An implanted upper-extremity neuroprosthesis using myoelectric control.
OBJECTIVE
The purpose of this study was to evaluate the potential of a second-generation implantable neuroprosthesis that provides improved control of hand grasp and elbow extension for individuals with cervical level spinal cord injury. The key feature of this system is that users control their stimulated function through electromyographic (EMG) signals.


METHODS
The second-generation neuroprosthesis consists of 12 stimulating electrodes, 2 EMG signal recording electrodes, an implanted stimulator-telemeter device, an external control unit, and a transmit/receive coil. The system was implanted in a single surgical procedure. Functional outcomes for each subject were evaluated in the domains of body functions and structures, activity performance, and societal participation.


RESULTS
Three individuals with C5/C6 spinal cord injury received system implantation with subsequent prospective evaluation for a minimum of 2 years. All 3 subjects demonstrated that EMG signals can be recorded from voluntary muscles in the presence of electrical stimulation of nearby muscles. Significantly increased pinch force and grasp function was achieved for each subject. Functional evaluation demonstrated improvement in at least 5 activities of daily living using the Activities of Daily Living Abilities Test. Each subject was able to use the device at home. There were no system failures. Two of 6 EMG electrodes required surgical revision because of suboptimal location of the recording electrodes.


CONCLUSIONS
These results indicate that a neuroprosthesis with implanted myoelectric control is an effective method for restoring hand function in midcervical level spinal cord injury.
Kilgore
Kevin L
KL
MetroHealth Medical Center, Cleveland, OH, USA. klk4@case.edu
Hoyen
Harry A
HA
Bryden
Anne M
AM
Hart
Ronald L
RL
Keith
Michael W
MW
Peckham
P Hunter
PH
D000203:Activities of Daily Living; D000328:Adult; D001186:Artificial Limbs; D002574:Cervical Vertebrae; D015331:Cohort Studies; D004567:Electrodes, Implanted; D004576:Electromyography; D006225:Hand / Q000503:physiopathology*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D011474:Prosthesis Design; D011782:Quadriplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D020127:Recovery of Function / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation