An advanced neuroprosthesis for restoration of hand and upper arm control using an implantable controller

Peckham, P. Hunter; Kilgore, Kevin L.; Keith, Michael W.; Bryden, Anne M.; Bhadra, Niloy; Montague, Fred W.

doi:10.1053/jhsu.2002.30919

Cited by 100 publications

(61 citation statements)

References 31 publications

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“…Surface electrodes are commonly used for FES Prochazka et al, 1997;Snoek et al, 2000) and for the rehabilitation training of individuals with acute paralysis (Chae et al, 1998) because they are easily placed by the FES-users and are noninvasive. However, implanted nerve cuff electrodes are also used during FES, especially for individuals with chronic paralysis following spinal cord injury or stroke (Chae et al, 2001;Daly and Ruff, 2000;Peckham and Knutson, 2005;Peckham et al, 2002). Further studies are therefore needed to assess the validity of our current findings during stimulation using implanted electrodes.…”

Section: Discussionmentioning

confidence: 99%

Effects of stimulation frequency versus pulse duration modulation on muscle fatigue

Kesar

Chou

Binder‐Macleod

2008

Journal of Electromyography and Kinesiology

110

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During functional electrical stimulation (FES), both the frequency and intensity can be increased to increase muscle force output and counteract the effects of muscle fatigue. Most current FES systems, however, deliver a constant frequency and only vary the stimulation intensity to control muscle force. This study compared muscle performance and fatigue produced during repetitive electrical stimulation using three different strategies: (1) constant pulse-duration and stepwise increases in frequency (frequency-modulation); (2) constant frequency and stepwise increases in pulse-duration (pulse-duration-modulation); and (3) constant frequency and pulse-duration (no-modulation). Surface electrical stimulation was delivered to the quadriceps femoris muscles of 12 healthy individuals and isometric forces were recorded. Muscle performance was assessed by measuring the percent changes in the peak forces and force-time integrals between the first and the last fatiguing trains. Muscle fatigue was assessed by measuring percent declines in peak force between the 60 Hz pre-and post-fatigue testing trains. The results showed that frequency-modulation showed better performance for both peak forces and force-time integrals in response to the fatiguing trains than pulse-duration-modulation, while producing similar levels of muscle fatigue. Although frequencymodulation is not commonly used during FES, clinicians should consider this strategy to improve muscle performance.

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Section: Discussionmentioning

confidence: 99%

Effects of stimulation frequency versus pulse duration modulation on muscle fatigue

Kesar

Chou

Binder‐Macleod

2008

Journal of Electromyography and Kinesiology

110

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Section: Neuroprosthesis Implantation and Implementationmentioning

confidence: 99%

“…Typically, deep and small muscles were implanted with intramuscular electrodes. 19 The electrode leads were subcutaneously tunneled to the upper arm approximately along the course of the median and radial nerves to the 2 connector sites.The EMG recording electrodes were sutured on the muscle surface just distal to the motor point of the muscle, as identified through direct electrical stimulation using an epimysial mapping probe. For some muscles, such as the platysma, anatomic restrictions defined the placement of the recording electrode (eg, avoiding movement of the electrode over the clavicle).…”

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confidence: 99%

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An Implanted Upper-Extremity Neuroprosthesis Using Myoelectric Control

Kilgore

Hoyen

Bryden

et al. 2008

The Journal of Hand Surgery

Self Cite

171

123

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Purpose-The purpose of this study was evaluate the potential of a second-generation implantable neuroprosthesis that provides improved control of hand grasp and elbow extension for individuals with cervical level spinal cord injury. The key feature of this system is that users control their stimulated function through electromyographic (EMG) signals.Methods-The second-generation neuroprosthesis consists of 12 stimulating electrodes, 2 EMG signal recording electrodes, an implanted stimulator-telemeter device, an external control unit, and a transmit/receive coil. The system was implanted in a single surgical procedure. Functional outcomes for each subject were evaluated in the domains of body functions and structures, activity performance, and societal participation.Results-Three individuals with C5/C6 spinal cord injury received system implantation with subsequent prospective evaluation for a minimum of 2 years. All 3 subjects demonstrated that EMG signals can be recorded from voluntary muscles in the presence of electrical stimulation of nearby muscles. Significantly increased pinch force and grasp function was achieved for each subject. Functional evaluation demonstrated improvement in at least 5 activities of daily living using the Activities of Daily Living Abilities Test. Each subject was able to use the device at home. There were no system failures. Two of 6 EMG electrodes required surgical revision because of suboptimal location of the recording electrodes.Conclusions-These results indicate that a neuroprosthesis with implanted myoelectric control is an effective method for restoring hand function in midcervical level spinal cord injury. Type of study/level of evidence-Therapeutic IV.Keywords functional electrical stimulation; neuroprosthesis; spinal cord injury; electromyography; activities of daily livingThe Ability To Grasp And Manipulate objects is an important factor in determining if the tetraplegic individual can regain independence and return to a functional role in society. Implantable functional electrical stimulation systems, or neuroprostheses, provide hand and arm function that is both versatile and transparent. These systems have evolved from the feasibility stage through clinical evaluation in an outpatient population to a Food and DrugCorresponding author: Kevin L. Kilgore, PhD, MetroHealth Medical Center, Hamann 601, 2500 MetroHealth Dr., Cleveland, OH 44109; e-mail: klk4@case.edu. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptAdministration (FDA)-approved medical product. 1 Neuroprostheses provide the user with increased independence, thus improving the opportunity for a better quality of life.A first-generation upper-extremity neuroprosthesis (NP) for hand control 2 was first implanted in 1986 3 and became known as the Freehand System. [4][5][6][7][8][9][10][11][12] The Freehand NP (NeuroControl Corp., Valley View, OH) used an 8-channel implanted receiver-stimulator with 8 epimysial or intramuscular forearm and hand electrodes, leads...

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“…For people with high-level spinal cord injuries, implanted stimulation systems can directly activate peripheral nerves and generate the coordinated muscle contractions needed to achieve functional movements of the paralyzed limbs (Keith & Hoyen, 2002;Peckham, et al, 2002). For people with missing limbs, advanced prosthetics are being developed with the capabilities of generating independent movement in each of the many joints of the wrist and fingers (e.g.…”

Section: Introduction Virtual Reality In Brain-machine Interfacing Anmentioning

confidence: 99%

Virtual reality hardware and graphic display options for brain–machine interfaces

Marathe

Carey

Taylor

2008

Journal of Neuroscience Methods

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Virtual reality hardware and graphic displays are reviewed here as a development environment for brain-machine interfaces (BMIs). Two desktop stereoscopic monitors and one 2D monitor were compared in a visual depth discrimination task and in a 3D target-matching task where ablebodied individuals used actual hand movements to match a virtual hand to different target hands. Three graphic representations of the hand were compared: a plain sphere, a sphere attached to the fingertip of a realistic hand and arm, and a stylized pacman-like hand. Several subjects had great difficulty using either stereo monitor for depth perception when perspective size cues were removed. A mismatch in stereo and size cues generated inappropriate depth illusions. This phenomenon has implications for choosing target and virtual hand sizes in BMI experiments. Target matching accuracy was about as good with the 2D monitor as with either 3D monitor. However, users achieved this accuracy by exploring the boundaries of the hand in the target with carefully controlled movements. This method of determining relative depth may not be possible in BMI experiments if movement control is more limited. Intuitive depth cues, such as including a virtual arm, can significantly improve depth perception accuracy with or without stereo viewing.

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An advanced neuroprosthesis for restoration of hand and upper arm control using an implantable controller

Cited by 100 publications

References 31 publications

Effects of stimulation frequency versus pulse duration modulation on muscle fatigue

Effects of stimulation frequency versus pulse duration modulation on muscle fatigue

An Implanted Upper-Extremity Neuroprosthesis Using Myoelectric Control

Virtual reality hardware and graphic display options for brain–machine interfaces

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