A noninvasive neuroprosthesis augments hand grasp force in individuals with cervical spinal cord injury: the functional and therapeutic effects.
OBJECTIVE
The primary purpose of this study was to evaluate myoelectrically controlled functional electrical stimulation (MeCFES) for enhancing the tenodesis grip in people with tetraplegia. The second aim was to estimate the potential number of candidates for the MeCFES device. The application of MeCFES provides the user with direct control of the grasp force as opposed to triggered FES systems.


METHODS
Screening 253 medical records of C5 to C7 spinal cord injury resulted in 27 participants who trained activities of daily living for 12 × 2 hours, using the MeCFES. Hand function was evaluated by the Action Research Arm Test (ARAT). Primary outcome was the ARAT change score with/without the device, before/after the intervention period. Secondary outcome was the number of positive or clinically relevant change scores with respect to the cohort.


RESULTS
The MeCFES improved hand test score in 63% of the subjects at first application. Training resulted in a significant therapeutic effect, which resulted in an overall increase of hand function in 89% of the participants and 30% experienced a clinically relevant change (6 points or more).


CONCLUSIONS
Clinical relevance was found both as an assistive aid and as a therapeutic tool in rehabilitation. The therapeutic effect deserves further investigation in clinical studies.
IRCCS-Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milan, Italy.
Rune
R
Thorsen
Spinal Unit, Ospedale Niguarda Ca' Granda, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy.
Davide
D
Dalla Costa
Spinal Unit, Ospedale Niguarda Ca' Granda, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy.
Sara
S
Chiaramonte
Spinal Unit, Ospedale Morelli, Via A. Zubiani 33, Sondalo, 23035 Sondrio, Italy.
Luca
L
Binda
Laboratory of Neurological Disorders, Istituto Mario Negri, Via La Masa 19, 20156 Milan, Italy.
Ettore
E
Beghi
Spinal Unit, Ospedale Niguarda Ca' Granda, Piazza dell'Ospedale Maggiore 3, 20162 Milan, Italy.
Tiziana
T
Redaelli
Spinal Unit, Ospedale Morelli, Via A. Zubiani 33, Sondalo, 23035 Sondrio, Italy.
Eugenio
E
Occhi
IRCCS-Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milan, Italy.
Maurizio
M
Ferrarin
D000328:Adult; D002574:Cervical Vertebrae / Q000473:pathology; D004558:Electric Stimulation / Q000295:instrumentation / Q000379:methods; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D016896:Treatment Outcome