Hybrid functional electrical stimulation for energy-efficient restoration of standing-up motion

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.