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Standing by Functional Neuromuscular Stimulation


Principal InvestigatorAffiliationContract NumberLink
Ron Triolo, Ph.D.Case Western Reserve Univ.N01-NS6-2351


The Neural Prosthesis Program (NPP) of the National Institute of Neurological Disorders and Stroke supports research and development on systems to restore function in neurologically impaired individuals through functional neuromuscular stimulation (FNS). Clinical research supported by the NPP has resulted in functional upper extremity systems for quadriplegic individuals. This initiative will conduct research on a system for people afflicted with paraplegia that would allow them to independently rise and remain standing so that they can do activities that they cannot accomplish in a wheelchair.

Specifically, the feasibility of developing a splint-free, low-energy standing system through FNS will be investigated. The goal is to develop a system that permits an individual to rise and stand for periods of at least 20 minutes and then sit again unassisted. Standing must be maintained without requiring exhausting muscular exertion or significant conscious attention to maintain balance. The system must also leave the hands and arms free for other tasks. Recent progress in the development of biomechanical models of standing and walking and in the development of solid-state sensors including multiple axes accelerometers and miniature gyroscopes combined with continued progress in FNS makes this a promising area for research at this time.

A bibliography listing publications from related studies supported by the NPP is available free of charge from the Neural Prosthesis Program, NIH, Federal Building, Room 916, Bethesda, MD 20892-9170 (fax: 301 402-1501, e-mail


Independently, and not as an agent of the Government, the contractor shall exert its best efforts to demonstrate the feasibility of a splint-free, low-energy standing system for paraplegic individuals.

Specifically, the contractor shall:

A. Obtain or develop a biomechanical model of the body including the ankle, knee, hip, and trunk that is suitable for modeling sit-stand and stand-sit transitions and standing.

1. The model shall include the actions of FNS on the muscles needed for these activities.

2. The model shall include simulated, body mounted sensors.

3. The model shall simulate closed-loop control of these activities using the sensors and FNS.

4. The model shall include methods for estimating energy expenditure during the standing activity.

B. Using the model of A.) as a starting point, design and implement a system of sensors and electrically stimulated muscles to effect stable standing with minimal energy expenditure.

C. Demonstrate in human paraplegic volunteers using the FNS system designed in B.), functional standing for periods of at least 20 minutes.

1. Stable standing shall be accomplished without the use of any orthotic bracing to the trunk, hip, knee or ankle.

2. Standing shall permit free use of the arms in lifting and moving loads of at least two kilograms.

3. The stability of the standing position shall be such that it will resist external destabilizing forces reasonably encountered in daily activity.

4. Muscular energy expenditure, as measured by oxygen consumption above the basal metabolic rate, shall not exceed two times the muscular energy expenditure required for standing in normal individuals.

5. Consideration shall be given to minimizing the risk of injury in the event of an unexpected disturbance that results in a fall.

D. Using the model of A.) as a starting point, design and implement a system of sensors and electrically stimulated muscles that, combined with the voluntary use of upper body musculature, can effect unassisted sit-to-stand and stand-to-sit transitions in paraplegic individuals.

Last Modified November 24, 2008