Reach and Palmar Grasp in Tetraplegics With Neuromuscular Electrical Stimulation

Abstract

Objective: To evaluate the movement strategies of quadriplegics, assisted by neuromuscular electrical stimulation, on reach and palmar grasp using objects of different weights. Methods: It was a prospective clinical trial. Four chronic quadriplegics (C5-C6), with injuries of traumatic origin, were recruited and all of them had their reach and palmar grasp movement captured by four infrared cameras and six retro-reflective markers attached to the trunk and right arm, assisted or not by neuromuscular electrical stimulation to the triceps, extensor carpi radialis longus, extensor digitorum communis, flexor digitorum superficialis, opponens pollicis and lumbricals. It was measured by a Neurological and Functional Classification of Spinal Cord Injuries of the American Spinal Injury Association, Functional Independence Measure and kinematic variables. Results: The patients were able to reach and execute palmar grasp in all cylinders using the stimulation sequences assisted by neuromuscular electrical stimulation. The quadriplegics produced lower peak velocity, a shorter time of movement and reduction in movement segmentation, when assisted by neuromuscular electrical stimulation. Conclusion: This study showed that reach and palmar grasp movement assisted by neuromuscular electrical stimulation was able to produce motor patterns more similar to healthy subjects. Level of evidence IV; Case series.

Functional electrical stimulation of the upper extremities of persons with quadriplegia

“…Two participants (injury level C6) adapted movements with reduced wrist flexion during extension. The third participant (injury level C5) improved wrist extension, opening and palming the cylinder, while the fourth (injury level C7) increased the flexor phase and contributed to wrist flexion and finger extension in the hand opening phase and wrist extension and finger flexion in the closures (2).…”

“…Impairment of hand and hand function is directly related to the loss of levels of functional independence, so the recovery of upper extremity movements is essential for rehabilitation. Tendon transfers, orthoses, and neuromuscular electrical stimulation (NMES) have been used to improve sensory and motor deficits (2). NMES is the application of electrical stimulation in movement rehabilitation that produces contraction of innervated paralyzed muscles, increases strength, creates movement, and increases participation in voluntary activities (3).…”

“…It causes neurophysiological changes in the central nervous system and cortical reorganization that depends on the ability to synchronize the voluntary command and the successsful execution of the intended task (7). Reaching and grasping movements assisted by neuromuscular electrical stimulation can produce motor patterns and are used for functional motor training (2).…”