Surgical Technique for Installing an Eight-Channel Neuroprosthesis for Standing

Davis, John A.; Triolo, Ronald J.; Uhlir, James; Bhadra, Niloy; Lissy, Dawn A.; Nandurkar, Sanjay; Marsolais, E.B.

doi:10.1097/00003086-200104000-00035

Cited by 66 publications

(48 citation statements)

References 8 publications

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“…Therefore, we were able to avoid stimulated hip¯exion in standing when stimulating the rectus femoris as reported in the study by Kobetic et al, 14 which limited standing time and increased the demand on the upper extremities. Our recent change to implanting the vastus lateralis in subject 9 also avoided the problem of hip¯exion in standing and demonstrated that sucient knee extension force for standing could be obtained by implanting this muscle, which concurs the work reported by Davis et al 17 and Uhlir et al 16 Davis et al 17 demonstrated that standing could be achieved by implanting the vastus lateralis for knee extension in seven subjects. In the study by Uhlir et al, three out of four subjects obtained sucient force for standing when using the vastus lateralis.…”

Section: Discussionsupporting

confidence: 87%

“…Despite some issues of undesired recruitment of the hip¯exors with stimulation, the subject reported perceived health bene®ts of increased energy and decreased spasticity in his lower extremities and a psychological bene®t of looking other people in the eye while standing. 14 Davis et al 17 implanted an 8-channel FES system in seven adults with low cervical and thoracic SCI. With this system, subjects were able to perform standing pivot transfers with an assistive device.…”

Section: Introductionmentioning

confidence: 99%

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Implanted functional electrical stimulation: an alternative for standing and walking in pediatric spinal cord injury

et al. 2003

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Study design: Post intervention, repeated measures design, comparing two interventions. Setting: Orthopedic pediatric hospital specializing in spinal cord injury. Methods: Nine subjects, ages 7 ± 20 years, received an eight-channel implanted lower extremity functional electrical stimulation (FES) system for standing and walking. Electrodes were placed to stimulate hip and knee extension, and hip abduction and adduction. Standing and walking were achieved through constant stimulation to the implanted muscles, allowing a swing through gait pattern with an assistive device. After training with FES and long leg braces (LLB), subjects were tested in eight upright mobility activities, which were scored based upon completion time and level of independence. Results: Seven subjects completed data collection. These subjects completed four activities faster (P50.02) and ®ve activities more independently (P50.025) with FES as compared to LLB. Transitions between sitting and standing, which were scored in isolation for two mobility activities, were achieved faster and with more independence with FES. In addition, subjects reported preferring FES for the majority of activities. No activity required more time or more assistance to complete with FES as compared to LLB. Conclusion: The implanted FES system provided these subjects with enhanced functional abilities over traditional LLB and decreased the need for physical assistance by a caregiver, suggesting that it is a realistic alternative for upright mobility in a pediatric population with spinal cord injury.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Implanted functional electrical stimulation: an alternative for standing and walking in pediatric spinal cord injury

et al. 2003

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“…Implantation of indwelling electrodes allows for more efficient muscle activation and greater force production and also removes the need to place surface electrodes. 19,20 FES of the bilateral erector spinae, gluteus maximus, semimembranosus, and vastus lateralis has been demonstrated to provide functional rise-to-stand movements, sustained standing, and even slow walking when assisted by a walker or orthosis in individuals with thoracic level SCI. 13,19 Unfortunately, loss of sensation after SCI makes balance and natural gait very difficult.…”

Section: Standing and Walkingmentioning

confidence: 99%

“…19,20 FES of the bilateral erector spinae, gluteus maximus, semimembranosus, and vastus lateralis has been demonstrated to provide functional rise-to-stand movements, sustained standing, and even slow walking when assisted by a walker or orthosis in individuals with thoracic level SCI. 13,19 Unfortunately, loss of sensation after SCI makes balance and natural gait very difficult. Researchers have combined FES with orthoses in order to improve balance reducing the reduce the energy requirements placed on the user's arm.…”

Section: Standing and Walkingmentioning

confidence: 99%

Neuroprosthetic technology for individuals with spinal cord injury

Collinger¹,

Foldes

Bruns

et al. 2013

The Journal of Spinal Cord Medicine

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Context: Spinal cord injury (SCI) results in a loss of function and sensation below the level of the lesion. Neuroprosthetic technology has been developed to help restore motor and autonomic functions as well as to provide sensory feedback. Findings: This paper provides an overview of neuroprosthetic technology that aims to address the priorities for functional restoration as defined by individuals with SCI. We describe neuroprostheses that are in various stages of preclinical development, clinical testing, and commercialization including functional electrical stimulators, epidural and intraspinal microstimulation, bladder neuroprosthesis, and cortical stimulation for restoring sensation. We also discuss neural recording technologies that may provide command or feedback signals for neuroprosthetic devices. Conclusion/clinical relevance: Neuroprostheses have begun to address the priorities of individuals with SCI, although there remains room for improvement. In addition to continued technological improvements, closing the loop between the technology and the user may help provide intuitive device control with high levels of performance.

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“…In the case of the hand grasp system just mentioned, a limited group of primary muscles for hand function was chosen and supramaximal surface stimulation was used to exclude muscles with complete denervation [3]. Similarly, in the design of lower-limb FES systems for standing, the target muscles were chosen based on biomechanical analysis, feedback from other users, and prior testing with surface and percutaneous electrodes [4]. These methods work well in systems that aim to restore a limited number of functions, such as simple hand grasp or a fixed standing pattern, but not in systems that target a wider range of movements.…”

Section: Introductionmentioning

confidence: 99%

Selection of muscle and nerve-cuff electrodes for neuroprostheses using customizable musculoskeletal model

Blana¹,

Hincapie²,

Chadwick³

et al. 2013

JRRD

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Abstract-Neuroprosthetic systems based on functional electrical stimulation aim to restore motor function to individuals with paralysis following spinal cord injury. Identifying the optimal electrode set for the neuroprosthesis is complicated because it depends on the characteristics of the individual (such as injury level), the force capacities of the muscles, the movements the system aims to restore, and the hardware limitations (number and type of electrodes available). An electrode-selection method has been developed that uses a customized musculoskeletal model. Candidate electrode sets are created based on desired functional outcomes and the hardware limitations of the proposed system. Inverse-dynamic simulations are performed to determine the proportion of target movements that can be accomplished with each set; the set that allows the most movements to be performed is chosen as the optimal set. The technique is demonstrated here for a system recently developed by our research group to restore whole-arm movement to individuals with high-level tetraplegia. The optimal set included selective nerve-cuff electrodes for the radial and musculocutaneous nerves; single-channel cuffs for the axillary, suprascapular, upper subscapular, and long-thoracic nerves; and muscle-based electrodes for the remaining channels. The importance of functional goals, hardware limitations, muscle and nerve anatomy, and surgical feasibility are highlighted.

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Surgical Technique for Installing an Eight-Channel Neuroprosthesis for Standing

Cited by 66 publications

References 8 publications

Implanted functional electrical stimulation: an alternative for standing and walking in pediatric spinal cord injury

Implanted functional electrical stimulation: an alternative for standing and walking in pediatric spinal cord injury

Neuroprosthetic technology for individuals with spinal cord injury

Selection of muscle and nerve-cuff electrodes for neuroprostheses using customizable musculoskeletal model

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