Closed-loop Neuroprosthetic Control through Spared Neural Activity Enables Proportional Foot Movements after Spinal Cord Injury

TL;DR

This study demonstrates that wearable EMG decoding combined with FES can enable voluntary, proportional foot movements in individuals with spinal cord injury through a closed-loop neuroprosthetic system.

Contribution

The paper introduces a wearable, machine learning-based neuroprosthetic that decodes neural signals to control FES for restoring foot movement after SCI.

Findings

Participants achieved over 70% accuracy in proportional foot movement control.

FES stimulation increased foot flexion range by up to 40%.

Voluntary control of multiple stimulation levels was demonstrated.

Abstract

Loss of voluntary foot movement after spinal cord injury (SCI) can significantly limit independent mobility and quality of life. To improve motor output after injury, functional electrical stimulation (FES) is used to deliver stimulation pulses through the skin to affected muscles. While commercial FES systems typically use motion-based triggers, prior research shows that spared movement intent can be decoded after SCI using surface electromyography (EMG). Our aim is to assess how well spared neural signals of the lower limb after SCI can be decoded and used to control electrical stimulation for restoring foot movement. We developed a wearable machine learning-powered neuroprosthetic that records EMG from the affected lower limb using a 32-channel electrode bracelet and enables closed-loop control of a FES device for foot movement restoration. Five participants with SCI used the predicted control signal to follow trajectories on a screen with their foot and achieve distinct motor activation patterns for foot flexion, extension, and inversion or eversion. Three of these participants also achieved 2 proportional activation levels during foot flexion/extension with more than 70% accuracy. To validate how these neural signals can be used for closed-loop neuroprosthetic control, two participants used their decoded activity to control a FES device and stimulate their affected foot. This resulted in an increased foot flexion range for both participants of 33.6% and 40% of a functional healthy range, respectively (p smaller than 0.001). One of the participants also achieved voluntary proportional control of up to 6 stimulation levels during foot flexion/extension. These results suggest that wearable EMG decoding coupled with FES systems provides a scalable strategy for closed-loop neuroprosthetic control supporting voluntary foot movement.