RESTORATION OF SHOULDER FUNCTION IN C5 TETRAPLEGIA

描述(改编自申请人的摘要)：这项研究将 实施、评估和优化基于功能的神经假体 神经肌肉刺激(FNS)将恢复肩部功能 脊髓损伤的C5四肢瘫痪患者。这样的人 几乎不能或根本不能主动控制移动鞋面的动作 手臂朝向中线，主要是由于胸大肌瘫痪 (PM)和背阔肌(LD)。这种失控显著地 减少手的活动范围，不包括重要的工作空间 中线附近的体积，并防止手臂在自然状态下稳定 被绑架的姿势被用在许多任务中，比如吃饭和写作。修复 这些功能将显著提高这些功能的独立性 个人在一些日常活动中，提高了自己的生活质量 并降低他们的随行护理费用。 这项研究的主要假设是少数站点的FNS在 PM和LD肌肉能显著改善小鼠肩关节功能。 C5患者的水平屈曲、内收和内旋 四肢瘫痪。受刺激的收缩会恢复失去的运动， 虽然保留了对对抗肌肉的自愿控制，但 个人克服刺激收缩并达到中期 位置和外力以一种完全自然的方式。之后 验证具有C5功能水平的个体保留的假设 在PM和LD中有足够的刺激力量和足够的自愿 控制他们的对手，实验将检验假设 肩部神经假体扩大了工作空间体积， 手，提高了姿势的稳定性，并允许更快速和准确的手臂 动静。 提高对部分瘫痪患者控制力的几种一般方法 肩部也将得到发展。将使用肩部刚度属性 以系统的方式识别姿势稳定性方面的缺陷并 建议改变电刺激模式以纠正缺陷。 使用肌电记录的可行性 自愿控制的肩部肌肉，以调节对 瘫痪的肌肉将被调查，因为这种调节可以改善 运动性能，防止疲劳，并补偿变化 不同肩部位置的收缩力量。

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.