Accessibility and mobility remain a problem for many paraplegic individuals despite great advances in spinal cord injured longevity and passage of the Americans with Disabilities Act. To be able to access restrooms and other areas of limited accessibility, to visit the home of a friend without having to be carried, to stand in a meeting and present one's views, and to participate fully in walking ceremonies are currently unrealistic goals. Lack of weight bearing makes bones weak and easily broken, and lack of use of joints allows them to become contracted and unable to move. Atrophic muscles fail to provide protection to the skin and bones, and pressure sores are common. Braces alone allow standing and walking but are inconvenient, labor-intensive, slow and confined to level surfaces. Functional neural stimulation (FNS) has accomplished laboratory demonstration of standing, walking over a meter per second, and stair climbing, but requires 48 channels and excessive amounts of energy. The CWRU hybrid prototype walking system has demonstrated functional mobility with only 8-16 channels of stimulation but needs further development. This proposal extends the combination of the 8 to 16 channel implanted muscle stimulator with a trunk-hip-knee-ankle-foot orthosis with programmable joint locks to provide more immediate mobility to paraplegic individuals and to allow the study of a functional mobility system requiring 8 channels instead of 48. This allows testing of implantable devices currently available through this research. The proposal couples the FNS, mechanics, control systems, and spinal surgical expertise of CWRU with the orthotics expertise of NYU and Stanford. The major contribution to previous work is the use of implantable stimulation to allow independent access to the muscles necessary for stair climbing, including the hip flexors. Additionally, the proposal extends the concept of programmable braking of brace joints.
| Medeiros, R C; Jaccard, A P B; Cliquet Jr, A (2012) Postural bipedance in paraplegics under neuromuscular electrical stimulation: is it possible to improve it based on sagittal spinal alignment? Spinal Cord 50:309-14 |
| Kobetic, Rudi; Marsolais, E Byron; Triolo, Ronald J et al. (2003) Development of a hybrid gait orthosis: a case report. J Spinal Cord Med 26:254-8 |
| Marsolais, E B; Kobetic, R; Polando, G et al. (2000) The Case Western Reserve University hybrid gait orthosis. J Spinal Cord Med 23:100-8 |
| Ferguson, K A; Polando, G; Kobetic, R et al. (1999) Walking with a hybrid orthosis system. Spinal Cord 37:800-4 |
