RESTORATION OF UPPER EXTREMITY FUNCTION IN HIGH LEVEL TETRAPLEGIA USING FES

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。本研究旨在评价植入式刺激系统的性能，该系统旨在为高位颈髓损伤（C1-C6）患者的瘫痪上肢提供激活和控制。这项研究是我们现有研究的延伸，以恢复此类患者的手功能。现有的研究集中于恢复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。本研究的重点是通过在两个阶段的过程中将神经袖带电极和双刺激器结合到当前系统中，为高度脊髓损伤的个体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系统旨在提供手抓握/释放、前臂旋前/旋后、腕部伸展/屈曲、肘关节屈曲/伸展和肩部旋转。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提供的操作能力。参与本研究的受试者将是患有高度（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植入参与受试者的一个上肢。除标准肌外膜和肌内电极外，还将使用神经袖带电极。四触点神经袖带电极最初将通过经皮连接到外部刺激器。评估将确定是否可以使用每个植入的袖带电极内的不同触点选择性地和最大限度地激活单个肌肉。在对其进行评价后，患者将神经袖带电极连接到植入式刺激器。

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.