Wise Young
09-27-2001, 11:02 AM
Feasibility of Restoring Upper Extremity Function in C3-C4 Tetraplegia
Principal Investigator:
Robert F. Kirsch, Ph.D.
Target population: Persons with spinal cord injury at the C3-C4 level
Abstract:
The goal of this project is to investigate the feasibility of restoring upper extremity function to individuals with high cervical spinal cord injury (C4 function or less) using functional neuromuscular stimulation and/or reconstructive surgery. This is the most disabled population of individuals with spinal cord injury, so restoration of just a few simple functions (e.g., simple self-feeding and grooming activities) would significantly increase the independence and quality of living for these individuals. However, restoring movement function to these individuals has been quite challenging and not very successful, for three primary reasons. First, the number of retained voluntary functions is so low that there is minimal opportunity to substitute for lost functions or even to use these motions to control external devices. Second, individuals with C3 or C4 level spinal cord injuries may exhibit extensive denervation of the shoulder and elbow muscles, which could limit the possibility of using functional neuromuscular stimulation (FNS) of these muscles to restore movement. Third, the mechanics of the human shoulder are too complex to allow the development of effective methods for restoring movement by trial and error.
The proposed project will address each of these issues so that meaningful and informed decisions can be made regarding the best approaches for restoring arm functions to individuals with high cervical spinal cord injuries. We will perform a survey of approximately 20 individuals with C3 or C4 spinal cord injuries to determine whether denervation is indeed a limiting factor in many individuals. We will further explore the feasibility of FNS in this population by implanting stimulating electrodes in the elbow and shoulder muscles of 8 of these individuals and quantifying the increase in strength and movement range produced by an FNS-mediated exercise regimen. Finally, we will address the mechanical complexity of the human shoulder by using the emerging field of musculoskeletal modeling as a tool for evaluating the feasibility of different rehabilitation. We will be able to estimate what types of functions might be restored for different individuals, whether adequate function can be provided without external orthoses, how many and which muscles are required for successful FNS, and which reconstructive surgeries may be required.
Project sponsor:
Spinal Cord Research Foundation, Paralyzed Veterans of America
For more information contact:
Robert F. Kirsch, Ph.D.
Rehabilitation Engineering Center
MetroHealth Medical Center, Hamann 601
2500 MetroHealth Drive
Cleveland, OH 44109-1998
(216) 778-4139 (216) 778-4259 FAX
E-Mail: rfk3@po.cwru.edu
[This message was edited by Wise Young on September 27, 2001 at 01:12 PM.]
Principal Investigator:
Robert F. Kirsch, Ph.D.
Target population: Persons with spinal cord injury at the C3-C4 level
Abstract:
The goal of this project is to investigate the feasibility of restoring upper extremity function to individuals with high cervical spinal cord injury (C4 function or less) using functional neuromuscular stimulation and/or reconstructive surgery. This is the most disabled population of individuals with spinal cord injury, so restoration of just a few simple functions (e.g., simple self-feeding and grooming activities) would significantly increase the independence and quality of living for these individuals. However, restoring movement function to these individuals has been quite challenging and not very successful, for three primary reasons. First, the number of retained voluntary functions is so low that there is minimal opportunity to substitute for lost functions or even to use these motions to control external devices. Second, individuals with C3 or C4 level spinal cord injuries may exhibit extensive denervation of the shoulder and elbow muscles, which could limit the possibility of using functional neuromuscular stimulation (FNS) of these muscles to restore movement. Third, the mechanics of the human shoulder are too complex to allow the development of effective methods for restoring movement by trial and error.
The proposed project will address each of these issues so that meaningful and informed decisions can be made regarding the best approaches for restoring arm functions to individuals with high cervical spinal cord injuries. We will perform a survey of approximately 20 individuals with C3 or C4 spinal cord injuries to determine whether denervation is indeed a limiting factor in many individuals. We will further explore the feasibility of FNS in this population by implanting stimulating electrodes in the elbow and shoulder muscles of 8 of these individuals and quantifying the increase in strength and movement range produced by an FNS-mediated exercise regimen. Finally, we will address the mechanical complexity of the human shoulder by using the emerging field of musculoskeletal modeling as a tool for evaluating the feasibility of different rehabilitation. We will be able to estimate what types of functions might be restored for different individuals, whether adequate function can be provided without external orthoses, how many and which muscles are required for successful FNS, and which reconstructive surgeries may be required.
Project sponsor:
Spinal Cord Research Foundation, Paralyzed Veterans of America
For more information contact:
Robert F. Kirsch, Ph.D.
Rehabilitation Engineering Center
MetroHealth Medical Center, Hamann 601
2500 MetroHealth Drive
Cleveland, OH 44109-1998
(216) 778-4139 (216) 778-4259 FAX
E-Mail: rfk3@po.cwru.edu
[This message was edited by Wise Young on September 27, 2001 at 01:12 PM.]