Catalogo Articoli (Spogli Riviste)


An implantable upper extremity neuroprosthesis in a growing child with a C5 spinal cord injury
Smith, BT; Mulcahey, MJ; Betz, RR;
Shriners Hosp Children, Res Dept, Philadelphia, PA 19140 USA Shriners HospChildren Philadelphia PA USA 19140 iladelphia, PA 19140 USA
Titolo Testata:
fascicolo: 2, volume: 39, anno: 2001,
pagine: 118 - 123
spinal cord injury; pediatrics; growth; outcome; upper extremity function; tetraplegia;
Tipo documento:
Settore Disciplinare:
Clinical Medicine
Indirizzi per estratti:
Indirizzo: Smith, BT Shriners Hosp Children, Res Dept, 3551 N Broad St, Philadelphia,PA 19140 USA Shriners Hosp Children 3551 N Broad St Philadelphia PA USA 19140
B.T. Smith et al., "An implantable upper extremity neuroprosthesis in a growing child with a C5 spinal cord injury", SPINAL CORD, 39(2), 2001, pp. 118-123


Objectives: To implement a functional electrical stimulation (FES) hand neuroprosthesis called the Freehand System in a growing child with spinal cord injury (SCI) using extra lead wire to accommodate limb growth, and to evaluate the performance of the Freehand System during the subject's maturation. Setting: Pediatric orthopedic hospital specializing in SCI rehabilitation. Subject: Ten-year-old female patient with a C5 level SCI. Method: The Freehand System was implanted. Eight electrodes were implantedto targeted forearm and hand muscles to provide grasp and release function. The lead wile associated with each electrode was pathed subcutaneously upthe al-m with 4 cm of extra lead distributed throughout the path to accommodate expected limb growth. All leads were attached to a stimulator placed in the upper chest. Measures of lead unwinding, limb growth, stimulated muscle strength, and hand function were made at 6 and 16 months after implant. Results: By 16 months post implant, the upper limb growth plates were closed and humeral and radial bone growth combined was 2.7 cm from the time of surgery. For all eight leads, lead unwinding in the upper arm was approximately 1.2 cm and was comparable to humeral bone growth (1.4 cm). Lead unwinding ill the lower arm was also measurable for the two electrodes in hand muscles. Six of eight electrodes maintained grade 3 or better stimulated muscle strength throughout the growth period according to a manual muscle test. Of the two other electrodes, one appeared to have lost function due to depletion of excess lead. However, hand function with FES was comparable at 6 and 16 months post implant suggesting that growth did not negatively impactperformance with the FES system. Hand function with FES was improved over voluntary hand function as well. Using the Freehand System, a pinch force of approximately 15 N was achieved compared to 1.3 N of voluntary tenodesis pinch force. Scores on the Functional Independence Measure (FIM) increased by 9 points what FES was used as compared to voluntary function. Improvements occurred primarily in eating and grooming. Independence in writing was achieved only with FES. Conclusions: For this child. hand function with the Freehand System was sustained over the growth period and was a significant functional improvementover voluntary hand function. By using excess lead wire, the Freehand System was successfully implemented before skeletal maturity, affording the child improved hand function earlier than would be otherwise indicated.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 27/01/20 alle ore 01:29:39