title: Implanted Functional Neuromuscular Stimulation systems for individuals with cervical spinal cord injuries: clinical case reports.
abstract: OBJECTIVE
  To determine the feasibility of providing the ability to stand and to facilitate the performance of standing transfers to individuals with cervical-level spinal cord injuries via functional neuromuscular stimulation (FNS). The applicability of implantable technology to this population was investigated, and the characteristics of the potential system users were explored. The effects of FNS on the effort and assistance required to stand and complete standing transfers were examined.
  
  
  METHODS
  Institutional rehabilitation practice.
  
  
  METHODS
  Nonrandomized controlled trial.
  
  
  METHODS
  Twenty-four individuals with low cervical spinal cord injuries were evaluated for inclusion in a program of lower extremity FNS, four of whom received the intervention.
  
  
  METHODS
  Chronically indwelling percutaneous intramuscular electrodes were used to exercise the hip, knee, and trunk extensors and develop activation patterns to produce standing function. These temporary systems were then replaced with silicone-enclosed helical wire electrodes suitable for eventual use with an eight-channel implantable receiver/stimulator.
  
  
  METHODS
  Full sensory and motor evaluations were performed and physical contraindications to stimulation were catalogued. For active subjects, American Spinal Injury Association Total Motor Scores with and without FNS were recorded, along with quadriceps strength and ability to complete exercise, standing, controlled sitting, and standing transfer maneuvers. Performances of implanted electrodes were determined by the stability of recruitment properties, impedances or surface potentials, and serial radiographs.
  
  
  RESULTS
  Motor scores increased an average of nine points with stimulation over baseline volitional values. With FNS, all four volunteers were able to exercise, stand, and sit independently or with minimal assistance. Although they required varying degrees of assistance with the pivot phase of the transfer maneuver, all were able to raise and lower their body weight independently with stimulation and to use the system to facilitate standing transfers. One participant received the implantable receiver/stimulator, which remains operational at follow-up more than 3 years later.
  
  
  CONCLUSIONS
  FNS can provide the ability to exercise, stand, and transfer to individuals with tetraplegia, even in the presence of medical complications and upper extremity impairment. FNS facilitates standing transfers by eliminating the heavy lifting usually required by a caregiver, thus decreasing the effort and assistance necessary to gain access to places impossible to approach with conventional sliding transfers.
authors.affiliation: Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Triolo
authors.forename: C
authors.initials: C
authors.lastname: Bieri
authors.forename: J
authors.initials: J
authors.lastname: Uhlir
authors.forename: R
authors.initials: R
authors.lastname: Kobetic
authors.forename: A
authors.initials: A
authors.lastname: Scheiner
authors.forename: E B
authors.initials: EB
authors.lastname: Marsolais
mesh_terms: D000328:Adult; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011187:Posture; D019736:Prostheses and Implants; D011597:Psychomotor Performance; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D016896:Treatment Outcome