Restoring Multidimensional Coordinated Reaching and Dexterous Grasping to Persons with Chronic Tetraplegia Through Functional Electrical Stimulation
Abstract
The primary objective of the proposal is to test the efficacy of a new device that will restore natural and coordinated arm and hand movements to people who have complete hand and arm paralysis due to spinal cord injury (SCI). This device will combine two novel technological: (1) Functional Electrical Stimulation (FES), and (2) a Brain-Computer Interface (BCI). FES applies electrical stimulation to paralyzed muscles, and when done so in a coordinated fashion, can reanimate limbs and other body parts that were once paralyzed. FES has a long standing history of successful use in the laboratory, and even clinically and commercially for restoring simple movements of the hand to people who had hand paralysis, having been used in over 1,000 people nationally and internationally. Our proposed FES system represents a major advance over previous FES systems, because it focuses on directly stimulating nerves, rather than muscles. Stimulating nerves directly is very advantageous, because we will then be able to more selectively activate specific muscles of interest (for example, we can then actuate individual fingers independently rather than just the whole hand), and we can use less electrical current (nerves are easier to actuate than muscles), thereby making the system safer. Additionally, previous FES systems were designed for people with lower level (C5-C6 and lower) SCI and required the user to be able to perform some movement to begin the stimulation. Because people with higher-level injuries (C1-C4) often do not have the ability to perform these required movements, a new approach is needed to adapt FES systems for persons with C1-C4 SCI. The second technology, a BCI, consists of electrodes implanted inside the brain that record the natural and intact brain signals remaining, even after injury. These signals can be deciphered or decoded using mathematical algorithms (known as a decoder), and then converted into a movement signal that is sent to the FES system to reanimate the limb. In essence, this combined FES+iBCI device is bypassing the spinal cord injury to Reconnect the Hand and Arm to the Brain (ReHaB). Our proposed ReHAB Clinical Trial aims to test the safety and efficacy of this combined device. Recent surveys have shown that people with SCI are knowledgeable of these two technologies and willing to receive them (even given the required surgeries), provided that the functional benefits are significant. Our ReHAB Clinical Trial aims to assess the functional benefits of such a system. We have previously demonstrated a Veteran with complete paralysis using a simpler and temporary version of the system to perform functional movements, such as feeding himself and taking a drink, whereas he could not move at all without the system. The time is right to move toward the proposed permanent and more advanced system to fully restore complex movements of the arm and hand to Veterans and others with complete paralysis. What types of patients will we help, and how will we help them? The study will recruit Veterans and others with high cervical (C1-C4) SCI, as this is the target population of people who will receive the system, although people with lower cervical SCI may receive benefit as well. The proposed device aims to restore natural arm and hand movements to this population to allow for performance of standard activities of daily living, such as self-feeding and manipulating objects, ultimately to increase personal independence and enhance quality of life. Potential Clinical Applications and Benefits: Our proposed technology will have the clinical benefit of restoring natural motor function to people who are paralyzed due to SCI. Functional Electrical Stimulation has been clinically and commercially successful for many years, and brain-computer interfaces have been under clinical trial for several years. Ultimately, the benefit of combining both technologies for people with SCI will be to restore a level of personal and funct
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910707
Entities
People
- Abidemi Ajiboye
Organizations
- Case Western Reserve University
- United States Army