SUMMARY
OF
RESULTS
AND
SETTINGS
Four
different
programs
have
been
saved
on
your
stimulator
that
can
be
accessed
by
the
remote
control
and
are
named
Program
D1,
D2,
D3,
D4.
All
programs
have
a
fixed
frequency
of
40Hz
and
a
pulse
width
of
200ms.
The
amplitude/intensity
of
stimulation
can
be
adjusted
through
the
remote
control,
as
was
explained
when
you
were
here.
Stimulation
configuration
of
Program
D1--‐4
With
each
program,
a
different
combination
of
electrodes
is
activated
on
the
array
that
has
been
implanted
on
your
spinal
cord.
See
program
name
and
configuration
below:
D1
D2
D3
D4
Generalization
of
functional
outcome
D1:
whole
leg
activation
L
+
R
(extensors
and
flexors)
D2:
hip
flexion
and
adduction
D3:
knee
extension
D4:
knee/hip
extension
and
adduction
Activation
for
training
standing
For
training
standing
you
want
to
increase
mostly
extensor
activity
(with
little
flexor
activity
for
stabilization).
For
this
reason
the
best
program
to
use
while
training
standing
is
a
combination
of
D1
and
D4.
The
intensity
of
these
programs
needs
to
be
tuned
properly
to
have
a
balance
between
activation
of
flexors
and
extensors.
We
saw
that
this
can
most
easily
be
checked
when
looking
at
the
muscle
activation
of
the
thigh,
just
above
the
knee.
Best
is
to
balance
the
muscle
activation
so
you
have
a
bit
more
activation
of
extensors
(frontside
of
leg)
compared
to
flexors
(backside
of
leg).
Be
careful
to
start
with
low
intensity
around
the
threshold
for
muscle
activation
(see
below).
Starting
at
high
intensity
will
give
a
‘hock’effect
when
stimulation
is
started.
At
a
later
stage
of
training,
to
perform
a
flexion
movement
at
the
hip
e.g.
for
lifting
the
knee,
it
might
be
helpful
to
involve
program
D2,
but
this
all
depends
on
the
results
of
training.
Threshold
for
muscle
activation
The
thresholds
can
change
quite
a
bit
when
comparing
different
positions
such
as
lying
down
or
standing.
The
threshold
for
muscle
activation
for
Program
D1
+
D4
was
around
2.8--‐3.0V.
This
is
when
you
start
seeing
the
first
signs
of
activation
of
muscles
in
the
legs.
Optimal
stimulation
for
muscle
activation
for
standing
The
goal
for
the
most
appropriate
training,
is
to
find
the
optimal
stimulation
for
1)
activating
the
legs
with
stimulation,
combined
with
2)
the
possibility
to
activate
your
legs
yourself.
This
can
be
different
from
day
to
day
(especially
when
you
start
using
stimulation),
this
can
change
within
a
session
(due
to
e.g.
fatigue),
and
can
evolve
with
training.
So
the
optimal
setting
should
be
quickly
checked
every
time
you
use
the
stimulation,
to
see
if
it
can
be
optimized.
Careful:
this
can
be
either
an
increase
or
a
decrease
of
intensity.
As
pointed
out
above,
first
start
stimulation
around
the
threshold,
then
gradually
increase
the
intensity
until
the
point
where
you
see
good
muscle
activation
for
standing.
--‐ Start
with
increasing
the
intensity
of
1
program
e.g.
Program
D4
and
tune
the
extensor
activity
of
the
leg
above
the
knee
on
the
frontside
of
the
leg.
--‐ When
you
see
nice
activation,
change
to
Program
D1
and
tune
the
intensity
of
this
program
as
well,
activating
(together
with
others)
the
muscles
above
the
knee
on
the
backside
of
the
leg.
--‐ Usually
you’l
have
to
go
back
to
Program
D4
to
adjust
a
little
bit,
to
balance
out
the
activation
between
the
frontside
and
backside
of
the
leg.
Here
we
found
quite
a
difference
between
the
two
days.
--‐
DAY
1:
Program
D1
optimal:
6.8V
Program
D4
optimal:
5V
--‐
DAY
2:
Program
D1
optimal:
9.4V
Program
D4
optimal:
8V
What
we
saw
was
that
on
Day
1
you
were
able
to
willingly
decrease
the
activation
of
muscles
(that
were
activated
by
stimulation),
however
this
happened
when
you
tried
to
activate
the
legs.
On
Day
2
you
also
showed
what
you
showed
on
Day
1,
however
on
this
day
you
were
also
able
to
increase
the
activation
of
extensor
muscles
of
the
leg,
which
are
needed
to
stand.
This
is
very
appropriate/useful
activation
to
learn
and
improve
active
standing.
And
this
is
what
should
be
trained.
REMINDER:
the
stimulation
has
been
optimized
for
training
standing,
since
it
focuses
on
constantly
activating
mainly
extensor
muscles
and
whole
limb
extension
for
bearing
weight
on
your
legs.
This
is
the
first
task
that
should
be
trained.
If
rhythmic
movements
can
be
made
voluntarily
with
bending
and
straightening
both
legs
independently,
another
program
should
be
used
to
optimize
the
training
of
such
movements.