Efficacy of an implanted neuroprosthesis for restoring hand grasp in tetraplegia: A multicenter study

Peckham, P. Hunter; Keith, Michael W.; Kilgore, Kevin L.; Grill, Julie H.; Wuolle, Kathy S.; Thrope, G. B.; Gorman, Peter H.; Hobby, John; Mulcahey, M. J.; Carroll, Sara; Hentz, Vincent R.; Wiegner, Allen W.

doi:10.1053/apmr.2001.25910

Cited by 284 publications

(188 citation statements)

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“…[15][16][17][18][19][20] The ISCSCI motor and sensory exams have also been used as inclusion criteria for entry into drug and device trials. [21][22][23][24][25][26][27][28] While the work by Bracken 21 added additional upper extremity muscles and variation in the scoring technique, the study used neurological motor level as the primary outcome in the study on high-dose methylprednisolone. Outcomes of activity-based rehabilitation, a program of intensive cycling, assisted treadmill training and swimming, also use the International standards as primary outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…22 Studies of functional electrical stimulation devices have extensive history using the International motor and sensory exams as both an entry criteria and outcome variable. [23][24][25][26][27][28] Despite the extensive use of the ISCSCI, few studies report the reliability of the motor and sensory data. The first reliability and validity studies 29,30 of both examination and classification skills were conducted following the 1992 revision 31 and showed much improved reliability of the examination using the ISCSCI, but no change in the marginal reliability of classification.…”

Section: Introductionmentioning

confidence: 99%

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The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths

et al. 2006

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Study design: Intra-rater reliability study, cross-sectional design. Objectives: To determine reliability of the International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) motor and sensory exam in children. Setting: Nonprofit pediatric hospital. Methods: In all, 74 subjects had two trials of the motor and sensory exams. Intraclass correlation coefficients (ICC), 95% confidence intervals (CI) were generated for total motor (TM), pin prick (PP) and light touch (LT) scores for the entire sample, four age groups, severity and type of injury.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths

et al. 2006

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“…[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, and connectors. A radio-frequency inductive link provided the communication and power to the implant receiver-stimulator.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

“…1,9 This clinical trial demonstrated that with the implanted NP, individuals retained the ability to hold and maintain object grasp during arm movement through increased pinch force. 9,16 The functional performance, as determined by an activities of daily living (ADL) test, 17 demonstrated that all subjects were more independent in at least 1 task, and 78% were more independent in at least 3 tasks. All subjects preferred to use the NP for at least 1 task and 96% preferred to use the NP for at least 3 tasks tested.…”

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An Implanted Upper-Extremity Neuroprosthesis Using Myoelectric Control

Kilgore

Hoyen

Bryden

et al. 2008

The Journal of Hand Surgery

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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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Functional Electrical Stimulation

Venkatasubramanian

Jung

Sweeney

2006

Encyclopedia of Medical Devices and Instrumentation

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Functional electrical stimulation (FES) is a rehabilitative technique where low level electrical voltages and currents are applied to an individual in order to improve or restore function lost to injury or disease. In its broadest definition, FES includes electrical stimulation technologies that, for example, are aimed at restoration of a sense of hearing for the deaf, vision for the blind, or suppression of seizures in epilepsy or tremors for people with Parkinson's disease. Most FES devices and systems are known then as “neuroprostheses” because through electrical stimulation they artificially modulate the excitability of neural tissue in order to restore function. While sometimes used synonymously with FES, the term functional neuromuscular stimulation (FNS) is most commonly used to describe only those FES technologies that are applied to the neuromuscular system in order to improve quality of life for people disabled by stroke, spinal cord injury, or other neurological conditions that result in impaired motor function (e.g., the abilities to move or breathe). Another technology closely related to FES is that of therapeutic electrical stimulation (TES), wherein electrical stimulation is applied to provide healing or recovery of tissues (e.g., muscle conditioning and strengthening, wound healing). As will be seen, some FES and FNS technologies concurrently provide or rely upon such therapeutic effects in order to successfully restore lost function. For illustrative purposes, much of this article is centered on FNS and related TES devices and technologies.

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Efficacy of an implanted neuroprosthesis for restoring hand grasp in tetraplegia: A multicenter study

Cited by 284 publications

References 23 publications

The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths

The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths

An Implanted Upper-Extremity Neuroprosthesis Using Myoelectric Control

Functional Electrical Stimulation

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