Control of paraplegic ankle joint stiffness using FES while standing.

The goal of this work was to investigate the feasibility of ankle stiffness control using functional electrical stimulation (FES) while standing, as relevant to the development of feedback systems for balance control in paraplegia. The work was carried out using apparatus in which the subject stands with all joints above the ankles braced, and where ankle moment is provided via FES of the ankle flexor and extensor muscles. A feedback control strategy for ankle stiffness control is proposed in which the ankle moment is controlled to a reference value equal to the product of the desired stiffness and the measured ankle angle. Two subjects participated in the study: one neurologically-intact person, and one paraplegic person with a complete thoracic spinal cord lesion. The results show that during forward-leaning postures, when the plantarflexor muscles are stimulated, relatively high ankle moments of up to 60 Nm can be generated and accurate moment tracking is achieved. As a consequence, ankle stiffness is close to the desired value. During backward lean, on the other hand, the dorsiflexor muscles are stimulated. These muscles are relatively weak and only modest ankle moments of up to around 15 Nm can be produced. As a result, dorsiflexor stimulation readily saturates giving poor stiffness control. It was further observed that when the desired stiffness is higher more external force has to be applied to perturb the body away from the neutral (upright) position. We conclude that: (i) accurate ankle stiffness control, up to the fundamental strength limits of the muscles, can be achieved with controlled FES; (ii) ankle stiffness control using FES in paraplegia has the potential to ease the task of stabilising upright posture by application of additional upper-body forces.