An Implanted Upper Extremity Neuroprosthesis Utilizing Myoelectric Control

Kilgore, Kevin L.; Peckham, P. Hunter; Montague, Fred W.; Hart, Ronald L.; Bryden, Anne; Keith, Michael W.; Hoyen, Harry A.; Bhadra, Niloy

doi:10.1109/cne.2005.1419634

Cited by 21 publications

(34 citation statements)

References 21 publications

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“…Functional neuromuscular stimulation (FNS) is being investigated for a variety of applications, including reaching and locomotion (Triolo et al 1996, Mirbagheri et al 2002, Chizeck et al 1988. The 'Freehand' system (Kilgore et al 1997(Kilgore et al , 2005 has FDA approval and has been implanted in an effort to restore the ability to open and close the hand in several hundred patients with C5-6 spinal injuries. However, finding the means for these patients to control multiple degrees of freedom is quite difficult.…”

Section: Cortical Control Of Muscle Contraction Via Fnsmentioning

confidence: 99%

Prediction of upper limb muscle activity from motor cortical discharge during reaching

et al. 2007

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Movement representation by the motor cortex (M1) has been a theoretical interest for many years, but in the past several years it has become a more practical question, with the advent of the brainmachine interface. An increasing number of groups have demonstrated the ability to predict a variety of kinematic signals on the basis of M1 recordings and to use these predictions to control the movement of a cursor or robotic limb. We, on the other hand, have undertaken the prediction of myoelectric (EMG) signals recorded from various muscles of the arm and hand during button pressing and prehension movements. We have shown that these signals can be predicted with accuracy that is similar to that of kinematic signals, despite their stochastic nature and greater bandwidth. The predictions were made using a subset of 12 or 16 neural signals selected in the order of each signal's unique, output-related information content. The accuracy of the resultant predictions remained stable through a typical experimental session. Accuracy remained above 80% of its initial level for most muscles even across periods as long as two weeks. We are exploring the use of these predictions as control signals for neuromuscular electrical stimulation in quadriplegic patients.

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Section: Cortical Control Of Muscle Contraction Via Fnsmentioning

confidence: 99%

Prediction of upper limb muscle activity from motor cortical discharge during reaching

et al. 2007

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“…These procedures are designed to facilitate the application of the Freehand System and are typically employed with the application of the system in adults and adolescents. 2,3 To allow for proper healing of the tendon transfers, the arm was casted for 4 weeks following surgery with the hand in the intrinsic plus position, the elbow in 108 of¯exion and the wrist in 208 of extension. 10 Following cast removal, the child underwent both a 4-week stimulated exercise program to hypertrophy forearm and hand muscles and traditional rehabilitation for transfer re-training involving the brachioradialis and deltoid muscles.…”

Section: Implantation Of Freehand Systemmentioning

confidence: 99%

“…Other than the fact that the subject was skeletally immature, she was considered an appropriate candidate for the Freehand System based on her level of motor function. 2 Informed consent was obtained from the child and family. An Investigational Device Exemption was obtained from the United States Food and Drug Administration for this study.…”

Section: Subjectmentioning

confidence: 99%

“…1 An external control unit supplies power and stimulation parameters to the internal stimulator by way of a radio frequency signal. The user controls stimulation of hand grasp with contralateral shoulder shrug sensed by an external position sensor 1 While the Freehand System has been implemented with both adults 2 and skeletally mature adolescents with SCI, 3,4 growing children have not yet been recipients of this device due to the unknown eect of limb growth on the performance of the internal components. At our institution, recent results using a canine model suggest that motor responses can be maintained with growth using the implanted electrodes of the Freehand System 5 and that excess electrode lead can unravel with growth such that electrodes will remain in position and provide a stable motor response.…”

Section: Introductionmentioning

confidence: 99%

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An implantable upper extremity neuroprosthesis in a growing child with a C5 spinal cord injury

2001

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Objectives: To implement a functional electrical stimulation (FES) hand neuroprosthesis called the Freehand System in a growing child with spinal cord injury (SCI) using extra lead wire to accommodate limb growth, and to evaluate the performance of the Freehand System during the subject's maturation. Setting: Pediatric orthopedic hospital specializing in SCI rehabilitation. Subject: Ten-year-old female patient with a C5 level SCI. Method: The Freehand System was implanted. Eight electrodes were implanted to targeted forearm and hand muscles to provide grasp and release function. The lead wire associated with each electrode was pathed subcutaneously up the arm with 4 cm of extra lead distributed throughout the path to accommodate expected limb growth. All leads were attached to a stimulator placed in the upper chest. Measures of lead unwinding, limb growth, stimulated muscle strength, and hand function were made at 6 and 16 months after implant. Results: By 16 months post implant, the upper limb growth plates were closed and humeral and radial bone growth combined was 2.7 cm from the time of surgery. For all eight leads, lead unwinding in the upper arm was approximately 1.2 cm and was comparable to humeral bone growth (1.4 cm). Lead unwinding in the lower arm was also measurable for the two electrodes in hand muscles. Six of eight electrodes maintained grade 3 or better stimulated muscle strength throughout the growth period according to a manual muscle test. Of the two other electrodes, one appeared to have lost function due to depletion of excess lead. However, hand function with FES was comparable at 6 and 16 months post implant suggesting that growth did not negatively impact performance with the FES system. Hand function with FES was improved over voluntary hand function as well. Using the Freehand System, a pinch force of approximately 15 N was achieved compared to 1.3 N of voluntary tenodesis pinch force. Scores on the Functional Independence Measure (FIM) increased by 9 points when FES was used as compared to voluntary function. Improvements occurred primarily in eating and grooming. Independence in writing was achieved only with FES. Conclusions: For this child, hand function with the Freehand System was sustained over the growth period and was a signi®cant functional improvement over voluntary hand function. By using excess lead wire, the Freehand System was successfully implemented before skeletal maturity, aording the child improved hand function earlier than would be otherwise indicated.

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“…Currently, such lower extremity applications still rely on the use of assistive devices and upper extremity exerti 'n for balance and support, and tend to be energy inefficient.u - 1 2 Although the applicability of FNS to individuals with cerebral palsy, 19 high (C4) ,20-22 or low (C6 and C7) cervical injuries23 are currently under investigation, upper extremity applications have concen trated primarily on providing prehension and release to persons with midcervical level tetraplegia. [23][24][25][26][27][28][29] The most advanced and well reported system employs 16 channels of percutaneous intramuscular stimulation to activate the finger flexors, extensors, and thumb muscles. The system is capable of generating two types of prehension pat terns: palmar grasp and lateral pinch.…”

Section: Candidate Selection For Pediatric Fns 825mentioning

confidence: 99%

Application of functional neuromuscular stimulation to children with spinal cord injuries: candidate selection for upper and lower extremity research

et al. 1994

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This paper summarizes the results of screening for partIcipation in research programs involving functional neuromuscular stimulation (FNS). It examines the characteristics of a group of children and teenagers with spinal cord injuries (SCI) identified as potential candidates for FNS as defined by the rigorous inclusion criteria of the research studies. One hundred and thirteen children and teenagers under the age of 20 with cervical, thoracic or lumbar level spinal cord injuries were examined for inclusion in an experimental program of FNS to provide standing, walking, or prehension. Although biased towards adolescents with complete midthoracic and midcervical injuries, the age, sex, injury level, etiology, and neurological status of the sample coincided with previously published reports and consisted predominantly of teenage males injured in motor vehicle or sports related accidents. Approximately half of the individuals examined were physically appropriate for research participation without pre paratory intervention. Treatment options to prepare individuals for FNS were identified in 25% of those considered inappropriate at the initial evaluation, indicating that the potential user population of clinical systems may be larger than estimates obtained from research applications. Peripheral denervation was the single most prevalent physical impediment to the application of FNS. Although the incidence of lower motor neuron (LMN) involvement was similar in subjects with tetraplegia and paraplegia, those with cervical lesions more frequently exhibited other medical complications that interfered with the appli cation of FNS. Surgical procedures involving transfer of paralyzed but excitable muscles were identified in almost one third of the candidates with tetraplegia who were excluded due to denervation. Of those physically appropriate, psychological factors eliminated several candidates from consideration. Such concerns may also be addressed with suitable intervention in preparation for the clinical application of FNS. Almost 50% of those appropriate for FNS research elected to participate in the programs, with those declining citing the hospitaliza tion, time and travel commitments as the primary factors influencing their decisions. Results suggest that FNS for standing, walking and hand grasp may be an option for a significant percentage of the pediatric SCI population.

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An Implanted Upper Extremity Neuroprosthesis Utilizing Myoelectric Control

Cited by 21 publications

References 21 publications

Prediction of upper limb muscle activity from motor cortical discharge during reaching

Prediction of upper limb muscle activity from motor cortical discharge during reaching

An implantable upper extremity neuroprosthesis in a growing child with a C5 spinal cord injury

Application of functional neuromuscular stimulation to children with spinal cord injuries: candidate selection for upper and lower extremity research

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