Transcutaneous functional electrical stimulation for grasping in subjects with cervical spinal cord injury.
METHODS
Case series.


OBJECTIVE
To evaluate the benefit, shortcomings and acceptance of a new transcutaneous functional electrical stimulation (FES) technology aimed at improving the grasp function in tetraplegic subjects in acute and postacute rehabilitation.


METHODS
Spinal cord injury (SCI) centre, university hospital.


METHODS
: Subjects (N=11) with complete or incomplete SCI at C4/5-C7 who started FES 1-67 months after their accident were included. Hand function tests, analysis of video recordings and of written documentation of FES sessions, status of muscle strength, and follow-up query were used as outcome measures.


RESULTS
Nine subjects used FES as a neuroprosthesis. Eight demonstrated improved grasp function and performance in activities of daily living. In one subject, no benefit from FES was observed. Two other subjects showed improvements in muscle strength and facilitation of active movement with FES. Four subjects successfully integrated FES as neuroprosthesis in everyday life within the rehabilitation centre. Three received the system for home use. The most relevant reasons for stopping the FES application were: (i) improvement of voluntary grasp function, (ii) physical and psychological problems, (iii) no available stimulator for home use, and (iv) insufficient assistance for electrode placement at home. Shortcomings related to the transcutaneous surface technology (eg pain or coactivation of neighbouring muscles) could usually be reduced, or did not limit the efficiency or acceptance of FES. Individually designed digital or analogue control devices were preferred.


CONCLUSIONS
Tetraplegic subjects in acute and postacute rehabilitation can profit from a new transcutaneous FES system with respect to functional use and independence. It can be implemented in the rehabilitation programme for muscle strengthening and facilitation of voluntary activity. For a successful application of FES, there is a need for individual electrode placement, stimulation programmes, and FES control devices.
Automatic Control Laboratory, Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, Switzerland.
S
S
Mangold
T
T
Keller
A
A
Curt
V
V
Dietz
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D004566:Electrodes / Q000592:standards; D005260:Female; D018737:Hand Strength / Q000502:physiology*; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000503:physiopathology / Q000628:therapy; D018482:Muscle, Skeletal / Q000503:physiopathology; D019838:Neck Injuries / Q000503:physiopathology / Q000628:therapy*; D010146:Pain / Q000517:prevention & control; D010342:Patient Acceptance of Health Care; D019736:Prostheses and Implants / Q000639:trends; D011782:Quadriplegia / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function / Q000502:physiology; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000628:therapy*; D011795:Surveys and Questionnaires; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome