Restoring Voluntary Grasping Function in Individuals with Incomplete Chronic Spinal Cord Injury: Pilot Study

Kapadia, Naaz; Zivanovic, Vera; Popović, Miloš R.

doi:10.1310/sci1904-279

Cited by 59 publications

(52 citation statements)

References 29 publications

(48 reference statements)

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“…They used a neuroprotesis with electrodes implanted in the upper limb muscles to create and assist on movements by FES. Kapadia et al (2013) used the Compex Motion Stimulator (FES) to restore eight tetraplegics in the subacute phase. Two groups were formed: occupational therapy exercises (control) and FES therapy (intervention).…”

Section: Discussionmentioning

confidence: 99%

Artificial motor control for electrically stimulated upper limbs of plegic or paretic people

et al. 2016

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Introduction: Functional Electrical Stimulation (FES) is a technique used in the restoration and generation of movements performed by subjects with neuromuscular disorders such as spinal cord injury (SCI). The purpose of this article is to outline the state of the art and perspectives of the use of FES in artificial motor control of the upper limbs in paretic or plegic people. Methods: The databases used in papers selection were Google Scholar and Capes' Portals as well as proceedings of the Annual Conference of the International Functional Electrical Stimulation Society (IFESS). Results: Approximately 85% of the reviewed studies showed FES profile with pulse duration ranging from 1 to 300 μs and modulating (burst) frequency between 10 and 40 Hz.Regarding the type of electrodes, 88% of the studies employed transcutaneous electrodes. Conclusion: We concluded that FES with closed-loop feedback and feedforward are the most used and most viable systems for upper limbs motor control, because they perform self-corrections slowing neuromuscular adaptation, allowing different planes and more range of movement and sensory-motor integration. One of the difficulties found in neuroprosthesis systems are electrical wires attached to the user, becoming uninteresting in relation to aesthetics and break. The future perspectives lead to a trend to miniaturization of the stimulation equipment and the availability of wireless networks, which allow the attachment of modules to other components without physical contact, and will become more attractive for daily use.

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Section: Discussionmentioning

confidence: 99%

Artificial motor control for electrically stimulated upper limbs of plegic or paretic people

et al. 2016

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“…Two of the selected studies were small, randomized controlled trials with measurements prior to commencing therapy and completion of therapy [13,14]. Applying the Jovell and Novarro-Rubio [12] classification, a methodological score of III was assigned.…”

Section: Methodological Quality Judgementmentioning

confidence: 99%

“…All five studies reported improvement, both immediate and at follow-up, in motor control and/or functional ability of upper extremity as a result of FES or FES with conventional therapy (Table 3) [13][14][15][16][17].…”

Section: Study Outcomesmentioning

confidence: 99%

Functional electrical stimulation for the upper limb in tetraplegic spinal cord injury: a systematic review

Patil

Raza

Jamil

et al. 2015

Journal of Medical Engineering & Technology

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Technological advances have helped to improve functional ability in spinal cord injury survivors. The aim of this study is to systematically review the evidence for functional electrical stimulation (FES) on functional tasks involving the upper limb in people with spinal cord injuries. The authors systematically searched from September 2009 to September 2014 in relevant databases using a combination of keywords covering spinal cord injury and FES. Studies were selected using pre-determined criteria. The search yielded 144 studies. Only five studies met the inclusion criteria. All five reported improvements immediately and at follow-up in functional ability as a result of FES or FES combined with conventional therapy. There is some preliminary evidence that FES may reduce disability due to upper limb-related activity limitations in tetraplegic spinal cord injury. Further work needs to examine the role of FES in more detail and in combination with other treatments.

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“…Trained subjects had significant increases in total motor scores and lower extremity motor scores, as well as walking speeds, and total distances walked. Kapadia et al (129) studied eight participants with subacute cervical SCI. Five received 39 h of FES training of hand function over 13-16 weeks and three did not.…”

Section: Peripheral Nerve Stimulationmentioning

confidence: 99%

“…Many clinical studies suggest that both central and peripheral electrical stimulation improve long-term motor (90) and sensory recovery (204), including standing (48), walking (96,105,130,204), and hand function (106,129).…”

Section: Introductionmentioning

confidence: 99%

Electrical Stimulation and Motor Recovery

Young

2015

Cell Transplant

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In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons that fire together, wire together." This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory. INTRODUCTIONIn the past decade, several prominent laboratories have shown axonal regeneration in animal spinal cord injury (SCI) models, but locomotor recovery did not follow regeneration (277). For example Lu et al. (159,160) and He's group (156,282) regenerated many axons that synapsed with neurons in the lower spinal cord, but the animals did not recover walking. To explain the lack of locomotor recovery, the investigators assume that insufficient numbers of regenerated axons have formed synapses with appropriate neurons in the lower spinal cord to support locomotion. Another explanation for the lack of locomotor recovery after complete SCI and regeneration is that the animals did not learn to use their newly regrown connections.Regenerated fibe...

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Restoring Voluntary Grasping Function in Individuals with Incomplete Chronic Spinal Cord Injury: Pilot Study

Abstract: The results of the pilot data justify a clinical trial to compare FES therapy and COT alone to improve voluntary hand function in individuals with chronic incomplete tetraplegia.

Cited by 59 publications

References 29 publications

Artificial motor control for electrically stimulated upper limbs of plegic or paretic people

Artificial motor control for electrically stimulated upper limbs of plegic or paretic people

Functional electrical stimulation for the upper limb in tetraplegic spinal cord injury: a systematic review

Electrical Stimulation and Motor Recovery

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