Restoring Standing and Stepping after Spinal Cord Injury

Spinal cord injury (SCI) resulting in paralysis has an enormous impact not only on the health of the individual, but more fundamentally, on their independence and self-image. Advancements in treatment and rehabilitation strategies have lead to an improvement in the quality of life of these individuals. Physiological systems and current rehabilitative devices are presented along with a series of studies conducted with the goal of developing functional electrical stimulation (FES) techniques for restoring standing and stepping after SCI. Knowledge of natural systems was applied to the development of physiologically-based control strategies and stimulation paradigms to achieve this goal. Intraspinal microstimulation (ISMS) is highlighted; a centrally applied FES technique which taps into some of the physiological characteristics of neuronal recruitment. ISMS results in increased fatigue resistance and more graded force recruitment relative to classical peripheral FES techniques. The studies described here have advanced the development of a FES system for restoring standing and stepping after SCI while also providing insight into the neural control of locomotion.