Functional electrical stimulation and spinal cord injury

Chester H Ho, Ronald J Triolo, Anastasia L Elias, Kevin L Kilgore, Anthony F DiMarco, Kath Bogie, Albert H Vette, Musa L Audu, Rudi Kobetic, Sarah R Chang, K Ming Chan, Sean Dukelow, Dennis J Bourbeau, Steven W Brose, Kenneth J Gustafson, Zelma H T Kiss, Vivian K Mushahwar, Chester H Ho, Ronald J Triolo, Anastasia L Elias, Kevin L Kilgore, Anthony F DiMarco, Kath Bogie, Albert H Vette, Musa L Audu, Rudi Kobetic, Sarah R Chang, K Ming Chan, Sean Dukelow, Dennis J Bourbeau, Steven W Brose, Kenneth J Gustafson, Zelma H T Kiss, Vivian K Mushahwar

Abstract

Spinal cord injuries (SCI) can disrupt communications between the brain and the body, resulting in loss of control over otherwise intact neuromuscular systems. Functional electrical stimulation (FES) of the central and peripheral nervous system can use these intact neuromuscular systems to provide therapeutic exercise options to allow functional restoration and to manage medical complications following SCI. The use of FES for the restoration of muscular and organ functions may significantly decrease the morbidity and mortality following SCI. Many FES devices are commercially available and should be considered as part of the lifelong rehabilitation care plan for all eligible persons with SCI.

Keywords: Electric stimulation; Electrodes; Muscle spasticity; Neurogenic urinary bladder; Paralysis; Pressure ulcer; Rehabilitation; Spinal cord injuries.

Copyright © 2014 Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Functional activities performed using the IST-12 myoelectrically-controlled neuroprosthesis. From left to right: eating with a fork, holding a pen to write, holding a cup, needle embroidery, holding a tennis racquet.
Figure 2
Figure 2
Implant recipient (C7 AIS C) standing with FES to the knee, hip and trunk extensors, and hip/trunk ab/adductors. Multi-contact cuff electrodes on the femoral nerves selectively activate the uniarticular heads of the quadriceps (vastus lateralis, intermedius and medialis).
Figure 3
Figure 3
Eight channel implant recipient (T9 AIS A) releases one had for overhead reaching activities while standing with the neuroprosthesis.
Figure 4
Figure 4
Subject with incomplete SCI (C5 AIS D) walking with an eight channel implanted receiver stimulator for activation of hip flexors and ankle dorsiflexors.
Figure 5
Figure 5
Effect of FES on seated posture. By stimulating the trunk and hip muscles, consistent significant changes in posterior pelvic tilt and shoulder height were recorded.
Figure 6
Figure 6
X-ray of an implanted trunk system showing intramuscular electrodes (inset) inserted into T12-L1 to activate the lumbar erector spinae muscles.
Figure 7
Figure 7
Simple threshold-based control of seated balance based on trunk tilt in a subject with C8 tetraplegia. Without stimulation (top) of the hip and trunk extensors, the subject cannot return to erect sitting from a fully forward-flexed position without use of the arms. With the controller active (bottom), forward trunk tilt is arrested prior to a forward fall, and upright posture is automatically restored.
Figure 8
Figure 8
Multistage longitudinal analysis and self-registration (LASR) analysis maps showing areas of significant change in seated interface pressures over time (output adjusted for simultaneous testing at multiple locations)
Figure 9
Figure 9
“Smart-e-pants” system showing garment, mesh panel for surface electrodes and stimulator.

Source: PubMed

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