Reconstruction of Standing and Gait in Paraplegia through Functional Electrical Stimulation (FES)

本研究旨在通过功能性电刺激（FES）重建截瘫患者的站立和步态功能，根据正常人几种运动过程中的肌电活动来确定电刺激模式，并对3例偏瘫患者和3例四肢瘫痪患者进行了临床辅助FES步态训练。经二维或三维运动分析仪评估，行走状态明显优于非FES步态。手术将约30根经皮电极丝植入双侧下肢选定的肌肉中。FESMATE 1230（NEC有限公司）被用作电刺激器。刺激参数为0.2msee，频率20 Hz。刺激电压在0至-15伏之间变化。缠绕在患者手上的手动开关用于控制刺激器。结果所有病例均获得双杠站立60分钟以上的FES，其中1例患者尝试FES行走。由于肌肉疲劳和反馈机制的缺乏，患者很难舒适地行走，因此，解决肌肉疲劳问题和重建反馈机制是功能性电刺激恢复截瘫患者站立和行走能力的关键。

The purpose of this study was to reconstruct standing and gait function for the paraplegic patients by means of functional electrical stimulation (FES).The electrical stimulation pattern was decided according to the EMG activities during several motions of the normal subjects.Clinically, assistive FES gait was performed in three hemiplegics and three tetraparetics. This was evaluated by the two or three dimensional motion analyzer, and the state of walking became better than non-FES gait.FES standing was applied for five paraplegics. About thirty percutaneous wire electrodes were implanted surgically into the selected muscles of bilateral lower extremity. FESMATE1230 (NEC Co.Ltd.) was used as an electrical stimulator. As to the stimulation parameters, 0.2 msee of pulse width and 20Hz of frequency were used. The stimulation voltage was variable from 0 to-15 volts. A hand switch that was winded around the patient's hand, was used to control the stimulator. As a result, over sixty minutes FES standing in the parallel bar, with no orthotics were obtained in all cases.FES gait for paraplegic was tried in one case. It was very difficult for the patient to walk comfortably because of the muscle fatigue and the lack of feedback mechanism.In conclusion, the settlement of the muscle fatigue problem and the reconstruction of the feedback mechanism seem to be essential to restore standing and walking abilities in paraplegics by functional electrical stimulation.