Electrical stimulation—a mapping system for hand dysfunction in tetraplegia

Bersch, Ines; Koch-Borner, Sabrina; Fridén, Jan

doi:10.1038/s41393-017-0042-2

Cited by 18 publications

(14 citation statements)

References 20 publications

(34 reference statements)

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“…Having a smaller cathode electrode and placing it close to the target nerve with the larger anode placed a distance away from the cathode can be used to generate more specific/accurate stimulation localization under the cathode while allowing a larger area of the skin under the anode to be used to close the electrical circuit and minimize discomfort under the cathode. Empirically, it is well-known that there are locations, where muscles are most sensitive to electrical stimulation, i.e., motor points (see [ 14 ] for upper limbs; [ 10 ] for upper body; and [ 21 ] for lower limbs). Larger muscles are known to have several motor points (e.g., seven quadriceps motor points were identified [ 21 ]), while smaller hand muscles typically have one optimal motor point [ 14 ].…”

Section: Electrical Stimulation Of Muscles and Nervesmentioning

confidence: 99%

“…Empirically, it is well-known that there are locations, where muscles are most sensitive to electrical stimulation, i.e., motor points (see [ 14 ] for upper limbs; [ 10 ] for upper body; and [ 21 ] for lower limbs). Larger muscles are known to have several motor points (e.g., seven quadriceps motor points were identified [ 21 ]), while smaller hand muscles typically have one optimal motor point [ 14 ]. Placement of electrodes on the motor point also plays an important role in generating strong muscle contractions [ 45 ].…”

Section: Electrical Stimulation Of Muscles and Nervesmentioning

confidence: 99%

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Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation

et al. 2020

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Delivering short trains of electric pulses to the muscles and nerves can elicit action potentials resulting in muscle contractions. When the stimulations are sequenced to generate functional movements, such as grasping or walking, the application is referred to as functional electrical stimulation (FES). Implications of the motor and sensory recruitment of muscles using FES go beyond simple contraction of muscles. Evidence suggests that FES can induce short- and long-term neurophysiological changes in the central nervous system by varying the stimulation parameters and delivery methods. By taking advantage of this, FES has been used to restore voluntary movement in individuals with neurological injuries with a technique called FES therapy (FEST). However, long-lasting cortical re-organization (neuroplasticity) depends on the ability to synchronize the descending (voluntary) commands and the successful execution of the intended task using a FES. Brain-computer interface (BCI) technologies offer a way to synchronize cortical commands and movements generated by FES, which can be advantageous for inducing neuroplasticity. Therefore, the aim of this review paper is to discuss the neurophysiological mechanisms of electrical stimulation of muscles and nerves and how BCI-controlled FES can be used in rehabilitation to improve motor function.

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Section: Electrical Stimulation Of Muscles and Nervesmentioning

confidence: 99%

Section: Electrical Stimulation Of Muscles and Nervesmentioning

confidence: 99%

Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation

et al. 2020

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“…All muscles and functional groups have multiple roots innervation and multiple peripheral nerve overlap, often with combinations of innervation, atrophy and recovery potential. We believe that refined and more exact mapping of the motor endplate integrity will allow for further accuracy in the selection of the muscles with intact lower motor neurons and therefore produce better functional results after nerve transfers (Bersch et al, 2018(Bersch et al, , 2020Bersch and Fride ´n, 2020) (Figure 1).…”

Section: Refined Diagnostics In Nerve Transfer Surgerymentioning

confidence: 99%

Improving hand function after spinal cord injury

Fridén

House

Keith

et al. 2021

J Hand Surg Eur Vol

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Nerve transfer surgery has expanded reconstructive options for restoring upper extremity function following spinal cord injury. By adding new motor donors to the pool already available through tendon transfers, the effectiveness of treatment should improve. Planning which procedures and in which order to perform, along with their details must be delineated. To meet these demands, refined diagnostics are needed, along with awareness of the remaining challenges to restore intrinsic muscle function and to address spasticity and its consequences. This article summaries recent advances in surgical reanimation of upper extremity motor control, together with an overview of the development of neuro-prosthetic and neuromodulation techniques to modify recovery or substitute for functional losses after spinal cord injuries.

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“…Similarly, Triolo and colleagues 34 found some degree of upper limb denervation in 28% of people with tetraplegia. Recently Bersch and colleagues 35 found that LMN damage as detected by surface electrical stimulation of the forearm extensor muscles influenced hand position and the development of a tenodesis grasp. Others have advocated for the utility of using surface electrical stimulation to identify LMN pathology.…”

Section: Lmn Damage In Scimentioning

confidence: 99%

Advanced Assessment of the Upper Limb in Tetraplegia: A Three-Tiered Approach to Characterizing Paralysis

Bryden

Kilgore

Nemunaitis

2018

Topics in Spinal Cord Injury Rehabilitation

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More than half of all individuals who sustain a spinal cord injury (SCI) experience some degree of impairment in the upper limb. Functional use of the arm and hand is of paramount importance to these individuals. Fortunately, the number of clinical trials and advanced interventions targeting upper limb function are increasing, generating optimism for improved recovery and restoration after SCI. New interventions for restoring function and improving recovery require more detailed examination of the motor capacities of the upper limb. The purpose of this article is to introduce a three-tiered approach to evaluating motor function, with specific attention to the characteristics of weak and fully paralyzed muscles during acute rehabilitation. The three tiers include (1) evaluation of voluntary strength via manual muscle testing, (2) evaluation of lower motor neuron integrity in upper motor neuron-paralyzed muscles using surface electrical stimulation, and (3) evaluation of latent motor responses in paralyzed muscles that exhibit a strong response to electrical stimulation, using surface electromyographic recording electrodes. These characteristics contribute important information that can be utilized to mitigate potential secondary conditions such as contractures and identify effective interventions such as activity-based interventions or reconstructive procedures. Our goal is to encourage frontline clinicians - occupational and physical therapists who are experts in muscle assessment - to consider a more in-depth analysis of paralysis after SCI. Given the rapid advancements in SCI research and clinical interventions, it is critical that methods of evaluation and classification evolve. The success or failure of these interventions may depend on the specific characteristics identified in our three-tiered assessment. Without this assessment, the physiological starting point for each individual is unknown, adding significant variability in the outcomes of these interventions.

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Electrical stimulation—a mapping system for hand dysfunction in tetraplegia

Abstract: Surface ES may serve as a diagnostic tool to detect an UMN or LMN lesion of the key actuator muscles affecting the tenodesis grasp. These findings provide information that is essential for the choice of treatment to optimise function of the tetraplegic hand.

Cited by 18 publications

References 20 publications

Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation

Why brain-controlled neuroprosthetics matter: mechanisms underlying electrical stimulation of muscles and nerves in rehabilitation

Improving hand function after spinal cord injury

Advanced Assessment of the Upper Limb in Tetraplegia: A Three-Tiered Approach to Characterizing Paralysis

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