Changes in Muscle Activation and Joint Motion During Walking After Transtibial Amputation with Sensory Feedback from Spinal Cord Stimulation: A Case Study

Background: The goal of this study was to examine the effects of spinal cord stimulation (SCS) on muscle activity during walking after lower-limb amputation. Amputation results in a loss of sensory feedback and alterations in gait biomechanics, including co-contractions of antagonist muscles about the knee and ankle, and reduced pelvic obliquity range-of-motion and pelvic drop. SCS can restore sensation in the missing limb, but its effects on muscle activation and gait biomechanics have not been studied in people with lower-limb amputation. Methods: This case study included a participant with transtibial amputation who was implanted percutaneously with SCS electrodes over the lumbosacral enlargement for 84 days. SCS was used during in-lab experiments to provide somatosensory feedback from the missing limb, relaying a sense of plantar pressure when the prosthesis was in the stance phase of the gait cycle. We used electromyography (EMG) to record muscle activity from the residual and intact limbs, and 3D motion capture to measure pelvic obliquity. EMG signals were recorded during walking with and without SCS at early and late time points across the implant duration. Results: During walking, co-contraction of knee antagonist muscles was reduced following multiple sessions of SCS-mediated sensory restoration. Additionally, the activation of the hip abductor (tensor fasciae latae) muscle increased activity during gait with SCS-mediated sensory restoration, which corresponded to an increase in pelvic obliquity range-of-motion and pelvic drop, towards normal. Conclusions: Restoring sensation in the missing limb using SCS modulated muscle activity during walking leading to improved coordination and pelvic motion in an individual with lower-limb amputation.