RESTORATION OF UPPER EXTREMITY FUNCTION IN HIGH LEVEL TETRAPLEGIA USING FES

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。本研究的目的是评估植入式刺激系统的性能，该系统旨在为高水平颈脊髓损伤（C1-C6）患者的瘫痪上肢提供激活和控制。本研究是我们现有研究的延伸，旨在恢复此类患者的手功能。现有的研究侧重于恢复C5/6节段损伤患者的上肢功能，或在C1-C4节段损伤患者中使用经皮电极。本研究将通过将神经套电极和双刺激器结合到现有系统中，分两阶段为高水平脊髓损伤患者提供一种可植入的刺激系统。通过应用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/释放、前臂旋前/旋后、手腕伸/屈、肘关节屈/伸和肩部旋转。这项工作的意义在于，FES可以为四肢瘫痪患者提供其他方法无法获得的操作能力。本研究的受试者为重度（C1-C6）四肢瘫痪患者。两个12通道的可植入刺激系统将被手术放置在参与者的上肢。除了标准的膜外电极和肌内电极外，还将使用神经袖电极。四触点神经套电极最初将经皮连接到外部刺激器。评估将决定单个肌肉是否可以选择性地激活，并最大限度地使用每个植入的袖带电极的不同接触。评估完成后，患者将把神经套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.