Australian experience with the Freehand System for restoring grasp in quadriplegia.
BACKGROUND
The purpose of the present study was to document the value of an implanted multichannel neuroprosthesis (Freehand System) for restoring hand grasp in the first Australians to receive this device.


METHODS
Hand function in C5 quadriplegic patients was assessed via measurement of pinch forces, a grasp release test and tests of activities of daily living (ADL). Comparisons were made between presurgery scores and scores recorded after rehabilitation when the neuroprosthesis was and was not in use.


RESULTS
A significant difference for both lateral pinch (P = 0.003) and palmar grasp (P = 0.003) was found between forces recorded with and without the use of the neuroprosthesis after rehabilitation, but not between forces recorded presurgery and during rehabilitation without the neuroprosthesis. All subjects were able to grasp, move and release more objects within the 30-s test period with the neuroprosthesis than without it. Collective results for the eight ADL tests for all six subjects show that, in 35 of the 48 (73%) occasions, less physical assistance and/or adaptive equipment was required when the Freehand system was employed compared to when it was not used. In 41 of the 48 (85%) occasions, the six subjects expressed a preference for using the neuroprosthesis to perform these activities of daily living. Twelve months after rehabilitation, five of the six subjects still used the neuroprosthesis daily or every second day.


CONCLUSIONS
The Freehand neuroprosthesis has provided useful hand function with few surgical and technical difficulties in these patients. Regular ongoing use of the device indicates user satisfaction.
Carroll
S
S
Victorian Spinal Cord Service, Austin and Repatriation Medical Centre, Heidelberg, Australia. s.carroll@physio.unimelb.edu.au
Cooper
C
C
Brown
D
D
Sormann
G
G
Flood
S
S
Denison
M
M
D000203:Activities of Daily Living; D000328:Adult; D001315:Australia; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted; D004867:Equipment Design; D005260:Female; D006225:Hand / Q000503:physiopathology*; D018737:Hand Strength; D006801:Humans; D008297:Male; D018579:Patient Selection; D011782:Quadriplegia / Q000145:classification / Q000503:physiopathology* / Q000534:rehabilitation*; D012720:Severity of Illness Index; D016896:Treatment Outcome