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Hand Neuroprosthesis Program

Restoration of Hand Function and Arm Function for those with Tetraplegia

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For those with a high level spinal cord injury, C-5/6, the loss of hand function means a complete loss of independence. Without the ability to feed, perform activities of daily living, write, operate a keyboard or phone, these patients find themselves unacceptably dependent upon their caregivers. The restoration of hand function is the number one desire for quadraplegic patients and as such, there already exists a ready market and waiting list of patients desiring a hand neurotechnology system.
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Case Western Reserve University Functions restored to the user

Following a training period, the system can be programmed to meet the needs of the user. The user selects the desired grasp pattern using bursts of activity from the muscle that was implanted with the myoelectric sensor. Once the pattern is selected, the user has direct proportional control of the degree of hand opening and closing through the myoelectric signal level from their voluntary forearm musculature (either brachioradialis or extensor carpi radialis longus). Strong contraction of this muscle results in hand closing, whereas relaxation of the muscle results in hand opening. If the user desires to hold an object for a long period of time, he/she can initiate a lock command which disengages the grasp stimulation from control by the forearm myoelectric signal. The lock command is initiated by holding the myoelectric Case Western Reserve Universitysignal above a high threshold for two seconds. Once the hand is locked, it will remain locked until an unlock command is given. The unlock command can consist of two quick bursts of activity from the forearm (referred to as a double-click) or a quick burst of activity from the shoulder.

The user can also independently activate other functions, such as elbow extension or forearm pronation, by producing a specific pattern of myoelectric activity in the shoulder. The significant advantage of the myoelectric control, in addition to eliminating the need for external switches, is that all control signals are derived ipsilaterally, so the opposite arm is free to be utilized as a helper hand. Therefore, myoelectric control is ideally suited for bilateral implementation.






Restoration of Cough in SCI
Individuals with cervical and thoracic spinal cord injuries often experience paralysis of their expiratory muscles resulting in their inability to generate an effective cough mechanism. As a consequence, these individuals are prone to the development of respiratory tract infections, such as pneumonia and bronchitis, a major cause of death in this population.
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An effective cough system can be implemented through restorative electrical stimulation techniques (spinal cord stimulation) resulting in a reduction in the incidence of respiratory tract infections, reduced need for caregiver support and greater mobility.


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Restoration of Bladder & Bowel Function in SCI

Arguably the greatest disruption to one's quality of life, is the loss of control over bladder and bowel function. In SCI, the restoration of these functions varies with level of injury. For those with paraplegia and the ability to transfer independently, the desire for both elimination of bladder spasms and the ability to void on command creates a great deal of independence. For those with quadraplegia, the ability to stop bladder spasms means reduction or elimination of poorly tolerated medications. This program, lead by Dr. Ken Gustafson, utilizes the body's naturally occurring reflexes to restore varing levels of functions. Learn More.


Restoration of Trunk Control in SCI

A Neuroprosthesis for Seated Posture

1.) To define the feasibility for an implanted system designed specifically to provide trunk stability, seated postural control and essential bed mobility in individuals with spinal cord injuries.
2.) Determine the physical and functional effects of stabilizing the torso with FES applied to paralyzed trunk and pelvic musculature.

Objective: The purpose of this research is to determine the physical and functional effects of activating the trunk and hip musculature with FES on pulmonary function, spinal alignment, distribution of interface pressures, ability to provide the proximal stability required for both uni- and bi-manual activities, and subjective perceptions of effort and satisfaction.Learn More


Pressure Sore Management in SCI

Pressure sores are still a major complication that occur all too frequently for many people with long-term disability. Individuals with limited or restricted mobility is at increased risk for development of a pressure sore. Pressure ulcers can have a devastating impact on the quality of life resulting in frequent hospital admissions and long periods of bed rest. There continues to be a need for alternative approaches to pressure sore prevention. Neuromuscular electrical stimulation provides a unique methodology to alter the intrinsic properties of paralyzed muscle and improve regional tissue health. Previous studies have shown that regular daily use of therapeutic gluteal FES can have a positive impact on multiple indirect indicators of tissue health.

This program explores using a fully implanted gluteal stimulation system to prevent the occurrence of pressure sores/ulcers in individuals with a spinal cord injury. Electrical stimulation improves tissue health at the seat and provides a method of weight-shifting that makes conventional pressure relief adjustment maneuvers more effective. Learn More.


Restoration of Standing in SCI

The overall goal of this project is to improve the personal mobility of individuals with spinal cord injuries (SCI) through the application of surgically implanted functional electrical stimulation (FES) technology.

Participants with complete spinal injuries may benefit from the ability to stand and transfer. The intended result is the ability to stand for limited periods of time and perform transfers with little to no assistance. Rehabilitation and reconditioning exercises will be performed at the Center. Subjects will be trained to stand, balance and transfer with the neuroprosthesis and will be discharged to use the system at home.
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