Intramuscular Hand Neuroprosthesis for Chronic Stroke Survivors

Abstract

The purpose of this study was to assess the feasibility of a percutaneous band neuroprosthesis system for stroke survivors. Case reports of 4 chronic stroke survivors who were implanted with percutaneous intramuscular electrodes in various muscles of the forearm for hand grasp and release are presented. A percutaneous hand neuroprosthesis was able to open a spastic hemiparetic hand as long as the upper limb was in a resting position, the wrist and proximal forearm were supported, participants did not try to assist the stimulation, and an individual other than the participant modulated the stimulation. However, when participants tried to assist the stimulation or complete a functional task, hand opening was significantly reduced due to increased finger flexor hypertonia, even with increased stimulation intensity. Similarly, electrically stimulated hand opening was significantly reduced following voluntary hand closure. Techniques that provide real-time modulation of hypertonia with closed loop control, control strategies that are independent of the contralateral limb, and methods to enhance proximal control must be developed to demonstrate the feasibility of a hand neuroprosthesis system for persons with hemiparesis.

References

1. Peckham PH, Keith MW, Kilgore KL, et al. Efficacy of an implanted neuroprosthesis for restoring hand grasp in tetraplegia: a multicenter study . Arch Phys Med Rehabil 2001;82: 1380-1388 .

2. Rebersek S, Vodovnik L. Proportionally controlled functional electrical stimulation of hand . Arch Phys Med Rehabil 1973;54: 378-382 .

3. Merletti R, Acimovic R, Grobelnik S, et al. Elecrophysiologic orthosis for the upper extremity in hemiplegia: feasibility study . Arch Phys Med Rehabil 1975;56: 507-513 .

4. Cameron T, McDonald K, Anderson L, et al. The effect of wrist angle on electrically evoked hand opening in patients with spastic hemiplegia . IEEE Trans Rehab Eng 1999;7: 109-111 .

5. de Kroon JR, van der Lee JH, IJzerman MJ, et al. Therapeutic electrical stimulation to improve motor control and functional abilities of the upper extremity after stroke: a systematic review . Clin Rehabil 2002;16: 350-360 .

6. Hendricks IIT, IJzerman MJ, de Kroon JR, et al. Functional electrical stimulation by means of the “Ness Handmaster Orthosis” in chronic stroke patients: an exploratory study . Clin Rehabil 2001;15: 217-220 .

7. Lin C. The effects of ipsilateral forearm movement and contralateral hand grasp on the spastic hand opened by electrical stimulation . Neurorehabil Neural Repair 2000;14: 199-205 .

8. Chae J, Hart R. Comparison of discomfort associated with surface and percutaneous intramuscular electrical stimulation for persons with chronic hemiplegia . Am J Phys Med Rehabil 1998;77: 516-522 .

9. Yu DT, Chae J, Walker ME, et al. Comparing stimulation-induced pain during percutaneous (intramuscular) and transcutaneous neuromuscular electric stimulation for treating shoulder subluxation in hemiplegia . Arch Phys Med Rehabil 2001;82: 756-760 .

10.

10. Kilgore KL, Peckham PH. Grasp synthesis for upper-extremity FNS. Part 2. Evaluation of the influence of electrode recruitment properties . Med Biol Eng Comput 1993;31: 615-622 .

11.

11. Kilgore KL, Peckham PH. Grasp synthesis for upper-extremity FNS. Part 1. Automated method for synthesising the stimulus map . Med Biol Eng Comput 1993;31: 607-614 .

12.

12. Hart RL, Kilgore KL, Peckham PH. A comparison between control methods for implanted FES hand-grasp systems . IEEE Trans Rehabil Eng 1998;6: 208-218 .

13.

13. Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident . Phys Ther 1983;63: 1606-1610 .

14.

14. Berglund K, Fugl-Meyer AR. Upper extremity function in hemiplegia: a cross-validation study of two assessment methods . Scand J Rehabil Med 1986;18: 155-157 .

15.

15. Gregson JM, Leathley MJ, Moore AP, et al. Reliability of measurements of muscle tone and muscle power in stroke patients . Age Ageing 2000;29: 223-228 .

16.

16. Sahrmann SA, Norton BJ. Relationship of voluntary movement to spasticity in upper motor neuron syndrome . Ann Neurol 1977;2: 460-465 .

17.

17. Hammond M, Fitts S, Kraft G, et al. Co-contraction in the hemiparetic forearm: quantitative EMG evaluation . Arch Phys Med Rehabil 1988;69: 348-351 .

18.

18. Dewald JP, Pope PS, Given JD, et al. Abnormal muscle coactivation patterns during isometric torque generation at the elbow and shoulder in hemiparetic participants . Brain 1995;118: 495-510 .

19.

19. Chae J, Yang G, Park BK, et al. Delay in initiation and termination of muscle contraction, motor impairment and physical disability in upper limb hemiparesis . Muscle Nerve 2002;25: 568-575 .

20.

20. Chae J, Yang G, Park BK, et al. Muscle weakness and co-contraction in upper limb hemiparesis: relationship to motor impairment and physical disability . Neurorehabil Neural Repair 2002;16: 241-248 .

21.

21. Delwaide PJ. Human reflex studies for understanding the motor system . Phys Med Rehabil Clin N Am 1993;4: 669-686 .

22.

22. Ghez C. The control of movement. In: Kandal ER, Schwartz JH, Jessell TM, eds. Principles of neural sciences. Norwalk, CT: Appleton & Lange ; 1991:533-563.

23.

23. Dewald JP, Beer RF, Given JD, et al. Reorganization of flexion reflexes in the upper extremity of hemiparetic participants . Muscle Nerve 1999;22: 1209-1221 .

24.

24. Dewald JP, Beer RF. Abnormal joint torque patterns in the paretic upper limb of participants with hemiparesis . Muscle Nerve 2001;24: 273-283 .

25.

25. Kamper DG, Rymer WZ. Impairment of voluntary control of finger motion following stroke: role of inappropriate muscle coactivation . Muscle Nerve 2001;24: 673-681 .

26.

26. Peckham PH, Kilgore KL, Keith MW, et al. An advanced neuroprosthesis for restoration of hand and upper arm control using an implantable controller . J Hand Surg [Am] 2002;27: 265-276 .

27.

27. van den Honert C, Mortimer JT. A technique for collision block of peripheral nerve: frequency dependence . IEEE Trans Biomed Eng 1981;28: 379-382 .

28.

28. van den Honert C, Mortimer JT. A technique for collision block of peripheral nerve: single stimulus analysis . IEEE Trans Biomed Eng 1981;28: 373-378 .

29.

29. Crago PE, Mortimer JT, Peckham PH. Closed-loop control of force during electrical stimulation of muscle . IEEE Trans Biomed Eng 1980;27: 306-312 .

30.

30. Lauer RT, Peckham PH, Kilgore KL. EEG-based control of a hand grasp neuroprosthesis . Neuroreport 1999;10: 1767-1771 .

31.

31. Wiebe-Velazquez S, Blume WT. Seizures . Physical Medicine and Rehabilitation: State of the Art Review 1993;7: 73-88 .

32.

32. Richardson EP, Dodge PR: Epilepsy in cerebral vascular disease . Epilepsia 1954;3: 49-74 .

33.

33. Nudo RJ, Plautz EJ, Frost SB: Role of adaptive plasticity in recovery of function after damage to motor cortex . Muscle Nerve 2001;24: 1000-1019 .

34.

34. Liepert J, Bauder H, Wolfgang HR, et al. Treatment-induced cortical reorganization after stroke in humans . Stroke 2000;31: 1210-1216 .

35.

35. Volpe BT, Krebs HI, Hogan N, et al. A novel approach to stroke rehabilitation: robot-aided sensorimotor stimulation . Neurology 2000;54: 1938-1944 .