Implanted Neuroprosthesis for Restoring Arm and Hand Function in People With High Level Tetraplegia
Implanted Neuroprosthesis for Restoring Arm and Hand Function in People With High Level Tetraplegia
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DOI：
10.1016/j.apmr.2014.01.028
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发表时间：
2014-06-01
影响因子：
4.3
通讯作者：
Kirsch, Robert F.
中科院分区：
文献类型：
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作者：
Memberg, William D.;Polasek, Katharine H.;Kirsch, Robert F.
目的：研制并应用植入式神经假体修复重度四肢瘫痪患者的手臂和手部功能。设计：案例研究。单位：临床研究室。参与者：C4运动水平或以上的脊髓损伤个体（N=2）。干预措施：每人植入2个刺激器（共24个刺激通道和4个肌电记录通道）。刺激电极被放置在肩膀和手臂上，据我们所知，这是螺旋神经套电极第一次长期应用于激活人体肢体。在头部和颈部放置肌电记录电极。主要观察指标：神经假体安装和操作成功，电极性能，活动范围，握力，关节力矩，日常生活活动表现。结果：两例患者均成功植入神经假体。螺旋神经套电极被放置在上肢神经周围并激活预期的肌肉。在这两例患者中，神经假体在植入后至少正常工作了2.5年。手，手腕，前臂，肘部和肩部的运动实现。在进行功能活动时，需要一个可移动的手臂支架来支撑手臂的质量。一个人能够进行一些日常生活活动，但由于痉挛而受到一些限制。第二个人能够部分完成日常生活活动。结论：功能性电刺激是恢复四肢瘫痪患者手臂和手部功能的一种可行的干预措施。手、手腕、肘部和肩部产生的力量和运动允许进行日常生活活动，但有一些限制需要使用移动手臂支撑来辅助受刺激的肩部力量。(C) 2014年由美国康复医学大会发布
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. (C) 2014 by the American Congress of Rehabilitation Medicine