RESTORATION OF UPPER EXTREMITY FUNCTION IN HIGH LEVEL TETRAPLEGIA USING FES

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。这项研究的目的是评估植入式刺激系统的性能，该系统旨在为高位颈髓损伤(C1-C6)患者提供上肢瘫痪的激活和控制。这项研究是我们现有研究的延伸，目的是恢复此类患者的手功能。现有的研究主要集中在恢复C5/6级损伤患者的上肢功能，或利用经皮电极治疗C1-C4级损伤患者。本研究将通过将神经袖带电极和双刺激器分两个阶段整合到现有系统中，为高度脊髓损伤患者提供植入式刺激系统。通过施加小电流恢复功能性运动的技术被称为功能性电刺激(FES)或功能性神经肌肉刺激(FNS)。本研究中使用的FES系统旨在提供手握持/松开、前臂旋前/旋后、腕关节伸展/屈曲、肘关节屈曲/伸展和肩部旋转的功能。这项工作的意义在于，FES可以为四肢瘫痪受试者提供替代手段无法获得的操纵能力。参与这项研究的对象将是患有高水平(C1-C6)四肢瘫痪的个体。两个12通道植入式刺激系统将通过手术方式放置在参与受试者的一个上肢。除了标准的肌外膜和肌内电极外，还将使用神经袖带电极。四接触神经袖带电极最初将与外部刺激器进行经皮连接。评估将确定是否可以使用每个植入的袖带电极内的不同接触来选择性和最大限度地激活个别肌肉。在评估之后，患者将把神经袖带电极连接到植入的刺激器上。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The purpose of this study is to evaluate the performance of an implantable stimulation system designed to provide activation and control of the paralyzed upper extremity in patients with a high level cervical spinal cord injury (C1-C6). This research is an extension of our existing studies to restore hand function in such patients. The existing studies focus on restoring upper extremity function in individuals with C5/6 level injuries or utilize percutaneous electrodes in individuals with C1-C4 level injuries. This study will focus on providing an implantable stimulation system for individuals with high level spinal cord injuries by incorporating nerve cuff electrodes and dual stimulator into the current system in a two-stage process. The technique of restoring functional movement via application of small electrical currents is known as Functional Electrical Stimulation (FES) or Functional Neuromuscular Stimulation (FNS). The FES system to be employed in this study is designed to provide hand grasp/release, forearm pronation/ supination, wrist extension/flexion, elbow flexion/extension, and shoulder rotation. The significance of this work is that FES may provide tetraplegic subjects with manipulative capabilities unavailable by alternative means. Subjects participating in this study will be individuals with high level (C1-C6) tetraplegia. Two 12- channel implantable stimulation systems will be surgically placed in one upper extremity of participating subjects. Nerve cuff electrodes will be used in addition to the standard epimysial and intramuscular electrodes. The four-contact nerve cuff electrodes will initially have a percutaneous connection to an external stimulator. Evaluations will determine whether individual muscles can be activated selectively and maximally using different contacts within each implanted cuff electrode. After they have been evaluated, the patient will have the nerve cuff electrodes connected to an implanted stimulator.