Restoring Standing and Stepping after Spinal Cord Injury

Spinal cord injury (SCI) resulting in paralysis hasan enormous impact not only on the health of theindividual but more fundamentally on theirindependence and self-image. Advancements intreatment and rehabilitation strategies have lead toan improvement in the quality of life of theseindividuals. Physiological systems and currentrehabilitative devices are presented along with aseries of studies conducted with the goal ofdeveloping functional electrical stimulation (FES)techniques for restoring standing and stepping afterSCI. Knowledge of natural systems was applied to thedevelopment of physiologically-based controlstrategies and stimulation paradigms to achieve thisgoal. Intraspinal microstimulation (ISMS) ishighlighted; a centrally applied FES technique whichtaps into some of the physiological characteristicsof neuronal recruitment. ISMS results in increasedfatigue resistance and more graded force recruitmentrelative to classical peripheral FES techniques. Thestudies described here have advanced the developmentof a FES system for restoring standing and steppingafter SCI while also providing insight into theneural control of locomotion.