Abstract
Objective
To develop and apply an implanted neuroprosthesis to restore arm and hand function
to individuals with high level tetraplegia.
Design
Case study.
Setting
Clinical research laboratory.
Participants
Individuals with spinal cord injuries (N=2) at or above the C4 motor level.
Interventions
The individuals were each implanted with 2 stimulators (24 stimulation channels and
4 myoelectric recording channels total). Stimulating electrodes were placed in the
shoulder and arm, being, to our knowledge, the first long-term application of spiral
nerve cuff electrodes to activate a human limb. Myoelectric recording electrodes were
placed in the head and neck areas.
Main Outcome Measures
Successful installation and operation of the neuroprosthesis and electrode performance,
range of motion, grasp strength, joint moments, and performance in activities of daily
living.
Results
The neuroprosthesis system was successfully implanted in both individuals. Spiral
nerve cuff electrodes were placed around upper extremity nerves and activated the
intended muscles. In both individuals, the neuroprosthesis has functioned properly
for at least 2.5 years postimplant. Hand, wrist, forearm, elbow, and shoulder movements
were achieved. A mobile arm support was needed to support the mass of the arm during
functional activities. One individual was able to perform several activities of daily
living with some limitations as a result of spasticity. The second individual was
able to partially complete 2 activities of daily living.
Conclusions
Functional electrical stimulation is a feasible intervention for restoring arm and
hand functions to individuals with high tetraplegia. Forces and movements were generated
at the hand, wrist, elbow, and shoulder that allowed the performance of activities
of daily living, with some limitations requiring the use of a mobile arm support to
assist the stimulated shoulder forces.
Keywords
List of abbreviations:
ADL (activities of daily living), ECU (external control unit), FES (functional electrical stimulation), IST-12 (implantable stimulator-telemeter (12-channel)), SCI (spinal cord injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 21, 2014
Footnotes
Supported in part by the National Institutes of Health, National Institute of Neurological Disorders and Stroke (grant nos. N01-NS-1-2333 and N01-NS-5-2365) and Case Western Reserve University/Cleveland Clinic Clinical and Translational Science Award (grant no. UL1 RR024989) from the National Center for Research Resources, a component of the National Institutes of Health and National Institutes of Health Roadmap for Medical Research.
The contents of the article are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or National Institutes of Health.
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated (Hart, Bryden, Kilgore, Nemunaitis, Hoyen, Keith, Kirsch).
A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit on the author or one or more of the authors. Memberg and Polasek may potentially receive royalties paid by Ardiem Medical for the nerve cuff electrode.
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
