title: First permanent implant of nerve stimulation leads activated by surface electrodes, enabling hand grasp and release: the stimulus router neuroprosthesis.
abstract: BACKGROUND
  . More than 150 000 neuroprostheses (NPs) have been implanted in people to restore bodily function in a variety of neural disorders. The authors developed a novel NP, the Stimulus Router System (SRS), in which only passive leads are implanted. Each lead picks up a portion of the current delivered through the skin by an external stimulator.
  
  
  OBJECTIVE
  . The authors report on the first human implant of an SRS.
  
  
  METHODS
  . The recipient was a tetraplegic man with bilateral hand paralysis. Three SRS leads were implanted in his right forearm to activate the finger extensors, finger flexors, and thumb flexor. A wristlet containing a surface stimulator and electrodes was used to pass trains of electrical pulses through the skin to each lead. Hand opening and grasp were controlled via a wireless earpiece that sensed small tooth-clicks and transmitted signals to the wristlet.
  
  
  RESULTS
  . The current required to activate the muscles was less than half that required prior to implantation and below perceptual threshold. Maximal grip force and hand opening aperture were both larger using the SRS. The implanted leads have remained functional for 3 years. The recipient reported various tasks of daily life that improved during SRS usage. An electronic counter revealed mean monthly usage of 18.5 hours, equivalent to 55 hours of continuous manual activity.
  
  
  CONCLUSIONS
  . This first implant of the SRS indicates that it can be effective and reliable and has potential to provide an alternative to existing NPs.
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Liu Shi
authors.initials: LS
authors.lastname: Gan
authors.forename: Einat
authors.initials: E
authors.lastname: Ravid
authors.forename: Jan Andrzej
authors.initials: JA
authors.lastname: Kowalczewski
authors.forename: Jaret Lawrence
authors.initials: JL
authors.lastname: Olson
authors.forename: Michael
authors.initials: M
authors.lastname: Morhart
authors.forename: Arthur
authors.initials: A
authors.lastname: Prochazka
mesh_terms: D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods*; D004567:Electrodes, Implanted; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D018482:Muscle, Skeletal / Q000294:innervation / Q000502:physiology; D011782:Quadriplegia / Q000209:etiology / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000628:therapy*; D014953:Wrist / Q000294:innervation