Article

OBJECTIVES: To explore and quantify the physical and functional effects of
stabilizing the torso with electrical stimulation of the paralyzed hip and trunk
musculature after motor complete tetraplegia. DESIGN: Single-subject case study
with repeated measures and concurrent controls. SETTING: Academic outpatient
rehabilitation center. PARTICIPANTS: Forty-four-year-old man with C4 American
Spinal Injury Association grade A tetraplegia 20 years postspinal cord injury.
INTERVENTION: A surgically implanted multichannel pulse generator and
intramuscular stimulating electrodes to activate lumbar erector spinae, quadratus
lumborum, and gluteus maximus muscles bilaterally. MAIN OUTCOME MEASURES:
Outcomes assessed with and without stimulation included (1) spinal alignment and
pelvic orientation, (2) pulmonary function and ventilatory volumes, (3) forward
bimanual reaching distance, (4) seated stability and resistance to externally
applied disturbances, (5) maximal force and speed of rowing-like movements, and
the ability to (6) independently return to an erect seated position from full
forward or lateral flexion and (7) roll in bed without assistance. RESULTS:
Stimulation improved spinal convexity and kyphosis by 26 degrees and 21 degrees ,
reduced posterior pelvic tilt by 11 degrees , increased forced expiratory volume
and vital capacity by 10% and 22%, and improved forward reach by more than 7cm.
Average resistance to sagittal disturbances increased by more than 40% (P<.002),
and mean force exerted during underhanded pulling more than doubled (P=.014) with
stimulation. Restoration of upright sitting in both sagittal and coronal planes
and bed turning was made possible through appropriately timed activation of the
hip and trunk muscles. CONCLUSIONS: A neuroprosthesis for controlling the
paralyzed torso can positively impact spinal alignment, seated posture, pulmonary
function, trunk stability, and reach. Stimulation of hip and trunk muscles can
improve performance of activities of daily living as well as enable independent
wheelchair and bed mobility.

Langue : ANGLAIS