The data suggest that the rhythmic motor patterns generated by the imposed stepping were responses of spinal reflex circuits to the cyclic sensory feedback. Tonic 30-Hz tSCS provided for additional excitation and engaged spinal rhythm-generating networks. The synergistic effects of these rhythm-generating mechanisms suggest that tSCS in combination with treadmill training might augment rehabilitation outcomes after severe spinal cord injury.

The Tongue Drive System (TDS) is a wireless and wearable assistive technology, designed to allow individuals with severe motor impairments such as tetraplegia to access their environment using voluntary tongue motion. Previous TDS trials used a magnetic tracer temporarily attached to the top surface of the tongue with tissue adhesive. We investigated TDS efficacy for controlling a computer and driving a powered wheelchair in two groups of able-bodied subjects and a group of volunteers with spinal cord injury (SCI) at C6 or above. All participants received a magnetic tongue barbell and used the TDS for five to six consecutive sessions. The performance of the group was compared for TDS versus keypad and TDS versus a sip-and-puff device (SnP) using accepted measures of speed and accuracy. All performance measures improved over the course of the trial. The gap between keypad and TDS performance narrowed for able-bodied subjects. Despite participants with SCI already having familiarity with the SnP, their performance measures were up to three times better with the TDS than with the SnP and continued to improve. TDS flexibility and the inherent characteristics of the human tongue enabled individuals with high-level motor impairments to access computers and drive wheelchairs at speeds that were faster than traditional assistive technologies but with comparable accuracy.

Tongue-Drive System (TDS) is a wireless and wearable assistive technology that enables people with severe disabilities to control their computers, wheelchairs, and smartphones using voluntary tongue motion. To evaluate the efficacy of the TDS, several experiments were conducted, in which the performance of nine able-bodied (AB) participants using a mouse, a keypad, and the TDS, as well as a cohort of 11 participants with tetraplegia (TP) using the TDS, were observed and compared. Experiments included the Fitts' law tapping, wheelchair driving, phone-dialing, and weight-shifting tasks over five to six consecutive sessions. All participants received a tongue piercing, wore a magnetic tongue stud, and completed the trials as evaluable participants. Although AB participants were already familiar with the keypad, throughputs of their tapping tasks using the keypad were only 1.4 times better than those using the TDS. The completion times of wheelchair driving task using the TDS for AB and TP participants were between 157 s and 180 s with three different control strategies. Participants with TP completed phone-dialing and weight-shifting tasks in 81.9 s and 71.5 s, respectively, using tongue motions. Results showed statistically significant improvement or trending to improvement in performance status over the sessions. Most of the learning occurred between the first and second sessions, but trends did suggest that more practice would lead to increased improvement in performance using the TDS.

The Tongue Drive System (TDS) is a minimally invasive, wireless, and wearable assistive technology (AT) that enables people with severe disabilities to control their environments using tongue motion. TDS translates specific tongue gestures into commands by sensing the magnetic field created by a small magnetic tracer applied to the user’s tongue. We have previously quantitatively evaluated the TDS for accessing computers and powered wheelchairs, demonstrating its usability. In this study, we focused on its qualitative evaluation by people with high-level spinal cord injury who each received a magnetic tongue piercing and used the TDS for 6 wk. We used two questionnaires, an after-scenario and a poststudy, designed to evaluate the tongue-piercing experience and the TDS usability compared with that of the sip-and-puff and the users’ current ATs. After study completion, 73% of the participants were positive about keeping the magnetic tongue-barbell in order to use the TDS. All were satisfied with the TDS performance and most said that they were able to do more things using TDS than their current ATs (4.22/5).

Background: Individuals with high-level spinal cord injuries need effective ways to perform activities. Objectives: To develop and test a medically supervised tongue-piercing protocol and the wearing of a magnet-containing tongue barbell for use with the Tongue Drive System (TDS) in persons with tetraplegia. Methods: Volunteers with tetraplegia underwent initial screening sessions using a magnet glued on the tongue to activate and use the TDS. This was followed by tongue piercing, insertion of a standard barbell, a 4-week healing period, and an exchange of the standard barbell for a magnet-containing barbell. This was then used twice weekly for 6 to 8 weeks to perform computer tasks, drive a powered wheelchair, accomplish in-chair weight shifts, and dial a phone. Symptoms of intraoral dysfunction, change in tongue size following piercing, and subjective assessment of receiving and wearing a magnet-containing tongue barbell and its usability with the TDS were evaluated. Results: Twenty-one volunteers underwent initial trial sessions. Thirteen had their tongues pierced. One individual's barbell dislodged during healing resulting in tongue-tract closure. Twelve had the barbell exchanged for a magnet-containing barbell. One subject withdrew for unrelated issues. Eleven completed the TDS testing sessions and were able to complete the assigned tasks. No serious adverse events occurred related to wearing or using a tongue barbell to operate the TDS. Conclusions: Using careful selection criteria and a medically supervised piercing protocol, no excess risk was associated with tongue piercing and wearing a tongue barbell in people with tetraplegia. Participants were able to operate the TDS.

Malignant peripheral nerve sheath tumors (MPNSTs) are difficult to control despite aggressive treatment. In this report the authors describe the treatment and follow-up review of a patient with neurofibromatosis Type I who harbored a recurrent median nerve MPNST. The man underwent preoperative intraarterial and intravenous chemotherapy followed by additional surgery for gross-total removal and postoperative radiotherapy. Two courses of preoperative intraarterial cisplatin and intravenous Adriamycin produced significant tumor shrinkage. Gross-total removal of the remaining tumor without amputation of the arm was followed by fractionated radiotherapy (total minimum tumor dose 6485 cGy, maximal dose 6575 cGy). The patient is alive 9.5 years after treatment without evidence of tumor recurrence and with only focal median nerve functional deficits. A review of the patient's treatment is warranted to provide a description of a regimen that may be useful in the treatment of similar patients in the future.

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