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Objective:  Wheelchair safety is of great importance since falls from wheelchairs are prevalent and often have devastating consequences. We developed an automatic system to detect destabilizing events during wheelchair propulsion under real-world conditions and trigger neural stimulation to stiffen the trunk to maintain seated postures of users with paralysis. Design:  Cross-over intervention Setting:  Laboratory and community settings Participants:  Three able-bodied subjects and three individuals with SCI with previously implanted neurostimulation systems Interventions:  An algorithm to detect wheelchair sudden stops was developed. This was used to randomly trigger trunk extensor stimulation during sudden stops events Outcome Measures:  Algorithm success and false positive rates were determined. SCI users rated each condition on a seven-point Usability Rating Scale to indicate safety. Results:  The system detected sudden stops with a success rate of over 93% in community settings. When used to trigger trunk neurostimulation to ensure stability, the implant recipients consistently reported feeling safer ( P &lt;.05 for 2/3 subjects) with the system while encountering sudden stops as indicated by a 1–3 point change in safety rating. Conclusion:  These preliminary results suggest that this system could monitor wheelchair activity and only apply stabilizing neurostimulation when appropriate to maintain posture. Larger scale, unsupervised and longer-term trials at home and in the community are indicated. This system could be generalized and applied to individuals without an implanted stimulation by utilizing surface stimulation, or by actuating a mechanical restraint when necessary, thus allowing unrestricted trunk movements and only restraining the user when necessary to ensure safety. Trial Registration:  NCT01474148

Sudden stop detection and automatic seating support with neural stimulation during manual wheelchair propulsion