The authors acknowledge and appreciate&#160;all the SCI volunteers who participated in this study. This research was supported by the Ministry of Higher Education, Malaysia, and the University of Malaya through Fundamental Research Grant Scheme (FRGS) Grant No.&#160;FP002-2020;&#160;FRGS/1/2020/SKK0/UM/02/1.

The SitTS exercise and informed consent in this manuscript are described under ethical consideration by University of Malaya Medical Centre Ethics Committee (2017119-4828)12. Study procedures were explained in detail to each participant, and written informed consent was obtained before beginning the SitTS trial. This study was conducted as mixed-mode, where quantitative data were obtained using biomechanical analysis, whereas subjective scores were obtained from feedback sessions (of the participants) and audio recordings (of the researcher-participants interactions during the study). This pilot study compared the participant&#39;s contributions of arms and legs in SitTS exercise voluntarily versus their performance with the presence of FES.
1. Participants selection
<ol>
	<li>Perform an evaluation with potential SCI participants.
	<ol>
		<li>Explain the details of the SitTS protocol, including the length of study (4 days) and length of session (SitTS: 2 h). 
		NOTE: Voluntary SitTS was conducted on Day 1, followed by rest for 2 days. Functional electrical stimulation (FES)-assisted SitTS is then continued on the next day and defined as Day 2.</li>
		<li>Describe the medical requirements to the potential participant, including male or female with SCI AIS C&#160;(who can stand up), 18-60 years old, greater than 12-month post-injury, and demonstrate a willingness to wear specific clothes. 
		NOTE: SCI AIS C participants provided written, informed consent to volunteer in this study. Participant 1 was a male (45 years; Body Mass Index (BMI) 20.32 kg/m2) and Participant 2 was a female (49 years; BMI 33.54 kg/m2). Both of them presented 95 months and 33 months after the SCI injury, respectively. Both participants had their lower extremities (LE) muscle grade assessed. The LE muscle grade of Participant 1 were 2 (right side) and 4 (left side). Meanwhile, Participant 2 had LE muscle grade of 4 bilaterally12. Both participants had good trunk control. Participant 1 was diagnosed with a flaccid right leg with absent knee and ankle reflexes indicating a lower motor neuron injury. Besides that, his right leg was observed not to show any response to FES.</li>
		<li>Describe the exclusion criteria to the potential participants, including medical conditions that would cause them to fail in completing the instructions during the study. Other exemption criteria include participants that have osteoporosis and bone fracture12, cardiac pacemaker or other implanted electronic system, had existing electrical stimulation device (implantable cardioverter defibrillator, pacemaker, or spinal stimulation) or had botulinum toxin.</li>
	</ol>
	</li>
</ol>
2. SitTS experimental setup
NOTE: In this SitTS exercise, three parameters will be recorded. The first parameter is arms force and the second parameter is legs force. The third parameter is mechanomyography (MMG) which looks at the rectus femoris muscle activity.
<ol>
	<li>Chair and SF setup.
	<ol>
		<li>Design an armless chair with a height of 45 cm13,14 without a backrest according to the dimension of force plate 1 embedded in the floor of the motion analysis laboratory (Figure 1).</li>
		<li>Place the chair on the top of the force plate 1.</li>
		<li>Instrument each SF leg independently with force sensor15 at the bottom of SF&#39;s leg given the sensitive range of each sensor is from 0-12 kg (Figure 2). 
		NOTE: The sum values of four force sensor readings from SF were referred to as the arms force contribution.</li>
		<li>Position a portable and foldable SF in front of the chair within arm&#39;s reach12. Position four legs of the SF securely outside of force plate 2 to avoid double measurements (Figure 1).</li>
	</ol>
	</li>
	<li>Motion analysis setup
	<ol>
		<li>Enter participant&#39;s details (i.e., leg length, ankle width, knee width) in the motion analysis system.</li>
		<li>Place sixteen reflective markers on the participant&#39;s lower limbs with double-sided tape as mentioned in steps 2.2.3-2.2.5.</li>
		<li>Attach these markers directly over the bilateral anterior and posterior of the superior iliac spine. Second, attach markers on the lateral epicondyle of the left and right knee.</li>
		<li>Attach the marker over the lateral surface of the bilateral thigh and shank. Next, attach a marker on the lateral left and right malleolus.</li>
		<li>Attach markers over the left and right of the second metatarsal head. Attach the markers on the calcaneus at the same height of the second metatarsal head. 
		NOTE: The placement of reflective markers is based on the setup of the motion analysis system16.</li>
	</ol>
	</li>
	<li>Participant&#39;s preparation
	<ol>
		<li>Instruct the participant to be seated with their knees flexed at 90&#176; with both feet positioned on force plate 2.</li>
		<li>Ensure the participant&#39;s head and trunk are faced forward while sitting in an upright position. Ensure the participant is barefooted.</li>
		<li>Place hands on the handle of the SF.</li>
		<li>Identify the rectus femoris muscle by palpating the middle and bulky area of the thigh.</li>
		<li>Place two MMG sensors at the thigh area of the rectus femoris muscle bilaterally, one MMG per leg, to accurately measure the leg muscles&#39; sit-to-stand and stand-to-sit efforts12.</li>
		<li>Secure the sensors with a double-sided tape. Strap the MMG sensors around the thigh to reduce motion artefacts12.</li>
		<li>Connect the MMG sensors to the MMG device and the computer.</li>
	</ol>
	</li>
</ol>
3. SitTS protocol
<ol>
	<li>Day 1: Perform voluntary SitTS exercise. 
	NOTE: Participants were instructed to do a repetitive SitTS event with the assistance of the SF.
	<ol>
		<li>Before the experiment starts, ensure to turn on all setups to record the selected parameters. 
		NOTE: The parameters recorded were force sensors for upper limb contribution, force plate for lower limb contribution, and MMG data for muscle rectus femoris activity.</li>
		<li>Ask the participant to stand up from the stationary sitting position at the end of a countdown of 5 s timed by an electronic timer.</li>
		<li>Let the participant stand for 3 s and then sit back on the chair.</li>
		<li>Ask the participant to rest for 5 s. 
		NOTE: This was the resting interval in between the trials.</li>
		<li>Continue to do SitTS trials (repeat steps 3.1.2 and 3.1.4 until the participant cannot perform the same routine any longer).</li>
		<li>Turn off all the recorded data.</li>
		<li>Then, ask the participant to rest for 5 min before continuing the next set of the SitTS routine. Give 5 min break in between sets to provide muscle recovery amongst sets17.</li>
		<li>Repeat steps 3.1.1-3.1.7 for another two sets.</li>
		<li>Allow the participant to rest for at least 48 h.</li>
	</ol>
	</li>
	<li>Day 2: Perform FES-assisted SitTS exercise. 
	NOTE: Participants were instructed to do repetitive SitTS events with the assistance of the SF and FES.
	<ol>
		<li>Place FES electrodes on quadriceps and gluteus maximus muscles18.</li>
		<li>For quadriceps muscle, place the first electrode horizontally about two finger widths above the knee. Position the second electrode horizontally about a palm width below the hip joint.</li>
		<li>For the gluteus maximus muscle, ask the participant to bend forward and place the first electrode vertically closest to the hip bone. Attach the second electrode vertically closest to the tail bone, side by side from the first electrode.</li>
		<li>Attach all FES electrodes to the FES device and connect them to the FES software in the computer.</li>
		<li>Set up the FES software by selecting the pulse width of 300 and the frequency of 35 Hz.</li>
		<li>Define the FES current intensity by asking the participant if they can tolerate the current given to achieve knee and hip extension7. Determine the FES current amplitude through a number of practices before starting the actual trial. 
		NOTE: Table 1 shows the FES current stimulated towards the participants&#39; selected muscles during assisted FES SitTS session.</li>
		<li>Before the experiment starts, ensure to turn on all setups to record the selected parameters.</li>
		<li>Ask the participant to stand up from the stationary sitting position at the end of a countdown of 5 s timed by an electronic timer. At the end of the countdown, switch on the FES.</li>
		<li>Let the participant stand for 3 s. Then switch off the FES and let the participant sit back on the chair.</li>
		<li>Ask the participant to rest for 5 s.</li>
		<li>Continue to do SitTS trials (repeat steps 3.2.7-3.2.10 until the participant cannot perform the same routine any longer).</li>
		<li>Turn off all the recorded data.</li>
		<li>Then, ask the participant to rest for 5 min before continuing the next set of the SitTS routine.</li>
		<li>Repeat steps 3.2.7-3.2.13 for another two sets.</li>
	</ol>
	</li>
</ol>
4. Data acquisition and analysis
<ol>
	<li>Arm force contribution
	<ol>
		<li>Extract all raw data of the force sensor to the workbook file in the computer for offline analysis.</li>
	</ol>
	</li>
	<li>Leg force contribution
	<ol>
		<li>Analyze raw data of the SitTS kinematic and kinetic in the motion analysis software. Extract the force plate data and knee angle data to the workbook file in the computer for offline analysis. 
		NOTE: Force plate data represent the leg force contribution</li>
	</ol>
	</li>
	<li>MMG of rectus femoris muscle
	<ol>
		<li>Extract and store raw MMG data of rectus femoris muscle using two acquisition units and a vibromyography software to the workbook file for offline analysis. 
		&#8203;NOTE: The MMG signal were recorded by a vibromyography sensor at a sampling rate of 2 kHz. A finite impulse response band-pass filter between 20 Hz and 200 Hz was used to relay and transform the raw data of the MMG signal as recommended by the manufacturer for the muscle effort assessment19. For every trial, all data set were normalized and then synchronized as a complete cycle of SitTS exercise. An independent sample t-test was done to observe significant differences in mean time between voluntary and FES-assisted SItTS exercises.</li>
	</ol>
	</li>
</ol>
5. Feedback session
<ol>
	<li>Record audio during the feedback session (researcher-participant interactions).</li>
	<li>Ask four questions regarding the stability and fatigue experienced by the participants during the accomplishment of SitTS in Day 1 and Day 2. 
	NOTE: In this section, stability was interpreted by the participants as the highest balance in the SitTS event. The highest balance was achieved when they could hold on to the selected event longest. Meanwhile, fatigue was identified as their feeling of &#39;tiredness&#39; that leads to their lowest performance retrieved during the SitTS exercise.</li>
	<li>Collect and transcribe the audio.</li>
</ol>

<ol><li>Nithiatthawanon, T., Amatachaya, P., Thaweewannakij, T., Manimmanakorn, N., Mato, L., Amatachaya, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+use+of+lower+limb+loading+ability+as+an+indicator+for+independence+and+safety+in+ambulatory+individuals+with+spinal+cord+injury%5BTitle%5D)+AND+%22European+Journal+of+Physical+and+Rehabilitation+Medicine%22%5BJournal%5D)">The use of lower limb loading ability as an indicator for independence and safety in ambulatory individuals with spinal cord injury.</a> European Journal of Physical and Rehabilitation Medicine. 57 (1), 85-91 (2021).</li>
<li>Chaovalit, S., Taylor, N. F., Dodd, K. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Sit-to-stand+exercise+programs+improve+sit-to-stand+performance+in+people+with+physical+impairments+due+to+health+conditions%3A+a+systematic+review+and+meta-analysis%5BTitle%5D)+AND+%22Disability+and+Rehabilitation%22%5BJournal%5D)">Sit-to-stand exercise programs improve sit-to-stand performance in people with physical impairments due to health conditions: a systematic review and meta-analysis.</a> Disability and Rehabilitation. 42 (9), 1202-1211 (2020).</li>
<li>Tekmyster, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Physical+therapy+considerations+and+recommendations+for+patients+following+spinal+cord+stimulator+implant+surgery%5BTitle%5D)+AND+%22Neuromodulation%22%5BJournal%5D)">Physical therapy considerations and recommendations for patients following spinal cord stimulator implant surgery.</a> Neuromodulation. , (2021).</li>
<li>Kamnik, R., Bajd, T., Kralj, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Functional+electrical+stimulation+and+arm+supported+sit-to-stand+transfer+after+paraplegia%3A+A+study+of+kinetic+parameters%5BTitle%5D)+AND+%22Artificial+Organs%22%5BJournal%5D)">Functional electrical stimulation and arm supported sit-to-stand transfer after paraplegia: A study of kinetic parameters.</a> Artificial Organs. 23 (5), 413-417 (1999).</li>
<li>Bahrami, F., Riener, R., Jabedar-Maralani, P., Schmidt, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Biomechanical+analysis+of+sit-to-stand+transfer+in+healthy+and+paraplegic+subjects%5BTitle%5D)+AND+%22Clinical+Biomechanics%22%5BJournal%5D)">Biomechanical analysis of sit-to-stand transfer in healthy and paraplegic subjects.</a> Clinical Biomechanics. 15 (2), 123-133 (2000).</li>
<li>Roy, G., Nadeau, S., Gravel, D., Piotte, F., Malouin, F., McFadyen, B. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Side+difference+in+the+hip+and+knee+joint+moments+during+sit-to-stand+and+stand-to-sit+tasks+in+individuals+with+hemiparesis%5BTitle%5D)+AND+%22Clinical+Biomechanics%22%5BJournal%5D)">Side difference in the hip and knee joint moments during sit-to-stand and stand-to-sit tasks in individuals with hemiparesis.</a> Clinical Biomechanics. 22 (7), 795-804 (2007).</li>
<li>Crosbie, J., Tanhoffer, A., Fornusek, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((FES+assisted+standing+in+people+with+incomplete+spinal+cord+injury%3A+a+single+case+design+series%5BTitle%5D)+AND+%22Spinal+Cord%22%5BJournal%5D)">FES assisted standing in people with incomplete spinal cord injury: a single case design series.</a> Spinal Cord. 52 (3), 251-254 (2014).</li>
<li>Eitzen, I., Fernandes, L., Nordsletten, L., Snyder-Mackler, L., Risberg, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Weight-bearing+asymmetries+during+Sit-To-Stand+in+patients+with+mild-to-moderate+hip+osteoarthritis%5BTitle%5D)+AND+%22Gait+%26+Posture%22%5BJournal%5D)">Weight-bearing asymmetries during Sit-To-Stand in patients with mild-to-moderate hip osteoarthritis.</a> Gait & Posture. 39 (2), 683-688 (2014).</li>
<li>Petrella, M., Selistre, L. F. A., Serrao, P., Lessi, G. C., Goncalves, G. H., Mattiello, S. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Kinetics%2C+kinematics%2C+and+knee+muscle+activation+during+sit+to+stand+transition+in+unilateral+and+bilateral+knee+osteoarthritis%5BTitle%5D)+AND+%22Gait+%26+Posture%22%5BJournal%5D)">Kinetics, kinematics, and knee muscle activation during sit to stand transition in unilateral and bilateral knee osteoarthritis.</a> Gait & Posture. 86, 38-44 (2021).</li>
<li>Mao, Y. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+crucial+changes+of+Sit-to-Stand+phases+in+subacute+stroke+survivors+identified+by+movement+decomposition+analysis%5BTitle%5D)+AND+%22Frontiers+in+Neurology%22%5BJournal%5D)">The crucial changes of Sit-to-Stand phases in subacute stroke survivors identified by movement decomposition analysis.</a> Frontiers in Neurology. 9, (2018).</li>
<li>Zoulias, I. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Novel+instrumented+frame+for+standing+exercising+of+users+with+complete+spinal+cord+injuries%5BTitle%5D)+AND+%22Scientific+Reports%22%5BJournal%5D)">Novel instrumented frame for standing exercising of users with complete spinal cord injuries.</a> Scientific Reports. 9 (1), 13003(2019).</li>
<li>Abd Aziz, M., Hamzaid, N. A., Hasnan, N., Dzulkifli, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Mechanomyography-based+assessment+during+repetitive+sit-to-stand+and+stand-to-sit+in+two+incomplete+spinal+cord-injured+individuals%5BTitle%5D)+AND+%22Biomedical+Engineering%2FBiomedizinische+Technik%22%5BJournal%5D)">Mechanomyography-based assessment during repetitive sit-to-stand and stand-to-sit in two incomplete spinal cord-injured individuals.</a> Biomedical Engineering/Biomedizinische Technik. 65 (2), 175-181 (2020).</li>
<li>Mazza, C., Benvenuti, F., Bimbi, C., Stanhope, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Association+between+subject+functional+status%2C+seat+height%2C+and+movement+strategy+in+sit-to-stand+performance%5BTitle%5D)+AND+%22Journal+of+the+American+Geriatrics+Society%22%5BJournal%5D)">Association between subject functional status, seat height, and movement strategy in sit-to-stand performance.</a> Journal of the American Geriatrics Society. 52 (10), 1750-1754 (2004).</li>
<li>Moore, J. L., Potter, K., Blankshain, K., Kaplan, S. L., O'Dwyer, L. C., Sullivan, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+core+set+of+outcome+measures+for+adults+with+neurologic+conditions+undergoing+rehabilitation%3A+A+clinical+practice+guideline%5BTitle%5D)+AND+%22Journal+of+Neurologic+Physical+Therapy%22%5BJournal%5D)">A core set of outcome measures for adults with neurologic conditions undergoing rehabilitation: A clinical practice guideline.</a> Journal of Neurologic Physical Therapy. 42 (3), 174-220 (2018).</li>
<li>Abd Aziz, M., Hamzaid, N. A. FES Standing: The effect of arm support on stability and fatigue during Sit-to-Stand manoeuvres in sci individuals. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aAbd+Aziz%2C+M+%22International+Conference+for+Innovation+in+Biomedical+Engineering+and+Life+Sciences.+IFMBE+Proceedings%22">International Conference for Innovation in Biomedical Engineering and Life Sciences. IFMBE Proceedings</a>. 67, Springer. Singapore. (2017).</li>
<li>Plumlee, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Effects+of+ankle+bracing+on+knee+joint+biomechanics+during+an+unanticipated+cutting+maneuver%5BTitle%5D)+AND+%22Conference+Proceedings+of+the+Annual+Meeting+of+the+American+Society+of+Biomechanics%22%5BJournal%5D)">Effects of ankle bracing on knee joint biomechanics during an unanticipated cutting maneuver.</a> Conference Proceedings of the Annual Meeting of the American Society of Biomechanics. , 807-808 (2010).</li>
<li>Estigoni, E. H., Fornusek, C., Hamzaid, N. A., Hasnan, N., Smith, R. M., Davis, G. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evoked+EMG+versus+muscle+torque+during+fatiguing+functional+electrical+stimulation-evoked+muscle+contractions+and+short-term+recovery+in+individuals+with+spinal+cord+injury%5BTitle%5D)+AND+%22Sensors+%28Basel%29%22%5BJournal%5D)">Evoked EMG versus muscle torque during fatiguing functional electrical stimulation-evoked muscle contractions and short-term recovery in individuals with spinal cord injury.</a> Sensors (Basel). 14 (12), 22907-22920 (2014).</li>
<li>Hamzaid, N., Fornusek, C., Ruys, A., Davis, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Development+of+an+isokinetic+FES+leg+stepping+trainer+%28iFES-LST%29+for+individuals+with+neurological+disability%5BTitle%5D)+AND+%222009+IEEE+International+Conference+on+Rehabilitation+Robotics%22%5BJournal%5D)">Development of an isokinetic FES leg stepping trainer (iFES-LST) for individuals with neurological disability.</a> 2009 IEEE International Conference on Rehabilitation Robotics. , 480-485 (2009).</li>
<li>Assess muscle effort with vibromyography. Sonostics Inc. , Available from: 
 <a target="_blank" href="https://www.biopac.com/application-note/vibromyography-vmg-assess-muscles-effort/">https://www.biopac.com/application-note/vibromyography-vmg-assess-muscles-effort/</a> (2019).</li>
<li>Donovan-Hall, M. K., Burridge, J., Dibb, B., Ellis-Hill, C., Rushton, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+views+of+people+with+spinal+cord+injury+about+the+use+of+functional+electrical+stimulation%5BTitle%5D)+AND+%22Artificial+Organs%22%5BJournal%5D)">The views of people with spinal cord injury about the use of functional electrical stimulation.</a> Artificial Organs. 35 (3), 204-211 (2011).</li>
<li>Kagaya, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Restoration+and+analysis+of+standing-up+in+complete+paraplegia+utilizing+functional+electrical+stimulation%5BTitle%5D)+AND+%22Archives+of+Physical+Medicine+and+Rehabilitation%22%5BJournal%5D)">Restoration and analysis of standing-up in complete paraplegia utilizing functional electrical stimulation.</a> Archives of Physical Medicine and Rehabilitation. 76 (9), 876-881 (1995).</li>
<li>Jeon, W., Hsiao, H. Y., Griffin, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Effects+of+different+initial+foot+positions+on+kinematics%2C+muscle+activation+patterns%2C+and+postural+control+during+a+sit-to-stand+in+younger+and+older+adults%5BTitle%5D)+AND+%22Journal+of+Biomechanics%22%5BJournal%5D)">Effects of different initial foot positions on kinematics, muscle activation patterns, and postural control during a sit-to-stand in younger and older adults.</a> Journal of Biomechanics. 117, 110251(2021).</li>
<li>Nadeau, S., Desjardins, P., Briere, A., Roy, G., Gravel, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+chair+with+a+platform+setup+to+measure+the+forces+under+each+thigh+when+sitting%2C+rising+from+a+chair+and+sitting+down%5BTitle%5D)+AND+%22Medical+%26+Biological+Engineering+%26+Computing%22%5BJournal%5D)">A chair with a platform setup to measure the forces under each thigh when sitting, rising from a chair and sitting down.</a> Medical & Biological Engineering & Computing. 46 (3), 299-306 (2008).</li>
<li>Lee, S. K., Lee, S. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+effects+of+changing+angle+and+height+of+toilet+seat+on+movements+and+ground+reaction+forces+in+the+feet+during+sit-to-stand%5BTitle%5D)+AND+%22Journal+of+Exercise+Rehabilitation%22%5BJournal%5D)">The effects of changing angle and height of toilet seat on movements and ground reaction forces in the feet during sit-to-stand.</a> Journal of Exercise Rehabilitation. 12 (5), 438-441 (2016).</li>
<li>Camargos, A. C. R., Rodrigues-de-Paula-Goulart, F., Teixeira-Salmela, L. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+effects+of+foot+position+on+the+performance+of+the+sit-to-stand+movement+with+chronic+stroke+subjects%5BTitle%5D)+AND+%22Archives+of+Physical+Medicine+and+Rehabilitation%22%5BJournal%5D)">The effects of foot position on the performance of the sit-to-stand movement with chronic stroke subjects.</a> Archives of Physical Medicine and Rehabilitation. 90 (2), 314-319 (2009).</li>
<li>Beck, T. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Comparison+of+Fourier+and+wavelet+transform+procedures+for+examining+the+mechanomyographic+and+electromyographic+frequency+domain+responses+during+fatiguing+isokinetic+muscle+actions+of+the+biceps+brachii%5BTitle%5D)+AND+%22Journal+of+Electromyography+and+Kinesiology%22%5BJournal%5D)">Comparison of Fourier and wavelet transform procedures for examining the mechanomyographic and electromyographic frequency domain responses during fatiguing isokinetic muscle actions of the biceps brachii.</a> Journal of Electromyography and Kinesiology. 15 (2), 190-199 (2015).</li>
<li>Lee, M. Y., Lee, H. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Analysis+for+Sit-to-Stand+performance+according+to+the+angle+of+knee+flexion+in+individuals+with+hemiparesis%5BTitle%5D)+AND+%22Journal+of+Physical+Therapy+Science%22%5BJournal%5D)">Analysis for Sit-to-Stand performance according to the angle of knee flexion in individuals with hemiparesis.</a> Journal of Physical Therapy Science. 25 (12), 1583-1585 (2013).</li>
<li>Chang, S. R., Kobetic, R., Triolo, R. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Understanding+stand-to-sit+maneuver%3A+Implications+for+motor+system+neuroprostheses+after+paralysis%5BTitle%5D)+AND+%22Journal+of+Rehabilitation+Research+and+Development%22%5BJournal%5D)">Understanding stand-to-sit maneuver: Implications for motor system neuroprostheses after paralysis.</a> Journal of Rehabilitation Research and Development. 51 (9), 1339-1351 (2014).</li>
<li>Woods, B., Subramanian, M., Shafti, A., Faisal, A. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Mechanomyography+based+closed-loop+functional+electrical+stimulation+cycling+system%5BTitle%5D)+AND+%222018+7th+IEEE+International+Conference+on+Biomedical+Robotics+and+Biomechatronics+%28Biorob%22%5BJournal%5D)">Mechanomyography based closed-loop functional electrical stimulation cycling system.</a> 2018 7th IEEE International Conference on Biomedical Robotics and Biomechatronics (Biorob. , (2018).</li>
<li>Wessell, N., Khalil, J., Zavatsky, J., Ghacham, W., Bartol, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Verification+of+nerve+decompression+using+mechanomyography%5BTitle%5D)+AND+%22Spine+Journal%22%5BJournal%5D)">Verification of nerve decompression using mechanomyography.</a> Spine Journal. 16 (6), 679-686 (2016).</li>
<li>Britton, E., Harris, N., Turton, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((An+exploratory+randomized+controlled+trial+of+assisted+practice+for+improving+sit-to-stand+in+stroke+patients+in+the+hospital+setting%5BTitle%5D)+AND+%22Clinical+Rehabilitation%22%5BJournal%5D)">An exploratory randomized controlled trial of assisted practice for improving sit-to-stand in stroke patients in the hospital setting.</a> Clinical Rehabilitation. 22 (5), 458-468 (2008).</li>
</ol>

The authors have nothing to disclose.

The current study demonstrated a bodyweight contribution in SCI individuals during SitTS exercise. This study presented SF as an essential assistive device for paraplegics to do a successful SitTS cycle. Moreover, an instrumented SF was developed to ensure the arms force can be assessed too28. The application of MMG was added in the study to observe prime SitTS muscle that helps researchers to understand SitTS performance better. Furthermore, the feedback session enabled researchers to obtain insi...

Sit-To-Stand (SitTS) is a significant movement in a human&#39;s activity of daily living (ADL). It is also a prerequisite for basic functional activities such as standing, transferring, and walking. For patients with incomplete spinal cord injury (SCI), paraplegics in particular, SitTS exercise is a crucial activity for their functional independence1,2. This exercise is essential for independence training, which eventually helps SCI population to improve their quality of life. In order to perform a sufficient and adequate SitTS exercise, the knowledge regarding their biomechanics and muscle activity should be feasibly measurable during the training.
In a clinical rehabilitation program, SCI patients with grade American Spinal Cord Injury Association (ASIA) Impairment Scale, AIS&#160;C have a better progression and chance of recovering their motor function than those with grade AIS B, who has complete motor deficits. The SitTS performance plays an important measure in an SCI patient to indicate their motor functionality during the recovery process3. However, SCI AIS C patients require both support from the upper and lower limbs to achieve successful series of repeated SitTS movements. The upper limb support plays an important role in unloading the knees while providing adequate lifting forces and assuring the body balance during the exercise4.
The purpose of this study is to describe the biomechanical contributions of arms and legs throughout repetitive SitTS in incomplete SCI individuals. This study positions the biomechanical analysis in relation to the participants&#39; subjective sense of their arms and legs muscle performance and feelings of &#39;effort and tiredness&#39; throughout the SitTS exercise.
Many previous SitTS studies only concentrated on investigating the kinematics and kinetics aspects of the activity4,5,6,7. In a wider context of SitTS training, the development of this method which includes the instrumented standing frame (SF) and force plate analysis, could lead researchers to assess both upper and lower limb contribution of other populations such as stroke, elderly, and patients with osteoarthritis8,9,10. A previous study by Zoulias et al., instrumented custom-built hardware and software of SF presented a large frame design11. This method can be challenging to replicate. Hence this SitTS study highlighted a portable instrumented SF that can be adopted by other researchers with an existing motion analysis laboratory setup.

<table><tbody><tr><td>Customade chair</td><td></td><td></td><td>A customade chair was built to following to the force plate&#039;s dimension.</td></tr><tr><td>FES RehaStim 2</td><td>Hasomed</td><td></td><td>A device that can stimulate electrical current towards the muscle.</td></tr><tr><td>FlexiForce A201</td><td>Tekscan, Inc., USA</td><td>Force ranges: 0-100 lbs. (440 N)</td><td>Force sensors is used to capture arms force at standing frame.</td></tr><tr><td>Foldable standing frame</td><td></td><td>Height: 70.0 cm - 90.0 cm.</td><td>A walking frame that was bought from local medical company.</td></tr><tr><td>Motion Analysis</td><td>Vicon Oxford, UK</td><td></td><td>A system that records kinematic and kinetics of the activity.</td></tr><tr><td>Serial port terminal application</td><td>CoolTerm</td><td>version 1.4.6; Roger Meier&#039;s</td><td>An application to record the force sensor data.</td></tr><tr><td>Vibromyography software</td><td>BIOPAC System Inc., USA</td><td>AcqKnowledge 4.3.1</td><td>A software to record and strore raw MMG data. It also function for offline analyses.</td></tr><tr><td>VMG transducers and BIOPAC Vibromyography system</td><td>BIOPAC System Inc., USA</td><td>BP150 and HLT100C</td><td>A device to measure muscle activity.</td></tr></tbody></table>

quantifying arms and legs contributions during repetitive electrically-assisted sit-to-stand exercise in paraplegics: a pilot study

Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of arm support, in particular, is a significant assistive factor while executing SitTS movement in SCI population. In addition, the application of functional electrical stimulation (FES) onto quadriceps and gluteus maximus muscles is one of the prescribed management for incomplete SCI to improve muscle action for simple lower limb movements. However, the relative contribution of upper and lower extremities during SitTS has not been thoroughly investigated. Two motor incomplete SCI paraplegics performed repetitive SitTS to fatigue exercise challenge. Their performance was investigated as a mixed-method case-control study comparing SitTS with and without the assistance of FES. Three sets of SitTS tests were completed with 5-min resting period allocated in between sets, with mechanomyography (MMG) sensors attached over the rectus femoris muscles bilaterally. The exercise was separated into 2 sessions; Day 1 for voluntary SitTS and Day 2 for FES-assisted SitTS. Questionnaires were conducted after every session to gather the participants&#39; input about their repetitive SitTS experience. The analysis confirmed that a SitTS cycle could be divided into three phases; Phase 1 (Preparation to stand), Phase 2 (Seat-off), and Phase 3 (Initiation of hip extension), which contributed to 23% &#177; 7%, 16% &#177; 4% and 61% &#177; 6% of the SitTS cycle, respectively. The contribution of arms and legs during SitTS movement varied in different participants based on their legs&#39; Medical Research Council (MRC) muscle grade. In particular, the applied arm forces start to increase clearly when the leg forces start to decline during standing. This finding is supported by the significantly reduced MMG signal indicating leg muscle fatigue and their reported feeling of tiredness.

A total of 399 and 463 SitTS trials were completed without and with FES assisted correspondingly. The trials that contributed to each set are tabulated in Table 2. The participants could perform more SitTS trials with the presence of electrical stimulation on their legs, i.e., FES. Overall, both participants managed to perform more SitTS trials with the aid of FES. This suggests that FES helps in stimulating participants&#39; quadriceps to execute SitTS action in a prolonged period20</s...

Watch this Scientific Journal Video about Quantifying Arms and Legs Contributions during Repetitive Electrically-Assisted Sit-To-Stand Exercise in Paraplegics: A Pilot Study at JoVE.com

Quantifying Arms and Legs Contributions during Repetitive Electrically-Assisted Sit-To-Stand Exercise in Paraplegics: A Pilot Study

Arms contribution in Sit-To-Stand (SitTS) is determined by the legs' muscle condition. Several compensating strategies were discovered in efforts to achieve complete SitTS cycles. These findings triangulate the spinal cord injury (SCI) persons' biomechanical measures with their subjective feeling of load borne by both their limbs throughout the SitTS approaches.

Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of ...

quantifying-arms-legs-contributions-during-repetitive-electrically

Research

JoVE Journal

Engineering

1.1K Views.  Universiti Malaya. Dit protocol demonstreert de juiste richtlijnen door essentiële onderdelen uit te leggen en hoe ze worden uitgevoerd bij het uitvoeren van een zit-naar-sta-experiment met behulp van armondersteuning en functionele elektrische stimulatie. Deze techniek helpt bij het beheersen van de complexiteit van het hebben van een paar opstellingen, waaronder de instrumentatie van een staand frame, functionele elektrische stimulatie en mechanomyografie. Deze methode kan van toepassing zijn op andere popul...

Video: Quantifying Arms and Legs Contributions during Repetitive Electrically-Assisted Sit-To-Stand Exercise in Paraplegics: A Pilot Study

Sit-to-stand-and-walk from 120% Knee Height: A Novel Approach to Assess Dynamic Postural Control Independent of Lead-limb

Individuals with sensorimotor pathology e.g., stroke have difficulty executing the common task of rising from sitting and initiating gait (sit-to-walk: STW). Thus, in clinical rehabilitation separation of sit-to-stand and gait initiation - termed sit-to-stand-and-walk (STSW) - is usual. However, a standardized STSW protocol with a clearly defined analytical approach suitable for pathological assessment has yet to be defined.
Hence, a goal-orientated protocol is defined that is suitable for healthy and compromised individuals by requiring the rising phase to be initiated from 120% knee height with a wide base of support independent of lead limb. Optical capture of three-dimensional (3D) segmental movement trajectories, and force platforms to yield two-dimensional (2D) center-of-pressure (COP) trajectories permit tracking of the horizontal distance between COP and whole-body-center-of-mass (BCOM), the decrease of which increases positional stability but is proposed to represent poor dynamic postural control.
BCOM-COP distance is expressed with and without normalization to subjects&#39; leg length. Whilst COP-BCOM distances vary through STSW, normalized data at the key movement events of seat-off and initial toe-off (TO1) during steps 1 and 2 have low intra and inter subject variability in 5 repeated trials performed by 10 young healthy individuals. Thus, comparing COP-BCOM distance at key events during performance of an STSW paradigm between patients with upper motor neuron injury, or other compromised patient groups, and normative data in young healthy individuals is a novel methodology for evaluation of dynamic postural stability.

Here, we present a novel protocol to measure positional stability at key events during the sit-to-stand-to-walk using the center-of-pressure to the whole-body-center-of-mass distance. This was derived from the force platform and three-dimensional motion-capture technology. The paradigm is reliable and can be utilized for the assessment of neurologically compromised individuals.

Individuals with sensorimotor pathology e.g., stroke have difficulty executing the common task of rising from sitting and initiating gait (sit-to-walk: ...

Behavior

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with numerous cardiometabolic health consequences. These changes are likely to increase the risk of developing chronic secondary conditions and impact the quality of life in persons with SCI. Surface neuromuscular electrical stimulation evoked resistance training (NMES-RT) was developed as a strategy to attenuate the process of skeletal muscle atrophy, decrease ectopic adiposity, improve insulin sensitivity and enhance mitochondrial capacity. However, NMES-RT is limited to only a single muscle group. Involving multiple muscle groups of the lower extremities may maximize the health benefits of training. Functional electrical stimulation-lower extremity cycling (FES-LEC) allows for the activation of 6 muscle groups, which is likely to evoke greater metabolic and cardiovascular adaptation. Appropriate knowledge of the stimulation parameters is key to maximizing the outcomes of electrical stimulation training in persons with SCI. Adopting strategies for long-term use of NMES-RT and FES-LEC during rehabilitation may maintain the integrity of the musculoskeletal system, a pre-requisite for clinical trials aiming to restore walking after injury. The current manuscript presents a combined protocol using NMES-RT prior to FES-LEC. We hypothesize that muscles conditioned for 12 weeks prior to cycling will be capable of generating greater power, cycle against higher resistance and result in greater adaptation in persons with SCI.

Spinal cord injury is a traumatic medical condition that may result in elevated risks of chronic secondary metabolic disorders. Here, we presented a protocol using surface neuromuscular electrical stimulation-resistance training in conjunction with functional electrical stimulation-lower extremities cycling as a strategy to ameliorate several of these medical problems.

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with ...

Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. 
Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment.

Training a person with paralysis to ambulate using a powered exoskeleton may present challenges. The goals are to present the candidate selection criteria and the training procedures for exoskeletal-assisted walking and other mobility skills that can be progressed as the participant's skill level improves.

Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper ...

Bioengineering

Standing Neurophysiological Assessment of Lower Extremity Muscles Post-Stroke

Transcranial magnetic stimulation (TMS) is a common tool used to measure the behavior of motor circuits in healthy and neurologically impaired populations. TMS is used extensively to study motor control and the response to neurorehabilitation of the upper extremities. However, TMS has been less utilized in the study of lower extremity postural and walking-specific motor control. The limited use and the additional methodological challenges of lower extremity TMS assessments have contributed to the lack of consistency in lower extremity TMS procedures within the literature. Inspired by the decreased ability to record lower extremity TMS motor evoked potentials (MEP), this methodological report details steps to enable post-stroke TMS assessments in a standing posture. The standing posture allows for the activation of the neuromuscular system, reflecting a state more akin to the system's state during postural and walking tasks. Using dual-top force plates, we instructed participants to equally distribute their weight between their paretic and non-paretic legs. Visual feedback of the participants' weight distribution was provided. Using image guidance software, we delivered single TMS pulses via a double-cone coil to the participants' lesioned and non-lesioned hemispheres and measured the corticomotor response of the paretic and non-paretic tibialis anterior and soleus muscles. Performing assessments in the standing position increased the TMS response rate and allowed for the use of the lower stimulation intensities compared to the standard sitting/resting position. Utilization of this TMS protocol can provide a common approach to assess the lower extremity corticomotor response post-stroke when the neurorehabilitation of postural and gait impairments are of interest.

This protocol describes the process for performing a neurophysiological assessment of the lower extremity muscles, tibialis anterior and soleus, in a standing position using TMS in people post-stroke. This position provides a greater probability of eliciting a post-stroke TMS response and allows for the use of reduced stimulator power during neurophysiological assessments.

Transcranial magnetic stimulation (TMS) is a common tool used to measure the behavior of motor circuits in healthy and neurologically impaired ...

A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation

A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to reorganize its structure, function and connections as a response to intrinsic or extrinsic stimuli is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. Beneficial neuroplastic changes may be facilitated with non-invasive electrotherapy, such as neuromuscular electrical stimulation (NMES) and sensory electrical stimulation (SES). NMES involves coordinated electrical stimulation of motor nerves and muscles to activate them with continuous short pulses of electrical current while SES involves stimulation of sensory nerves with electrical current resulting in sensations that vary from barely perceivable to highly unpleasant. Here, active cortical participation in rehabilitation procedures may be facilitated by driving the non-invasive electrotherapy with biosignals (electromyogram (EMG), electroencephalogram (EEG), electrooculogram (EOG)) that represent simultaneous active perception and volitional effort. To achieve this in a resource-poor setting, e.g., in low- and middle-income countries, we present a low-cost human-machine-interface (HMI) by leveraging recent advances in off-the-shelf video game sensor technology. In this paper, we discuss the open-source software interface that integrates low-cost off-the-shelf sensors for visual-auditory biofeedback with non-invasive electrotherapy to assist postural control during balance rehabilitation. We demonstrate the proof-of-concept on healthy volunteers.

A novel low-cost human-machine interface for interactive post-stroke balance rehabilitation system is presented in this article. The system integrates off-the-shelf low-cost sensors towards volitionally driven electrotherapy paradigm. The proof-of-concept software interface is demonstrated on healthy volunteers.

A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing ...

Neuroscience

Isokinetic Robotic Device to Improve Test-Retest and Inter-Rater Reliability for Stretch Reflex Measurements in Stroke Patients with Spasticity

Measuring spasticity is important in treatment planning and determining efficacy after treatment. However, the current tool used in clinical settings has been shown to be limited in inter-rater reliability. One factor in this poor inter-rater reliability is the variability of passive motion while measuring the angle of catch (AoC) measurements. Therefore, an isokinetic device has been proposed to standardize the manual joint motion; however, the benefits of isokinetic motion for AoC measurements has not been tested in a standardized manner. This protocol investigates whether isokinetic motion itself can improve inter-rater reliability for AoC measurements. For this purpose, a robotic isokinetic device was developed that is combined with surface electromyography (EMG). Two conditions, manual and isokinetic motions, are compared with the standardized method to measure the angle and subjective feeling of catch. It is shown that in 17 stroke patients with mild elbow flexor spasticity, isokinetic motion improved the intraclass correlation coefficient (ICC) for inter-rater reliability of AoC measurements to 0.890 [95% confidence interval (CI): 0.685&#8211;0.961] by the EMG criteria, and 0.931 (95% CI: 0.791&#8211;0.978) by the torque criteria, from 0.788 (95% CI: 0.493&#8211;0.920) by manual motion. In conclusion, isokinetic motion itself can improve inter-rater reliability of AoC measurements in stroke patients with mild spasticity. Given that this system may provide greater standardized angle measurements and catch of feeling, it may be a good option for the evaluation of spasticity in a clinical setting.

Using a robotic isokinetic device with electromyography (EMG) measurements, this protocol illustrates that isokinetic motion itself can improve inter-rater reliability for the angle of catch measurements in stroke patients with mild elbow flexor spasticity.

Measuring spasticity is important in treatment planning and determining efficacy after treatment. However, the current tool used in clinical settings has ...

Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals

Reliable exercise protocols are required to test changes in exercise performance in elite athletes. Performance improvements in these athletes may be small; therefore, sensitive tools are fundamental to exercise physiology. There are currently many exercise tests that allow for the examination of exercise capacity in able-bodied athletes, with protocols mainly for lower-body or whole-body exercise. There is a trend to test athletes in a sport-specific setting that closely resembles the actions that the participants are used to performing. Only a few protocols test short-term, high-intensity exercise capacity in participants with an impairment of the lower body. Most of these protocols are very sport-specific and are not applicable to a wide range of athletes. One well-known test protocol is the 30 s Wingate test, which is well-established in cycling and in arm crank exercise testing. This test analyzes high-intensity exercise performance over a 30 s time duration. In order to monitor exercise performance over a longer duration, a different method was modified for application to the upper body. The 3 min, all-out arm crank ergometer test allows athletes to be tested in a manner specific to 1,500 m wheelchair racing (in terms of exercise duration), as well as to upper body exercises such as rowing or hand-cycling. In order to increase the reliability with identical test conditions, it is crucial to precisely replicate settings such as the resistance (i.e., torque factor) and the position of the participants (i.e., the height of the crank, the distance between the crank and the participant, and the fixation of the participant). Another important issue concerns the beginning of the exercise test. Fixed revolutions per minute are required to standardize the test conditions for the start of the exercise test. This exercise protocol shows the importance of accurate operations to reproduce identical test conditions and settings.

We present a protocol to test the aerobic and anaerobic power of the upper body muscles over a duration of 3 min in able-bodied as well as in paraplegic and tetraplegic individuals. The protocol presents specific modifications in its application for upper-body exercise in individuals with or without disability.

Reliable exercise protocols are required to test changes in exercise performance in elite athletes. Performance improvements in these athletes may be ...

Medicine

The Muscle Cuff Regenerative Peripheral Nerve Interface for the Amplification of Intact Peripheral Nerve Signals

Robotic exoskeletons have gained recent acclaim within the field of rehabilitative medicine as a promising modality for functional restoration for those individuals with extremity weakness. However, their use remains largely confined to research institutions, frequently operating as a means of static extremity support as motor detection methods remain unreliable. Peripheral nerve interfaces have arisen as a potential solution to this shortcoming; however, due to their inherently small amplitudes, these signals can be difficult to differentiate from background noise, lowering their overall motor detection accuracy. As current interfaces rely on abiotic materials, inherent material breakdown can occur alongside foreign body tissue reaction over time, further impacting their accuracy. The Muscle Cuff Regenerative Peripheral Nerve Interface (MC-RPNI) was designed to overcome these noted complications. Consisting of a segment of free muscle graft secured circumferentially to an intact peripheral nerve, the construct regenerates and becomes reinnervated by the contained nerve over time. In rats, this construct has demonstrated the ability to amplify a peripheral nerve's motor efferent action potentials up to 100 times the normal value through the generation of compound muscle action potentials (CMAPs). This signal amplification facilitates high accuracy detection of motor intent, potentially enabling reliable utilization of exoskeleton devices.

This manuscript provides an innovative method for developing a biologic peripheral nerve interface termed the Muscle Cuff Regenerative Peripheral Nerve Interface (MC-RPNI). This surgical construct can amplify its associated peripheral nerve's motor efferent signals to facilitate accurate detection of motor intent and the potential control of exoskeleton devices.

Robotic exoskeletons have gained recent acclaim within the field of rehabilitative medicine as a promising modality for functional restoration for those ...

Evaluating Brain Activation by fNIRS During a Lower Limb Robotic Therapy Session

An Experiment Using Functional Near-Infrared Spectroscopy and Robot-Assisted Multi-Joint Pointing Movements of the Lower Limb

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise in helping stroke patients regain lost motor functions. One potential avenue for increasing the understanding of how motor recovery occurs is to study brain activation during the movements that are targeted by therapy in healthy individuals. Functional Near-Infrared Spectroscopy (fNIRS) has emerged as a promising neuroimaging technique for examining neural underpinnings of motor function. This study aimed to investigate fNIRS neural correlates of complex lower limb movements in healthy subjects. Participants were asked to perform cycles of rest and movement for 6 min using a robotic device for motor rehabilitation. The task required coordinated knee and ankle joint movements to point to targets displayed on a computer screen. Two experimental conditions with different levels of movement assistance provided by the robot were explored. The results showed that the fNIRS protocol effectively detected brain regions associated with motor control during the task. Notably, all subjects exhibited greater activation in the contralateral premotor area during the no-assistance condition compared to the assisted condition. In conclusion, fNIRS appears to be a valuable approach for detecting changes in oxyhemoglobin concentration associated with multi-joint pointing movements of the lower limb. This research might contribute to the understanding of stroke motor recovery mechanisms and might pave the way for improved rehabilitation treatments for stroke patients. However, further research is needed to fully elucidate the potential of fNIRS in studying motor function and its applications in clinical settings.

Author Spotlight: Assessing Brain Activity in Robotic-Assisted Lower Limb Rehabilitation Using fNIRS

It is estimated that 1 in 6 individuals worldwide will have a stroke in their lifetime, causing long-term disability, whose rehabilitation mechanisms are still poorly understood. This study proposes a protocol to evaluate brain activation by functional near-infrared spectroscopy (fNIRS) during a lower limb robotic therapy session.

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise ...

Dual Upper Limb Robotic Training in Stroke Rehabilitation

Application of a Dual Upper Limb Task-Oriented Robotic System for the Functional Recovery of the Upper Limb in Stroke Patients

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm training can help stroke survivors regain their upper limb function and improve their daily activities. The dual upper limb task-oriented robotic system is designed to assist the healthy side of the stroke patient in driving the affected side to perform bilateral arm training through the use of a robotic device. It can also guide the patient in carrying out dual upper limb coordinated movements and engage them in a task-oriented virtual game using force feedback and human-computer interaction technology. This study aimed to assess the efficacy of the system in enhancing upper limb function and activities of daily living in stroke patients. The assessment methods used included motor evoked potential (MEP), functional test for the hemiplegic upper extremity-Hong Kong (FTHUE-HK), Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), and modified Barthel index (MBI). The results of the study indicate that the dual upper limb task-oriented robotic system can significantly improve the corticospinal pathway, upper limb function, and activities of daily living in stroke patients after 6 weeks of treatment. This system can serve as an effective adjunct to upper limb functional rehabilitation in stroke survivors, reducing the dependence on rehabilitation therapists. In conclusion, the dual upper limb task-oriented robotic system provides a new strategy for post-stroke limb functional rehabilitation and holds great potential for application, as it offers certain social and financial benefits.

Author Spotlight: Enhancing Upper Limb Rehabilitation in Stroke Patients Through Advanced Robotic and Neuromodulation Technologies

This experimental protocol outlines the use of a dual upper limb task-oriented robotic system for stroke patients with upper limb dysfunction. The findings indicate that this system can significantly improve stroke patients' upper limb function and daily living activities.

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm ...

Quantifying Arms and Legs Contributions during Repetitive Electrically-Assisted Sit-To-Stand Exercise in Paraplegics: A Pilot Study

Samenvatting

Meer video's verkennen