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Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation

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A Review on Functional Electrical Stimulation in Tetraplegic Patients to Restore Hand Function.

Gregory G Degnan¹, Tyler C Wind², Elizabeth V Jones³

¹Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, Virginia.

Journal of Long-Term Effects of Medical Implants

|May 19, 2018

Summary

This review details a new neuroprosthesis using functional electrical stimulation to restore hand grasp and pinch for individuals with C5-C6 spinal cord injuries. Surgical modifications overcome muscle damage, enabling improved upper extremity function.

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Area of Science:

Biomedical Engineering
Neurorehabilitation
Reconstructive Surgery

Background:

Spinal cord injuries, particularly at the C5 and C6 motor levels, often result in significant loss of upper extremity function, impacting daily living.
Restoring hand function like lateral pinch and palmar grasp is crucial for improving independence and quality of life in individuals with tetraplegia.
Existing neuroprosthetic technologies face challenges, including potential lower motor neuron damage in key muscles required for hand function.

Purpose of the Study:

To describe a novel neuroprosthesis system designed for functional electrical stimulation.
To detail the application of this technology for restoring lateral pinch and palmar grasp in individuals with C5 and C6 spinal cord injuries.
To highlight the innovative solutions addressing limitations such as muscle damage.

Main Methods:

The neuroprosthesis integrates external and implanted components, including a receiver-stimulator implanted subcutaneously.
Eight epimysial or intramuscular electrodes are surgically placed to stimulate target muscles.
An external transmitting coil, activated by contralateral shoulder movements, wirelessly signals the implanted receiver.

Main Results:

The system successfully induces muscle contractions necessary for hand grasp and pinch.
Individuals with C5 and C6 spinal cord injuries are regaining functional hand use.
Surgical modifications to hand biomechanics effectively address lower motor neuron damage, enabling successful muscle stimulation.

Conclusions:

This neuroprosthesis represents a significant advancement in restoring hand function for individuals with tetraplegia.
The technology offers a viable solution for improving upper extremity function after spinal cord injury.
Combined surgical and technological approaches enhance the efficacy of functional electrical stimulation for neurorehabilitation.