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

本研究旨在利用功能性电刺激（FES）重建截瘫患者的站立和步态功能。电刺激模式是根据正常受试者在几个运动过程中的肌电图活动来确定的。临床上，对3例偏瘫和3例四肢瘫痪患者进行了辅助FES步态。通过二维或三维运动分析仪评估，行走状态优于非fes步态。5名截瘫患者申请了FES站立。大约30个经皮导线电极通过手术植入双侧下肢选定的肌肉。使用FESMATE1230 （NEC Co.Ltd）作为电刺激器。刺激参数为脉冲宽度0.2 msee，频率20Hz。刺激电压在0 -15伏之间变化。一个缠绕在病人手上的手开关被用来控制刺激器。结果，在没有矫形器的情况下，在双杠上站立超过60分钟的FES。对1例截瘫患者进行了FES步态试验。由于肌肉疲劳和缺乏反馈机制，患者很难舒适地行走。综上所述，通过功能电刺激恢复截瘫患者的站立和行走能力，肌肉疲劳问题的解决和反馈机制的重建至关重要。

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.