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Hybrid functional electrical stimulation for energy-efficient restoration of standing-up motion
S Miyamoto1, Y Shimada, K Sato
1Department of Orthopedic Surgery, Akita University School of Medicine, Akita City, Japan.
Objective:
To find the most energy-efficient standing-up motion for quadriceps and to restore that motion in a person with complete paraplegia by using hybrid functional electrical stimulation.
Design:
Nonrandomized control trial.
Setting:
A referral center and institutional practice providing outpatient care.
Participants:
Twenty-nine volunteer samples were used to collect normal data. One patient with complete paraplegia received treatment for the restoration of standing-up motion.
Main Outcome Measurements:
Joint angles and ground reaction forces were investigated during the standing-up motion with arms crossed in front of the chest with an ankle-foot orthosis set at various angles. The electromyogram (EMG) was performed during the standing-up motion with and without the orthosis. The energy costs of quadriceps during the standing-up motion were calculated using a mathematical model. Standing-up motion in a person with complete paraplegia was restored and then analyzed by measuring the vertical ground reaction force and the hip and knee angles.
Results:
Quadriceps energy cost was lowest (p < .05) in subjects wearing the ankle-foot orthosis set at neutral with a flat sole line. In the integrated EMG the peak value of rectus femoris contraction was larger with the orthosis than without it (p < .05). A patient with complete paraplegia was able to stand up smoothly from a wheelchair based on stimulation patterns obtained from healthy subjects.
Conclusions:
Energy-efficient standing-up motion in a patient with complete paraplegia was restored when the patient used an ankle-foot orthosis set at neutral with a flat sole line.