimulation of paraplegics to facilitate...

We describe and evaluate above- and below-lesion EMG control of functional electrical stimulation (FES) in upper motor neuron paraplegics, in order to provide them with a patient-responsive system for walking with a walker support. Control is considered in terms of a combination of above-lesion EMG control and below-lesion response-EMG control. The above-lesion EMG is used to control the activation of limb functions involved in standing up and walking with FES, control being accomplished by analysing raw surface-EMG time-series patterns to discriminate between upper-trunk muscle contraction patterns, which in turn, are correlated with intended lower-limb functions involved in walking, so that natural and instinctive balance changes in paraplegics are controlled by the patient from above the lesion. The below-lesion response-EMG is the EMG produced in response to the FES pulses at the stimulation sites, for adjusting stimulation levels as needed when contractions weaken due to muscle fatigue. Above-lesion EMG is a stochastic (random-like) signal, being a response to unsynchronized motor neuron firings, whereas the below-lesion EMG is a deterministic signal responding to synchronized firings that result solely from the FES pulses. We also discuss the merits and difficulties of EMG control, and evaluate patient performance under such control, noting that FES-activated walking without adequate and patient-responsive control is of very limited use to paraplegics.