Abstract
This review describes the state of art in the field of Functional Electrical Stimulation (FES) and its impact on improving grasping and walking functions in acute and chronic Spinal Cord Injured (SCI) patients. It is argued that during the early rehabilitation period the FES systems with surface stimulation electrodes should be used to assist training of hand and leg movements in SCI patients. Our clinical trials have shown that a number of acute SCI patients with impaired walking and grasping functions could improve these functions due to training with an adjustable FES system to the point that they finally did not need the FES system to carry out these tasks. Other acute SCI patients, who did not recover the desired function, were enabled to perform either walking or grasping with the FES assistance. We believe that the subjects who can perform grasping or walking with the help of FES, and still use the neuroprosthesis 6 months after being subjected to the FES training, should consider the FES system as a prosthetic device in Activities of Daily Living (ADL). Despite the significant technical progress achieved in the last 10 to 15 years in the FES field, there is a general consensus that these systems are not sufficiently advanced and that they need further development. The limited acceptance of the FES technology can be in part explained by the fact that it is not completely mature and that the patients still require daily assistance to use the FES systems. Nevertheless the present FES treatments combined with conventional occupational and physical therapy still remain the most promising approach in rehabilitating SCI patients. In this review, advantages and limitations of different FES systems that are used to restore grasping and walking functions are discussed.
Spinal Cord (2001) 39, 403–412.
References
Kantrowitz A . Electronic Physiological Aids Report on the Maimonides Hospital Brooklyn 1960 4–5
Baker L et al. Neuromuscular Electrical Stimulation – A Practical Guide 3rd edn USA: Rehabilitation Engineering Program, Los Amigos Research and Education Institute, Rancho Los Amigos Medical Center 1993
Guyton A, Hall J Textbook of Medical Physiology 9th edn W.B. Saunders Company 1996
Quintern J . Application of functional electrical stimulation in paraplegic patients NeuroRehabilitation 1998 10: 205–250
Cameron T et al. Micromodular implants to provide electrical stimulation of paralyzed muscles and limbs IEEE Tr Biomed Eng 1997 44: 781–790
Hoshiyama N, Handa Y . A master-slave type multichannel functional electrical stimulation (FES) system for the control of the paralyzed upper extremities Automedica 1989 11: 209–220
Smith B, Peckham P, Keith M, Roscoe D . An externally powered, multichannel, implantable stimulator for versatile control of paralyzed muscle IEEE Tr Biomech Eng 1987 34: 499–508
Tyler D, Durand A . A slowly penetrating interfascicular nerve electrodes for selective activation of peripheral nerves IEEE Tr Rehab Eng 1997 5: 51–61
Kobetic R, Morsolais E . Synthesis of paraplegic gait with multichannel functional neuromuscular stimulation IEEE Tr Rehab Eng 1994 2: 66–78
Mortimer J . Motor prostheses Handbook of Physiology – The Nervous System II American Physiological Society 1981 pp 155–187
Ditunno JF, Young W, Donovan WH, Creasy G . The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury Paraplegia 1994 32: 70–80
Sollerman C, Ejeskar A . Sollerman hand function test: A standardized method and its use in tetraplegic patients Scand J Plast Reconstr Surg Hand Surg 1995 29: 167–176
Ditunno JF et al. Walking Index for Spinal Cord Injury (WISCI): An international multicenter validity and reliability study Spinal Cord 2000 38: 234–243
Rutz S, Dietz V, Curt A . Diagnostic and prognostic value of compound motor action potential of lower limbs in acute paraplegic patients Spinal Cord 2000 38: 203–210
Curt A, Dietz V . Traumatic cervical spinal cord injury: relation between somatosensory-evoked potentials, neurological deficits, and hand function Arch Phys Med Rehabil 1996 77: 48–53
Curt A, Dietz V . Neurographic assessment of intramedullar motoneurone lesions in cervical spinal cord injury: consequences for hand function Spinal Cord 1996 34: 326–332
Curt A, Dietz V . Nerve conduction in cervical spinal cord injury: significance for hand function NeuroRehabilitation 1996 7: 165–173
Curt A, Dietz V . Ambulatory capacity in spinal cord injury: significance of somatosensory evoked potentials and ASIA protocols in predicting outcome Arch Phys Med Rehabil 1997 78: 39–43
Curt A, Keck M, Dietz V . Clinical value of F-wave recordings in traumatic cervical spinal cord injury Electroenceph Clin Neurophysiol 1997 105: 189–193
Curt A, Dietz V . Electrophysiological recordings in patients with spinal cord injury: significance for predicting outcome Spinal Cord 1999 37: 157–165
Dietz V . Neurophysiology of gait disorders: present and future applications Electroenceph Clin Neurophysiol 1997 103: 333–335
Popovic MR et al. Surface-stimulation technology for grasping and walking neuroprostheses IEEE Eng Med Biol Magazine 2001 20: 82–93
Bajd T et al. Use of functional electrical stimulation in the rehabilitation of patients with incomplete spinal cord injuries J Biomed Eng 1989 11: 96–102
Popovic D et al. Clinical evaluation of the Bionic Glove Arch Phys Med Rehabil 1999 80: 299–304
Ijzerman M et al. The NESS Handmaster orthosis: restoration of hand function in C5 and stroke patients by means of electrical stimulation J Rehabil Sci 1996 9: 86–89
Prochazka A, Gauthier M, Wieler M, Kanwell Z . The Bionic Glove: An electrical stimulator garment that provides controlled grasp and hand opening in quadriplegia Arch Phys Med Rehabil 1997 78: 1–7
Graupe D, Davis R, Kordylewski H, Kohn KH . Ambulation by traumatic T4-12 paraplegics using functional neuromuscular stimulation Crit Rev Neurosurg 1998 8: 221–231
Graupe D, Kohn KH . Functional neuromuscular stimulator for short-distance ambulation by certain thoracic-level spinal-cord-injured paraplegics Surg Neurol 1998 50: 202–207
Wieler M, Naaman S, Stein RB . WalkAid: An improved functional electrical stimulator for correcting foot-drop Proceedings of the 1st Annual Conference of the International FES Society 1996 pp 101–104
Taylor PN et al. Correction of bilateral dropped foot using the Odstock 2 channel stimulator (O2CHS) Proceedings of the 4th Annual Conference of the International FES Society 1999 pp 257–260
Davis R, Houdayer T, Andrews B, Barriskill A Paraplegia: implanted Praxis24–FES system for multi-functional restoration Proceedings of the 4th Annual Conference of the International FES Society 1999 pp 155–158
Kobetic R, Triolo R, Morsolais E . Muscle selection and walking performance of multichannel FES systems for ambulation in paraplegia IEEE Tr Rehab Eng 1997 5: 23–28
Taylor P, Esnouf J, Hobby J . Pattern of use and user satisfaction of neuro control freehand system Spinal Cord 2001 39: 156–160
Haugland M, Lickel A, Haase J, Sinkjaer T . Control of FES thumb force using slip information obtained from the cutaneous electroneurogram in quadriplegic man IEEE Tr Rehab Eng 1999 7: 215–227
Lickel A . Restoration of lateral hand grasp in a tetraplegic patient applying natural sensory feedback. Center for sensory-motor interaction SMI, Aalborg University, Denmark 1998
Catz A et al. SCIM – Spinal Cord Independence Measure: a new disability scale for patients with spinal cord lesions Spinal Cord 1997 35: 850–856
Rebersk S, Vodovnik L . Proportionally controlled functional electrical stimulation of hand Arch Phys Med Rehabil 1973 54: 168–172
Popovic D et al.. Clinical evaluation of the Belgrade Grasping System. Proceedings of the 6th Vienna International Workshop on FES1998 pp 247–250
Hart RL, Kilgore KL, Peckham PH . A comparison between control methods for implanted FES hand-grasp systems IEEE Tr Rehab Eng 1998 6: 208–218
Grill JH, Peckham PH . Functional neuromuscular stimulation for combined control of elbow extension and hand grasp in C5 and C6 quadriplegics IEEE Tr Rehab Eng 1998 6: 190–199
Liberson WT, Holmquest HJ, Scot D, Dow M . Functional electrotherapy: Stimulation of the peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients Arch Phys Med Rehabil 1961 42: 101–105
Vodovnik L et al. Recent applications of functional electrical stimulation to stroke patients in Ljubljana Clin Orthopaed Related Res 1978 131: 64–70
MicroFES – Manual. Institut ‘Jozef Stefan’ Ljubljana, Slovenia 1991
Solomonow M et al. Reciprocating gait orthosis powered with electrical muscle stimulation (RGO II) Part I: Performance evaluation of 70 paraplegic patients Orthopaedics 1997 20: 315–324
Solomonow M et al. Reciprocating gait orthosis powered with electrical muscle stimulation (RGO II) Part II: Medical evaluation of 70 paraplegic patients Orthopedics 1997 20: 411–418
Popovic D, Tomovic R, Schwirtlich L . Hybrid assistive system – the motor neuroprosthesis IEEE Tr Biomed Eng 1989 36: 729–737
Kralj A, Bajd T, Turk R . Enhancement of gait restoration in spinal injured patients by functional electrical stimulation Clin Orthopaed Related Res 1988 223: 34–43
Bajd T, Kralj A, Stefancic M, Lavrac N . Use of functional electrical stimulation in the lower extremities of incomplete spinal cord injured patients Artificial Organs 1999 23: 403–409
Phillips CA . An interactive system of electrical stimulators and gait orthosis for walking in the spinal cord injured Automedica 1989 11: 247–261
Pappas IPI et al. Reliable gait phase detection system IEEE Tr Neural Syst Rehab Eng 2001 9: 113–125
Acknowledgements
The project presented in this review is supported by the Swiss National Science Foundation (project No. 5002-057811.1), the Committee for Technology and Innovation (project No. 4891.1) and company Compex SA, all located in Switzerland. Additional information regarding this and other projects of our group can be found at http://www.aut.ee.ethz.ch/∼fes/.
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Institute of Biomaterials and Biomedical Engineering, University of Toronto, Canada
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Popovic, M., Curt, A., Keller, T. et al. Functional electrical stimulation for grasping and walking: indications and limitations. Spinal Cord 39, 403–412 (2001). https://doi.org/10.1038/sj.sc.3101191
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DOI: https://doi.org/10.1038/sj.sc.3101191
Keywords
- functional electrical stimulation
- neuroprostheses
- grasping function
- walking function
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