Repetetive hindlimb movement using intermittent adaptive neuromuscular electrical stimulation in an incomplete spinal cord injury rodent model.

The long-term objective of this work is to understand the mechanisms by which electrical stimulation based movement therapies may harness neural plasticity to accelerate and enhance sensorimotor recovery after incomplete spinal cord injury (iSCI). An adaptive neuromuscular electrical stimulation (aNMES) paradigm was implemented in adult Long Evans rats with thoracic contusion injury (T8 vertebral level, 155+/-2 Kdyne). In lengthy sessions with lightly anesthetized animals, hip flexor and extensor muscles were stimulated using an aNMES control system in order to generate desired hip movements. The aNMES control system, which used a pattern generator/pattern shaper structure, adjusted pulse amplitude to modulate muscle force in order to control hip movement. An intermittent stimulation paradigm was used (5-cycles/set; 20-second rest between sets; 100 sets). In each cycle, hip rotation caused the foot plantar surface to contact a stationary brush for appropriately timed cutaneous input. Sessions were repeated over several days while the animals recovered from injury. Results indicated that aNMES automatically and reliably tracked the desired hip trajectory with low error and maintained range of motion with only gradual increase in stimulation during the long sessions. Intermittent aNMES thus accounted for the numerous factors that can influence the response to NMES: electrode stability, excitability of spinal neural circuitry, non-linear muscle recruitment, fatigue, spinal reflexes due to cutaneous input, and the endogenous recovery of the animals. This novel aNMES application in the iSCI rodent model can thus be used in chronic stimulation studies to investigate the mechanisms of neuroplasticity targeted by NMES-based repetitive movement therapy.

Adaptive control of movement for neuromuscular stimulation-assisted therapy in a rodent model.

Neuromotor therapy after spinal cord or brain injury often attempts to utilize activity-dependent plasticity to promote functional recovery. Neuromuscular electrical stimulation that activates paralyzed or paretic muscles may enhance passive assistance therapy by activating more muscle mass and enriching the sensory pattern with appropriately timed muscle spindle activation. To enable studies of activity-dependent plasticity, a rodent model for stimulation-assisted locomotor therapy was developed previously. To be effective, however, such a system must allow lengthy sessions of repetitive movements. In this study, we implemented an adaptive pattern generator/pattern shaper (PG/PS) control system for a rodent model of neuromotor therapy and evaluated its ability to generate accurate and repeatable hip movements in lengthy sessions by adjusting the activation patterns of an agonist/antagonist muscle pair. In 100-cycle movement trials, the PG/PS control system provided excellent movement tracking (<<10% error), but stimulation levels steadily increased to account for muscle fatigue. In trials using an intermittent movement paradigm (100 sets of five-cycle bouts interspersed by 20-s rest periods), excellent performance (<<8% error) was also observed with less stimulation, thus indicating reduced muscle fatigue. These results demonstrate the ability of the PG/PS control system to utilize an agonist/antagonist muscle pair to control movement at a joint in a rodent model. The demonstration of repeatable movements over lengthy intermittent sessions suggests that it may be well suited to provide efficient neuromotor therapy.