William D Memberg1, Katharine H Polasek2, Ronald L Hart3, Anne M Bryden2, Kevin L Kilgore4, Gregory A Nemunaitis5, Harry A Hoyen5, Michael W Keith5, Robert F Kirsch4. 1. Case Western Reserve University, Cleveland, OH. Electronic address: wdm@case.edu. 2. Case Western Reserve University, Cleveland, OH. 3. Louis Stokes Veterans Affairs Medical Center, Cleveland, OH. 4. Case Western Reserve University, Cleveland, OH; Louis Stokes Veterans Affairs Medical Center, Cleveland, OH; MetroHealth Medical Center, Cleveland, OH. 5. MetroHealth Medical Center, Cleveland, OH.
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.
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.
Authors: Kevin L Kilgore; Harry A Hoyen; Anne M Bryden; Ronald L Hart; Michael W Keith; P Hunter Peckham Journal: J Hand Surg Am Date: 2008-04 Impact factor: 2.230
Authors: Katharine H Polasek; Harry A Hoyen; Michael W Keith; Dustin J Tyler Journal: IEEE Trans Neural Syst Rehabil Eng Date: 2007-03 Impact factor: 3.802
Authors: Michal S Atkins; Jane M Baumgarten; Yuriko Lynn Yasuda; Rodney Adkins; Robert L Waters; Pierre Leung; Philip Requejo Journal: J Spinal Cord Med Date: 2008 Impact factor: 1.985
Authors: Lee E Fisher; Michael E Miller; Stephanie N Bailey; John A Davis; James S Anderson; Lori Rhode; Dustin J Tyler; Ronald J Triolo Journal: IEEE Trans Neural Syst Rehabil Eng Date: 2008-10 Impact factor: 3.802
Authors: Philip P Vu; Alex K Vaskov; Zachary T Irwin; Phillip T Henning; Daniel R Lueders; Ann T Laidlaw; Alicia J Davis; Chrono S Nu; Deanna H Gates; R Brent Gillespie; Stephen W P Kemp; Theodore A Kung; Cynthia A Chestek; Paul S Cederna Journal: Sci Transl Med Date: 2020-03-04 Impact factor: 17.956
Authors: Max O Krucoff; Jonathan P Miller; Tarun Saxena; Ravi Bellamkonda; Shervin Rahimpour; Stephen C Harward; Shivanand P Lad; Dennis A Turner Journal: Neurosurgery Date: 2019-01-01 Impact factor: 4.654
Authors: Daniel C Lu; V Reggie Edgerton; Morteza Modaber; Nicholas AuYong; Erika Morikawa; Sharon Zdunowski; Melanie E Sarino; Majid Sarrafzadeh; Marc R Nuwer; Roland R Roy; Yury Gerasimenko Journal: Neurorehabil Neural Repair Date: 2016-05-18 Impact factor: 3.919
Authors: B J Holinski; K A Mazurek; D G Everaert; A Toossi; A M Lucas-Osma; P Troyk; R Etienne-Cummings; R B Stein; V K Mushahwar Journal: J Neural Eng Date: 2016-09-13 Impact factor: 5.379