RESTORATION OF SHOULDER FUNCTION IN C5 TETRAPLEGIA

C5 四肢瘫痪肩部功能的恢复

• 批准号: 2403478
• 负责人: Robert F. Kirsch
• 金额: $ 8.56万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-08-01 至 2001-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2403478
• 关键词: arm; assistive device /technology; biomechanics; biomedical equipment development; clinical research; electrodes; electromyography; electrostimulus; functional ability; hand; human subject; human therapy evaluation; implant; joint stiffness; joints; limb movement; muscle contraction; neuromuscular function; neuromuscular stimulator; paralysis; posture; quality of life; spinal cord injury

DESCRIPTION (Adapted from the Applicant's Abstract): This study will implement, evaluate, and optimize a neuroprosthesis based on functional neuromuscular stimulation (FNS) which will restore shoulder function to spinal cord injured individuals with C5 tetraplegia. Such individuals retain little or no voluntary control over motions acting to move the upper arm toward the midline, due primarily to paralysis of the pectoralis major (PM) and latissimus dorsi (LD) muscles. This loss of control significantly reduces the range of motion of the hand, excluding an important workspace volume near the midline, and prevents arm stabilization in the natural abducted postures used in many tasks like eating and writing. Restoration of these functions would significantly improve the independence of these individuals in a number of daily activities, improving their quality of life and reducing their attendant care costs. The main hypothesis of this study is that FNS of a small number of sites in the PM and LD muscles can significantly improve shoulder function in horizontal flexion, adduction, and internal rotation in individuals with C5 tetraplegia. The stimulated contractions will restore the lost motions, while retained voluntary control of antagonistic muscles will be used by the individual to overcome the stimulated contractions and achieve intermediate positions and external forces in a completely natural manner. After verifying the hypothesis that individuals with a C5 Function level retain sufficient stimulated strength in the PM and LD and adequate voluntary control over their antagonists, experiments will test the hypotheses that the shoulder neuroprosthesis expands the workspace volume accessible to the hand, improves postural stability, and allows more rapid and accurate arm movements. Several general methods for improving control of the partially paralyzed shoulder will also be developed. Shoulder stiffness properties will be used to identify deficits in postural stability in a systematic manner and to suggest changes in electrical stimulation patterns to correct the deficits. The feasibility of using electromyographic recordings from voluntarily-controlled shoulder muscles to modulate stimulation of the paralyzed muscles will be investigated, since such modulation could improve movement performance, prevent fatigue, and compensate for changes in contraction strength in different shoulder positions.

描述（改编自申请人摘要）：本研究将 实施、评估和优化基于功能神经假体 神经肌肉刺激（FNS）将恢复肩部功能， 脊髓损伤患者C5四肢瘫痪。 这些个人 很少或根本没有对鞋帮运动的自主控制 手臂朝向中线，主要是由于胸大肌麻痹 (PM)和背阔肌（LD）肌肉。 这种失去控制的现象 减少了手部的运动范围，排除了重要的工作空间 体积靠近中线，并防止手臂稳定在自然 被绑架的姿势用于许多任务，如吃饭和写作。 恢复 这将大大提高这些功能的独立性。 个人在一些日常活动，提高他们的生活质量 并减少他们的护理费用。 本研究的主要假设是， PM和LD肌肉可以显着改善肩部功能， C5患者的水平屈曲、内收和内旋 四肢瘫痪 刺激收缩会恢复失去的运动， 而保留的对拮抗肌的随意控制将由 个人克服刺激收缩，并实现中间 自然的位置和外力。 后 验证具有C5功能水平的个体保留 在PM和LD中有足够的刺激强度， 控制他们的对手，实验将测试的假设， 肩神经假体扩展了可进入的工作空间体积， 手，提高姿势稳定性，并允许更快速和准确的手臂 动作 改善部分瘫痪系统控制的几种通用方法 肩膀也将得到发展。 将使用肩部刚度特性 以系统的方式识别姿势稳定性的缺陷， 建议改变电刺激模式以纠正缺陷。 使用肌电记录的可行性， 自动控制的肩部肌肉，以调节 瘫痪的肌肉将被研究，因为这种调制可以改善 运动性能，防止疲劳，并补偿 不同肩位的收缩力。