title: Safety and efficacy of medically performed tongue piercing in people with tetraplegia for use with tongue-operated assistive technology.
abstract: BACKGROUND
  Individuals with high-level spinal cord injuries need effective ways to perform activities.
  
  
  OBJECTIVE
  To develop and test a medically supervised tongue-piercing protocol and the wearing of a magnet-containing tongue barbell for use with the Tongue Drive System (TDS) in persons with tetraplegia.
  
  
  METHODS
  Volunteers with tetraplegia underwent initial screening sessions using a magnet glued on the tongue to activate and use the TDS. This was followed by tongue piercing, insertion of a standard barbell, a 4-week healing period, and an exchange of the standard barbell for a magnet-containing barbell. This was then used twice weekly for 6 to 8 weeks to perform computer tasks, drive a powered wheelchair, accomplish in-chair weight shifts, and dial a phone. Symptoms of intraoral dysfunction, change in tongue size following piercing, and subjective assessment of receiving and wearing a magnet-containing tongue barbell and its usability with the TDS were evaluated.
  
  
  RESULTS
  Twenty-one volunteers underwent initial trial sessions. Thirteen had their tongues pierced. One individual's barbell dislodged during healing resulting in tongue-tract closure. Twelve had the barbell exchanged for a magnet-containing barbell. One subject withdrew for unrelated issues. Eleven completed the TDS testing sessions and were able to complete the assigned tasks. No serious adverse events occurred related to wearing or using a tongue barbell to operate the TDS.
  
  
  CONCLUSIONS
  Using careful selection criteria and a medically supervised piercing protocol, no excess risk was associated with tongue piercing and wearing a tongue barbell in people with tetraplegia. Participants were able to operate the TDS.
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Anne
authors.initials: A
authors.lastname: Laumann
authors.affiliation: Department of Pediatrics, University of Chicago , Chicago, Illinois.
authors.forename: Jaimee
authors.initials: J
authors.lastname: Holbrook
authors.affiliation: Department of Dermatology, Southern California Permanente Medical Group , San Diego, California.
authors.forename: Julia
authors.initials: J
authors.lastname: Minocha
authors.affiliation: Department of Neurosurgery, Rush University Medical Center , Chicago, Illinois.
authors.forename: Diane
authors.initials: D
authors.lastname: Rowles
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Nardone
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Dennis
authors.initials: D
authors.lastname: West
authors.affiliation: GT-Bionics Lab, School of Electrical and Computer Engineering, Georgia Institute of Technology , Atlanta, Georgia.
authors.forename: Jeonghee
authors.initials: J
authors.lastname: Kim
authors.affiliation: Hulse Spinal Cord Injury Lab, Shepherd Center , Atlanta, Georgia.
authors.forename: Joy
authors.initials: J
authors.lastname: Bruce
authors.affiliation: Rehabilitation Institute of Chicago , Illinois ; Northwestern University , Chicago, Illinois.
authors.forename: Elliot J
authors.initials: EJ
authors.lastname: Roth
authors.affiliation: GT-Bionics Lab, School of Electrical and Computer Engineering, Georgia Institute of Technology , Atlanta, Georgia.
authors.forename: Maysam
authors.initials: M
authors.lastname: Ghovanloo
mesh_terms: D000328:Adult; D024803:Biomedical Enhancement / Q000379:methods; D046288:Body Piercing / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D059346:Magnets; D008297:Male; D008328:Man-Machine Systems; D008875:Middle Aged; D011782:Quadriplegia / Q000209:etiology / Q000534:rehabilitation*; D012656:Self-Help Devices; D013119:Spinal Cord Injuries / Q000150:complications / Q000534:rehabilitation*; D014059:Tongue; D014584:User-Computer Interface
keywords: assistive technology; plethysmography; spinal cord injury; tetraplegia; tongue drive system; tongue piercing