The Experts below are selected from a list of 2616 Experts worldwide ranked by ideXlab platform
Ronald J. Triolo - One of the best experts on this subject based on the ideXlab platform.
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Sensory Neuroprosthesis improves postural stability during Sensory Organization Test in lower-limb amputees.
Scientific reports, 2020Co-Authors: Hamid Charkhkar, Breanne P. Christie, Ronald J. TrioloAbstract:To maintain postural stability, unilateral lower-limb amputees (LLAs) heavily rely on visual and vestibular inputs, and somatosensory cues from their intact leg to compensate for missing somatosensory information from the amputated limb. When any of these resources are compromised, LLAs exhibit poor balance control compared to able-bodied individuals. We hypothesized that restoring somatosensation related to the missing limb via direct activation of the sensory nerves in the residuum would improve the standing stability of LLAs. We developed a closed-loop sensory Neuroprosthesis utilizing non-penetrating multi-contact cuff electrodes implanted around the residual nerves to elicit perceptions of the location and intensity of plantar pressures under the prosthetic feet of two transtibial amputees. Effects of the sensory Neuroprosthesis on balance were quantified with the Sensory Organization Test and other posturographic measures of sway. In both participants, the sensory Neuroprosthesis improved equilibrium and sway when somatosensation from the intact leg and visual inputs were perturbed simultaneously. One participant also showed improvement with the sensory Neuroprosthesis whenever somatosensation in the intact leg was compromised via perturbations of the platform. These observations suggest the sensory feedback elicited by neural stimulation can significantly improve the standing stability of LLAs, particularly when other sensory inputs are depleted or otherwise compromised.
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Effect of exoskeletal joint constraint and passive resistance on metabolic energy expenditure: Implications for walking in paraplegia
2017Co-Authors: Sarah R. Chang, Rudi Kobetic, Ronald J. TrioloAbstract:An important consideration in the design of a practical system to restore walking in individuals with spinal cord injury is to minimize metabolic energy demand on the user. In this study, the effects of exoskeletal constraints on metabolic energy expenditure were evaluated in able-bodied volunteers to gain insight into the demands of walking with a hybrid Neuroprosthesis after paralysis. The exoskeleton had a hydraulic mechanism to reciprocally couple hip flexion and extension, unlocked hydraulic stance controlled knee mechanisms, and ankles fixed at neutral by ankle-foot orthoses. These mechanisms added passive resistance to the hip (15 Nm) and knee (6 Nm) joints while the exoskeleton constrained joint motion to the sagittal plane. The average oxygen consumption when walking with the exoskeleton was 22.5 ± 3.4 ml O2/min/kg as compared to 11.7 ± 2.0 ml O2/min/kg when walking without the exoskeleton at a comparable speed. The heart rate and physiological cost index with the exoskeleton were at least 30% and 4.3 times higher, respectively, than walking without it. The maximum average speed achieved with the exoskeleton was 1.2 ± 0.2 m/s, at a cadence of 104 ± 11 steps/min, and step length of 70 ± 7 cm. Average peak hip joint angles (25 ± 7°) were within normal range, while average peak knee joint angles (40 ± 8°) were less than normal. Both hip and knee angular velocities were reduced with the exoskeleton as compared to normal. While the walking speed achieved with the exoskeleton could be sufficient for community ambulation, metabolic energy expenditure was significantly increased and unsustainable for such activities. This suggests that passive resistance, constraining leg motion to the sagittal plane, reciprocally coupling the hip joints, and weight of exoskeleton place considerable limitations on the utility of the device and need to be minimized in future designs of practical hybrid neuroprostheses for walking after paraplegia.
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Finite State Control of a Variable Impedance Hybrid Neuroprosthesis for Locomotion After Paralysis
IEEE Transactions on Neural Systems and Rehabilitation Engineering, 2013Co-Authors: Thomas C. Bulea, Rudi Kobetic, Musa L. Audu, John R. Schnellenberger, Ronald J. TrioloAbstract:We have previously reported on a novel variable impedance knee mechanism (VIKM). The VIKM was designed as a component of a hybrid Neuroprosthesis to regulate knee flexion. The hybrid Neuroprosthesis is a device that uses a controllable brace to support the body against collapse while stimulation provides power for movement. The hybrid Neuroprosthesis requires a control system to coordinate the actions of the VIKM with the stimulation system; the development and evaluation of such a controller is presented. Brace mounted sensors and a baseline open loop stimulation pattern are utilized as control signals to activate the VIKM during stance phase while simultaneously modulating muscle stimulation in an on-off fashion. The objective is twofold: reduce the amount of stimulation necessary for walking while simultaneously restoring more biologically correct knee motion during stance using the VIKM. Custom designed hardware and software components were developed for controller implementation. The VIKM hybrid Neuroprosthesis (VIKM-HNP) was evaluated during walking in one participant with thoracic level spinal cord injury. In comparison to walking with functional neuromuscular stimulation alone, the VIKM-HNP restored near normal stance phase knee flexion during loading response and pre-swing phases while decreasing knee extensor stimulation by up to 40%.
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Longitudinal performance of a surgically implanted Neuroprosthesis for lower-extremity exercise, standing, and transfers after spinal cord injury.
Archives of physical medicine and rehabilitation, 2012Co-Authors: Ronald J. Triolo, John A. Davis, Michael E. Miller, Stephanie Nogan Bailey, Loretta M. Rohde, James S. Anderson, James J. Abbas, Lisa Diponio, George Forrest, David R. GaterAbstract:Abstract Triolo RJ, Bailey SN, Miller ME, Rohde LM, Anderson JS, Davis JA Jr, Abbas JJ, DiPonio LA, Forrest GP, Gater DR Jr, Yang LJ. Longitudinal performance of a surgically implanted Neuroprosthesis for lower-extremity exercise, standing, and transfers after spinal cord injury. Objective To investigate the longitudinal performance of a surgically implanted Neuroprosthesis for lower-extremity exercise, standing, and transfers after spinal cord injury. Design Case series. Setting Research or outpatient physical therapy departments of 4 academic hospitals. Participants Subjects (N=15) with thoracic or low cervical level spinal cord injuries who had received the 8-channel Neuroprosthesis for exercise and standing. Intervention After completing rehabilitation with the device, the subjects were discharged to unrestricted home use of the system. A series of assessments were performed before discharge and at a follow-up appointment approximately 1 year later. Main Outcome Measures Neuroprosthesis usage, maximum standing time, body weight support, knee strength, knee fatigue index, electrode stability, and component survivability. Results Levels of maximum standing time, body weight support, knee strength, and knee fatigue index were not statistically different from discharge to follow-up ( P >.05). Additionally, Neuroprosthesis usage was consistent with subjects choosing to use the system on approximately half of the days during each monitoring period. Although the number of hours using the Neuroprosthesis remained constant, subjects shifted their usage to more functional standing versus more maintenance exercise, suggesting that the subjects incorporated the Neuroprosthesis into their lives. Safety and reliability of the system were demonstrated by electrode stability and a high component survivability rate (>90%). Conclusions This group of 15 subjects is the largest cohort of implanted lower-extremity neuroprosthetic exercise and standing system users. The safety and efficiency data from this group, and acceptance of the Neuroprosthesis as demonstrated by continued usage, indicate that future efforts toward commercialization of a similar device may be warranted.
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Intraoperative Evaluation of the Spiral Nerve Cuff Electrode for a Standing Neuroprosthesis
2007 3rd International IEEE EMBS Conference on Neural Engineering, 2007Co-Authors: Katharine H. Polasek, Ronald J. Triolo, Matthew A. Schiefer, Gilles C. Pinault, Dustin J. TylerAbstract:Evaluation of the spiral nerve cuff electrode on the proximal femoral nerve for a standing Neuroprosthesis was performed intraoperatively in 4 subjects. The mean stimulation threshold was 17.7 plusmn 12 nC, similar to stimulation thresholds in upper extremity nerves. The femoral nerve was found to have an oblong cross section with an average width of 9 mm and height of 1-2 mm. In all 4 subjects where data was recorded, selective activation of at least one hip flexor (rectus femoris or sartorius) was possible. For a standing Neuroprosthesis, knee extension without hip flexion is desired. A more selective electrode is needed for this application.
John A. Davis - One of the best experts on this subject based on the ideXlab platform.
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Longitudinal performance of a surgically implanted Neuroprosthesis for lower-extremity exercise, standing, and transfers after spinal cord injury.
Archives of physical medicine and rehabilitation, 2012Co-Authors: Ronald J. Triolo, John A. Davis, Michael E. Miller, Stephanie Nogan Bailey, Loretta M. Rohde, James S. Anderson, James J. Abbas, Lisa Diponio, George Forrest, David R. GaterAbstract:Abstract Triolo RJ, Bailey SN, Miller ME, Rohde LM, Anderson JS, Davis JA Jr, Abbas JJ, DiPonio LA, Forrest GP, Gater DR Jr, Yang LJ. Longitudinal performance of a surgically implanted Neuroprosthesis for lower-extremity exercise, standing, and transfers after spinal cord injury. Objective To investigate the longitudinal performance of a surgically implanted Neuroprosthesis for lower-extremity exercise, standing, and transfers after spinal cord injury. Design Case series. Setting Research or outpatient physical therapy departments of 4 academic hospitals. Participants Subjects (N=15) with thoracic or low cervical level spinal cord injuries who had received the 8-channel Neuroprosthesis for exercise and standing. Intervention After completing rehabilitation with the device, the subjects were discharged to unrestricted home use of the system. A series of assessments were performed before discharge and at a follow-up appointment approximately 1 year later. Main Outcome Measures Neuroprosthesis usage, maximum standing time, body weight support, knee strength, knee fatigue index, electrode stability, and component survivability. Results Levels of maximum standing time, body weight support, knee strength, and knee fatigue index were not statistically different from discharge to follow-up ( P >.05). Additionally, Neuroprosthesis usage was consistent with subjects choosing to use the system on approximately half of the days during each monitoring period. Although the number of hours using the Neuroprosthesis remained constant, subjects shifted their usage to more functional standing versus more maintenance exercise, suggesting that the subjects incorporated the Neuroprosthesis into their lives. Safety and reliability of the system were demonstrated by electrode stability and a high component survivability rate (>90%). Conclusions This group of 15 subjects is the largest cohort of implanted lower-extremity neuroprosthetic exercise and standing system users. The safety and efficiency data from this group, and acceptance of the Neuroprosthesis as demonstrated by continued usage, indicate that future efforts toward commercialization of a similar device may be warranted.
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Energy cost of the case Western reserve standing Neuroprosthesis.
Archives of physical medicine and rehabilitation, 2007Co-Authors: George Forrest, Ronald J. Triolo, John A. Davis, Michael E. Miller, Thomas C. Smith, Jason P. Gagnon, Darryl J. Dirisio, Lori Murray, Atif IqbalAbstract:Abstract Forrest GP, Smith TC, Triolo RJ, Gagnon JP, DiRisio D, Miller ME, Murray L, Davis JA, Iqbal A. Energy cost of the Case Western Reserve standing Neuroprosthesis. Objective To determine the oxygen consumption of a person with C7 American Spinal Injury Association (ASIA) grade B tetraplegia using the Case Western Reserve/Veterans Administration (CWRU/VA) standing Neuroprosthesis. Design Measure the oxygen consumption and carbon dioxide production of a person with C7 ASIA grade B tetraplegia at rest, standing in the parallel bars with the CWRU/VA system on, ambulating in the parallel bars, and transferring from a wheelchair to a mat with the system on. Setting University medical center. Participant A 26-year-old man with C7 ASIA grade B tetraplegia. The subject was a recipient of the CWRU/VA standing Neuroprosthesis. Interventions Not applicable. Main Outcome Measures Measurement of oxygen consumption and carbon dioxide production using a metabolic cart. Results Oxygen consumption of the subject was 1.22mL·kg −1 ·min −1 at rest. It was 4.7mL·kg −1 ·min −1 while standing in the parallel bars, 7.2mL·kg −1 ·min −1 while ambulating in the parallel bars, and 7.9mL·kg −1 ·min −1 when transferring from a wheelchair to a mat. Conclusions Oxygen consumption of the subject when using the system is about 2 metabolic equivalent units, which is compatible with sustained use of the system for standing.
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Performance of epimysial stimulating electrodes in the lower extremities of individuals with spinal cord injury
IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society, 2004Co-Authors: James Uhlir, Ronald J. Triolo, John A. Davis, Carol BieriAbstract:This study describes the performance of surgically-implanted epimysial stimulating electrodes in the muscles of the lower extremities for use in functional neuromuscular stimulation (FNS) systems for standing after spinal cord injury. A total of 86 epimysial electrodes were implanted in 13 volunteers with low tetraplegia or paraplegia receiving the Case Western Reserve University/Veteran Affairs (CWRU/VA)-implanted standing/transfer Neuroprosthesis. The Neuroprosthesis consisted of bilateral epimysial electrodes in the knee and hip extensors (vastus lateralis, gluteus maximus, and adductor magnus or semimembranosus) and intramuscular electrodes at the T12/L1 or L1/L2 spinal roots for trunk extension. Recruitment properties, stimulated knee and hip extension moments, standing performance, and mechanical integrity over time were measured for a period up to four years post-implantation. Stimulated thresholds were stable and recruitment was sufficient to generate joint moments adequate for standing, with up to 97% body weight supported by the legs. Four mechanical failures were observed, all in the posterior muscles of the thigh, leaving 95% of all electrodes operational at all followup intervals. Probability of 24-month survival is estimated to be 93% plateauing to a steady state of 90% at four years. These results indicate that epimysial designs are appropriate for long-term clinical use in the large muscles of the lower extremities with implanted motor system neuroprostheses.
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Long-term user perceptions of an implanted Neuroprosthesis for exercise, standing, and transfers after spinal cord injury.
Journal of rehabilitation research and development, 2003Co-Authors: Sanjeev Agarwal, Ronald J. Triolo, Carol Bieri, Rudi Kobetic, Michael E. Miller, Sahana N. Kukke, Lori Rohde, John A. DavisAbstract:This study was completed to understand the usage patterns, system performance, degree of satisfaction, complications, and health benefits as perceived by recipients of a surgically implanted Neuroprosthesis for exercise, standing, and transfers in individuals with low-cervical or thoracic spinal cord injury (SCI). A standardized telephone survey was administered to 11 recipients of the Case Western Reserve University/Veterans Affairs (CWRU/VA) implanted standing Neuroprosthesis with more than 12 months of experience with the functional electrical stimulation (FES) system. Nine implant recipients were using the Neuroprosthesis regularly for standing and/or exercising at the time of the survey. All 11 implant recipients noted improved health and a reduced incidence of pressure sores, leg spasms, and urinary tract infections (UTIs). No incidents of deep-vein thrombosis, infection, cellulitis, or electrical burns because of the Neuroprosthesis were noted. System recipients uniformly felt that the Neuroprosthesis resulted in better overall health and general well-being. Subjects were moderately to very satisfied with the performance of the Neuroprosthesis and unanimously expressed a willingness to repeat the surgery and rehabilitation to obtain the same clinical outcome. All implant recipients reported the system to be safe, reliable, and easy to use. The implanted standing Neuroprosthesis appears to be a clinically acceptable and effective means of providing the ability to exercise, stand, and transfer to selected individuals with paraplegia or low tetraplegia.
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Preliminary performance of a surgically implanted Neuroprosthesis for standing and transfers--where do we stand?
Journal of rehabilitation research and development, 2001Co-Authors: John A. Davis, James Uhlir, Ronald J. Triolo, Carol Bieri, Lori Rohde, Dawn A. Lissy, Sahana N. KukkeAbstract:This paper describes the preliminary performance of a surgically implanted Neuroprosthesis for standing and transfers after spinal cord injury (SCI) in an initial group of 12 volunteers with longstanding paralysis. The CWRU/VA standing Neuroprosthesis consists of an 8-channel implanted receiver-stimulator, epimysial and surgically implanted intramuscular electrodes, and a programmable wearable external controller. After reconditioning exercise and rehabilitation with the system, most individuals with paraplegia or low tetraplegia were able to stand, transfer, and release one hand from a support device to manipulate objects in the environment or to perform swing-to ambulation in a walker. The effort and assistance required for transfers were reduced for users with mid-level tetraplegia, although the maneuvers were not independent. Neuroprosthesis users with tetraplegia and paraplegia alike benefited from the improvements in their general health derived from exercise, including reduced risk of decubiti and self-reported modulation of spasticity. Stimulated responses are stable and sufficiently strong for function, and implanted components are reliable with a 90% probability of epimysial electrode survival at 4 years post-implant. The techniques employed are repeatable and teachable, and suitable for multi-center clinical trial.
P Hunter Peckham - One of the best experts on this subject based on the ideXlab platform.
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Implementation of a Wireless Wearable Controller for an Upper Extremity Neuroprosthesis
2007Co-Authors: Christa A. Wheeler, P Hunter PeckhamAbstract:A wireless wearable controller has been designed to enable proportional control of an upper extremity Neuroprosthesis using wrist position. The wearable controller, which utilizes gigantic magnetoresistive (GMR) sensing techniques to measure wrist position, is worn on the forearm. A small dime-sized magnet is fixed to the back of the hand. Results indicate that the device is a feasible control method for an upper extremity Neuroprosthesis.
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An implanted myoelectrically-controlled Neuroprosthesis for upper extremity function in spinal cord injury.
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and, 2006Co-Authors: Kevin L Kilgore, Ronald L Hart, Fred W Montague, Anne M Bryden, Michael W Keith, Harry A Hoyen, Carol J Sams, P Hunter PeckhamAbstract:A second generation implantable Neuroprosthesis has been developed which provides improved control of grasp-release, forearm pronation, and elbow extension for individuals with cervical level spinal cord injury. In addition to the capacity to stimulate twelve muscles, the key technological feature of the advanced system is the capability to transmit data out of the body. This allows the use of myoelectric signal recording via implanted electrodes, thus minimizing the required external components. Clinical studies have been initiated with a second generation Neuroprosthesis that consists of twelve stimulating electrodes, two myoelectric signal recording electrodes, an implanted stimulator-telemeter device and an external control unit and transmit/receive coil. This system has now been implemented in nine arms in seven C5/C6 spinal cord injured individuals. The results from these subjects demonstrate that myoelectric signals can be recorded from voluntary muscles in the presence of electrical stimulation of nearby muscles. The functional results show that the Neuroprosthesis provides significantly increased pinch force and grasp function for each subject. All subjects have demonstrated increased independence and improved function in activities of daily living. We believe that these results indicate that implanted myoelectric control is a desirable option for neuroprostheses.
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Efficacy of an implanted Neuroprosthesis for restoring hand grasp in tetraplegia: a multicenter study.
Archives of physical medicine and rehabilitation, 2001Co-Authors: P Hunter Peckham, Kevin L Kilgore, Michael W Keith, Geoffrey B. Thrope, Julie Grill, Kathy S. Wuolle, Peter H. Gorman, John Hobby, M. J. Mulcahey, Sara CarrollAbstract:Abstract Peckham PH, Keith MW, Kilgore KL, Grill JH, Wuolle KS, Thrope GB, Gorman P, Hobby J, Mulcahey MJ, Carroll S, Hentz VR, Wiegner A, for the Implantable Neuroprosthesis Research Group. Efficacy of an implanted Neuroprosthesis for restoring hand grasp in tetraplegia: a multicenter study. Arch Phys Med Rehabil 2001;82:1380-8. Objective: To evaluate an implanted Neuroprosthesis that allows tetraplegic users to control grasp and release in 1 hand. Design: Multicenter cohort trial with at least 3 years of follow-up. Function for each participant was compared before and after implantation, and with and without the Neuroprosthesis activated. Setting: Tertiary spinal cord injury (SCI) care centers, 8 in the United States, 1 in the United Kingdom, and 1 in Australia. Participants: Fifty-one tetraplegic adults with C5 or C6 SCIs. Intervention: An implanted neuroprosthetic system, in which electric stimulation of the grasping muscles of 1 arm are controlled by using contralateral shoulder movements, and concurrent tendon transfer surgery. Assessed participants' ability to grasp, move, and release standardized objects; degree of assistance required to perform activities of daily living (ADLs), device usage; and user satisfaction. Main Outcome Measures: Pinch force; grasp and release tests; ADL abilities test and ADL assessment test; and user satisfaction survey. Results: Pinch force was significantly greater with the Neuroprosthesis in all available 50 participants, and grasp-release abilities were improved in 49. All tested participants (49/49) were more independent in performing ADLs with the Neuroprosthesis than they were without it. Home use of the device for regular function and exercise was reported by over 90% of the participants, and satisfaction with the Neuroprosthesis was high. Conclusions: The grasping ability provided by the Neuroprosthesis is substantial and lasting. The Neuroprosthesis is safe, well accepted by users, and offers improved independence for a population without comparable alternatives. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
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Satisfaction with and usage of a hand Neuroprosthesis.
Archives of physical medicine and rehabilitation, 1999Co-Authors: Kathryn Stroh Wuolle, Kevin L Kilgore, Anne M Bryden, Michael W Keith, P Hunter Peckham, Clayton L. Van Doren, Julie GrillAbstract:Abstract Objective: To measure the satisfaction with, clinical impact of, and use of an implantable hand Neuroprosthesis. Setting: Eight different medical centers. Participants: Thirty-four individuals with spinal cord injuries at the C5 or C6 motor level. Interventions: Participants were implemented with a hand Neuroprosthesis that provides grasp and release. The Neuroprosthesis includes a surgically implanted stimulator, implanted electrodes sutured to the hand and forearm muscles, and an externally mounted controller. Main Outcome Measure: A survey was mailed to study participants, who were asked to respond to statements such as “If I had it to do over, I would have the hand system implanted again,” using a 5-level Likert scale (“strongly agree” to “strongly disagree”). Results: Eighty-seven percent of participants were very satisfied with the Neuroprosthesis, 88% reported a positive impact on their life, 87% reported improvements in activities of daily living, and 81% reported improved independence. Participants reported using the Neuroprosthesis a median of 5.5 days per week; 15 participants used the Neuroprosthesis 7 days per week, and 5 participants reported not using the device. Conclusions: The Neuroprosthesis was used by most participants. The Neuroprosthesis performed satisfactorily, increased users' ability to perform activities of daily living and independence, and improved their quality of life.
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Patient selection for an upper extremity Neuroprosthesis in tetraplegic individuals
Spinal Cord, 1997Co-Authors: Peter H. Gorman, P Hunter Peckham, Kathy Stroh Wuolle, David HeydrickAbstract:One hundred and twenty persons with new onset traumatic tetraplegia consecutively admitted to our rehabilitation service were screened for consideration for use of an upper extremity Neuroprosthesis. Strict inclusion criteria allowed only for participation of patients with ASIA impairment scale A, B or C injuries at the C5 or C6 level. One hundred and six persons were excluded from participation for the following reasons: five patients died, 27 had central cord syndrome, two had Brown-Sequard syndrome, 12 were injured at too high a level, 42 were injured at too low a level, two were excluded on the basis of motor incompleteness alone, four were excessively denervated, two had limited range of motion, one had overriding medical complications, seven had psychosocial issues making participation impractical, and two elected tendon transfer surgery. In total, 14 patients (representing 11.7% of all tetraplegic individuals and 50% of the C5 or C6 ASIA Impairment Scale A, B or C patients) were found to be candidates for the Neuroprosthesis. Given the prevalence of tetraplegia, approximately 12,200 Americans would be candidates for the FES neuroprosthetic hand grasp system under the current research protocols. With both the expansion of current protocols to other diagnostic categories and further research and development, application of this Neuroprosthesis to a considerable number of previously excluded subjects will likely be possible.
Kevin L Kilgore - One of the best experts on this subject based on the ideXlab platform.
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Implanted Neuroprosthesis for Restoring Arm and Hand Function in People With High Level Tetraplegia
Archives of physical medicine and rehabilitation, 2014Co-Authors: William D. Memberg, Kevin L Kilgore, Ronald L Hart, Anne M Bryden, Michael W Keith, Harry A Hoyen, Katharine H. Polasek, Gregory Nemunaitis, Robert F KirschAbstract:Abstract Objective To develop and apply an implanted Neuroprosthesis to restore arm and hand function to individuals with high level tetraplegia. Design Case study. Setting Clinical research laboratory. Participants Individuals with spinal cord injuries (N=2) at or above the C4 motor level. Interventions The individuals were each implanted with 2 stimulators (24 stimulation channels and 4 myoelectric recording channels total). Stimulating electrodes were placed in the shoulder and arm, being, to our knowledge, the first long-term application of spiral nerve cuff electrodes to activate a human limb. Myoelectric recording electrodes were placed in the head and neck areas. Main Outcome Measures Successful installation and operation of the Neuroprosthesis and electrode performance, range of motion, grasp strength, joint moments, and performance in activities of daily living. Results The Neuroprosthesis system was successfully implanted in both individuals. Spiral nerve cuff electrodes were placed around upper extremity nerves and activated the intended muscles. In both individuals, the Neuroprosthesis has functioned properly for at least 2.5 years postimplant. Hand, wrist, forearm, elbow, and shoulder movements were achieved. A mobile arm support was needed to support the mass of the arm during functional activities. One individual was able to perform several activities of daily living with some limitations as a result of spasticity. The second individual was able to partially complete 2 activities of daily living. Conclusions Functional electrical stimulation is a feasible intervention for restoring arm and hand functions to individuals with high tetraplegia. Forces and movements were generated at the hand, wrist, elbow, and shoulder that allowed the performance of activities of daily living, with some limitations requiring the use of a mobile arm support to assist the stimulated shoulder forces.
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An implanted myoelectrically-controlled Neuroprosthesis for upper extremity function in spinal cord injury.
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and, 2006Co-Authors: Kevin L Kilgore, Ronald L Hart, Fred W Montague, Anne M Bryden, Michael W Keith, Harry A Hoyen, Carol J Sams, P Hunter PeckhamAbstract:A second generation implantable Neuroprosthesis has been developed which provides improved control of grasp-release, forearm pronation, and elbow extension for individuals with cervical level spinal cord injury. In addition to the capacity to stimulate twelve muscles, the key technological feature of the advanced system is the capability to transmit data out of the body. This allows the use of myoelectric signal recording via implanted electrodes, thus minimizing the required external components. Clinical studies have been initiated with a second generation Neuroprosthesis that consists of twelve stimulating electrodes, two myoelectric signal recording electrodes, an implanted stimulator-telemeter device and an external control unit and transmit/receive coil. This system has now been implemented in nine arms in seven C5/C6 spinal cord injured individuals. The results from these subjects demonstrate that myoelectric signals can be recorded from voluntary muscles in the presence of electrical stimulation of nearby muscles. The functional results show that the Neuroprosthesis provides significantly increased pinch force and grasp function for each subject. All subjects have demonstrated increased independence and improved function in activities of daily living. We believe that these results indicate that implanted myoelectric control is a desirable option for neuroprostheses.
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an advanced Neuroprosthesis for restoration of hand and upper arm control using an implantable controller
Journal of Hand Surgery (European Volume), 2002Co-Authors: Hunter P Peckham, Kevin L Kilgore, Anne M Bryden, Michael W Keith, Niloy Bhadra, Fred W MontagueAbstract:An advanced Neuroprosthesis that provides control of grasp-release, forearm pronation, and elbow extension to persons with cervical level spinal cord injury is described. The Neuroprosthesis includes implanted and external components. The implanted components are a 10-channel stimulator-telemeter, leads and electrodes, and a joint angle transducer; the external components are a control unit and transmitter-receiver coil. The system has completed preclinical testing and has been implanted fully in 3 persons and partially in 1 person, all with tetraplegia caused by spinal cord injury at C5 and C6. The minimum follow-up time for any system component is 16 months. All subjects had improvements in grasp strength, range of motion, and ability to grasp objects and increased independence in activities of daily living. Each subject became a regular user of the Neuroprosthesis and is satisfied with it. The implanted components have not caused any medical complications. The operation of the electrodes and sensors has been stable. The data show that this advanced neuroprosthetic system is safe and can provide grasping and reaching ability to individuals with cervical level spinal cord injury.
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Efficacy of an implanted Neuroprosthesis for restoring hand grasp in tetraplegia: a multicenter study.
Archives of physical medicine and rehabilitation, 2001Co-Authors: P Hunter Peckham, Kevin L Kilgore, Michael W Keith, Geoffrey B. Thrope, Julie Grill, Kathy S. Wuolle, Peter H. Gorman, John Hobby, M. J. Mulcahey, Sara CarrollAbstract:Abstract Peckham PH, Keith MW, Kilgore KL, Grill JH, Wuolle KS, Thrope GB, Gorman P, Hobby J, Mulcahey MJ, Carroll S, Hentz VR, Wiegner A, for the Implantable Neuroprosthesis Research Group. Efficacy of an implanted Neuroprosthesis for restoring hand grasp in tetraplegia: a multicenter study. Arch Phys Med Rehabil 2001;82:1380-8. Objective: To evaluate an implanted Neuroprosthesis that allows tetraplegic users to control grasp and release in 1 hand. Design: Multicenter cohort trial with at least 3 years of follow-up. Function for each participant was compared before and after implantation, and with and without the Neuroprosthesis activated. Setting: Tertiary spinal cord injury (SCI) care centers, 8 in the United States, 1 in the United Kingdom, and 1 in Australia. Participants: Fifty-one tetraplegic adults with C5 or C6 SCIs. Intervention: An implanted neuroprosthetic system, in which electric stimulation of the grasping muscles of 1 arm are controlled by using contralateral shoulder movements, and concurrent tendon transfer surgery. Assessed participants' ability to grasp, move, and release standardized objects; degree of assistance required to perform activities of daily living (ADLs), device usage; and user satisfaction. Main Outcome Measures: Pinch force; grasp and release tests; ADL abilities test and ADL assessment test; and user satisfaction survey. Results: Pinch force was significantly greater with the Neuroprosthesis in all available 50 participants, and grasp-release abilities were improved in 49. All tested participants (49/49) were more independent in performing ADLs with the Neuroprosthesis than they were without it. Home use of the device for regular function and exercise was reported by over 90% of the participants, and satisfaction with the Neuroprosthesis was high. Conclusions: The grasping ability provided by the Neuroprosthesis is substantial and lasting. The Neuroprosthesis is safe, well accepted by users, and offers improved independence for a population without comparable alternatives. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
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EEG-based control of a hand grasp Neuroprosthesis.
Neuroreport, 1999Co-Authors: Richard T. Lauer, P. H. Peckham, Kevin L KilgoreAbstract:The feasibility of using the EEG signal to operate a hand grasp Neuroprosthesis was investigated. Two able-bodied subjects and one Neuroprosthesis user were trained to control the amplitude of the beta rhythm recorded over the frontal areas. After 6 months, all subjects exhibited a high level of control, being able to use this signal to move a cursor to targets on a computer screen with a high (>90%) accuracy rate. Control over the EEG signal was unaffected by upper extremity movement or electrical activation of the muscles, indicating that this signal would be adequate for neuroprosthetic use. To test this concept, the Neuroprosthesis user operated his system with the cortical signal, and was able to effectively manipulate several objects.
Michael W Keith - One of the best experts on this subject based on the ideXlab platform.
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Implanted Neuroprosthesis for Restoring Arm and Hand Function in People With High Level Tetraplegia
Archives of physical medicine and rehabilitation, 2014Co-Authors: William D. Memberg, Kevin L Kilgore, Ronald L Hart, Anne M Bryden, Michael W Keith, Harry A Hoyen, Katharine H. Polasek, Gregory Nemunaitis, Robert F KirschAbstract:Abstract Objective To develop and apply an implanted Neuroprosthesis to restore arm and hand function to individuals with high level tetraplegia. Design Case study. Setting Clinical research laboratory. Participants Individuals with spinal cord injuries (N=2) at or above the C4 motor level. Interventions The individuals were each implanted with 2 stimulators (24 stimulation channels and 4 myoelectric recording channels total). Stimulating electrodes were placed in the shoulder and arm, being, to our knowledge, the first long-term application of spiral nerve cuff electrodes to activate a human limb. Myoelectric recording electrodes were placed in the head and neck areas. Main Outcome Measures Successful installation and operation of the Neuroprosthesis and electrode performance, range of motion, grasp strength, joint moments, and performance in activities of daily living. Results The Neuroprosthesis system was successfully implanted in both individuals. Spiral nerve cuff electrodes were placed around upper extremity nerves and activated the intended muscles. In both individuals, the Neuroprosthesis has functioned properly for at least 2.5 years postimplant. Hand, wrist, forearm, elbow, and shoulder movements were achieved. A mobile arm support was needed to support the mass of the arm during functional activities. One individual was able to perform several activities of daily living with some limitations as a result of spasticity. The second individual was able to partially complete 2 activities of daily living. Conclusions Functional electrical stimulation is a feasible intervention for restoring arm and hand functions to individuals with high tetraplegia. Forces and movements were generated at the hand, wrist, elbow, and shoulder that allowed the performance of activities of daily living, with some limitations requiring the use of a mobile arm support to assist the stimulated shoulder forces.
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An implanted myoelectrically-controlled Neuroprosthesis for upper extremity function in spinal cord injury.
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and, 2006Co-Authors: Kevin L Kilgore, Ronald L Hart, Fred W Montague, Anne M Bryden, Michael W Keith, Harry A Hoyen, Carol J Sams, P Hunter PeckhamAbstract:A second generation implantable Neuroprosthesis has been developed which provides improved control of grasp-release, forearm pronation, and elbow extension for individuals with cervical level spinal cord injury. In addition to the capacity to stimulate twelve muscles, the key technological feature of the advanced system is the capability to transmit data out of the body. This allows the use of myoelectric signal recording via implanted electrodes, thus minimizing the required external components. Clinical studies have been initiated with a second generation Neuroprosthesis that consists of twelve stimulating electrodes, two myoelectric signal recording electrodes, an implanted stimulator-telemeter device and an external control unit and transmit/receive coil. This system has now been implemented in nine arms in seven C5/C6 spinal cord injured individuals. The results from these subjects demonstrate that myoelectric signals can be recorded from voluntary muscles in the presence of electrical stimulation of nearby muscles. The functional results show that the Neuroprosthesis provides significantly increased pinch force and grasp function for each subject. All subjects have demonstrated increased independence and improved function in activities of daily living. We believe that these results indicate that implanted myoelectric control is a desirable option for neuroprostheses.
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an advanced Neuroprosthesis for restoration of hand and upper arm control using an implantable controller
Journal of Hand Surgery (European Volume), 2002Co-Authors: Hunter P Peckham, Kevin L Kilgore, Anne M Bryden, Michael W Keith, Niloy Bhadra, Fred W MontagueAbstract:An advanced Neuroprosthesis that provides control of grasp-release, forearm pronation, and elbow extension to persons with cervical level spinal cord injury is described. The Neuroprosthesis includes implanted and external components. The implanted components are a 10-channel stimulator-telemeter, leads and electrodes, and a joint angle transducer; the external components are a control unit and transmitter-receiver coil. The system has completed preclinical testing and has been implanted fully in 3 persons and partially in 1 person, all with tetraplegia caused by spinal cord injury at C5 and C6. The minimum follow-up time for any system component is 16 months. All subjects had improvements in grasp strength, range of motion, and ability to grasp objects and increased independence in activities of daily living. Each subject became a regular user of the Neuroprosthesis and is satisfied with it. The implanted components have not caused any medical complications. The operation of the electrodes and sensors has been stable. The data show that this advanced neuroprosthetic system is safe and can provide grasping and reaching ability to individuals with cervical level spinal cord injury.
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Efficacy of an implanted Neuroprosthesis for restoring hand grasp in tetraplegia: a multicenter study.
Archives of physical medicine and rehabilitation, 2001Co-Authors: P Hunter Peckham, Kevin L Kilgore, Michael W Keith, Geoffrey B. Thrope, Julie Grill, Kathy S. Wuolle, Peter H. Gorman, John Hobby, M. J. Mulcahey, Sara CarrollAbstract:Abstract Peckham PH, Keith MW, Kilgore KL, Grill JH, Wuolle KS, Thrope GB, Gorman P, Hobby J, Mulcahey MJ, Carroll S, Hentz VR, Wiegner A, for the Implantable Neuroprosthesis Research Group. Efficacy of an implanted Neuroprosthesis for restoring hand grasp in tetraplegia: a multicenter study. Arch Phys Med Rehabil 2001;82:1380-8. Objective: To evaluate an implanted Neuroprosthesis that allows tetraplegic users to control grasp and release in 1 hand. Design: Multicenter cohort trial with at least 3 years of follow-up. Function for each participant was compared before and after implantation, and with and without the Neuroprosthesis activated. Setting: Tertiary spinal cord injury (SCI) care centers, 8 in the United States, 1 in the United Kingdom, and 1 in Australia. Participants: Fifty-one tetraplegic adults with C5 or C6 SCIs. Intervention: An implanted neuroprosthetic system, in which electric stimulation of the grasping muscles of 1 arm are controlled by using contralateral shoulder movements, and concurrent tendon transfer surgery. Assessed participants' ability to grasp, move, and release standardized objects; degree of assistance required to perform activities of daily living (ADLs), device usage; and user satisfaction. Main Outcome Measures: Pinch force; grasp and release tests; ADL abilities test and ADL assessment test; and user satisfaction survey. Results: Pinch force was significantly greater with the Neuroprosthesis in all available 50 participants, and grasp-release abilities were improved in 49. All tested participants (49/49) were more independent in performing ADLs with the Neuroprosthesis than they were without it. Home use of the device for regular function and exercise was reported by over 90% of the participants, and satisfaction with the Neuroprosthesis was high. Conclusions: The grasping ability provided by the Neuroprosthesis is substantial and lasting. The Neuroprosthesis is safe, well accepted by users, and offers improved independence for a population without comparable alternatives. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
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Satisfaction with and usage of a hand Neuroprosthesis.
Archives of physical medicine and rehabilitation, 1999Co-Authors: Kathryn Stroh Wuolle, Kevin L Kilgore, Anne M Bryden, Michael W Keith, P Hunter Peckham, Clayton L. Van Doren, Julie GrillAbstract:Abstract Objective: To measure the satisfaction with, clinical impact of, and use of an implantable hand Neuroprosthesis. Setting: Eight different medical centers. Participants: Thirty-four individuals with spinal cord injuries at the C5 or C6 motor level. Interventions: Participants were implemented with a hand Neuroprosthesis that provides grasp and release. The Neuroprosthesis includes a surgically implanted stimulator, implanted electrodes sutured to the hand and forearm muscles, and an externally mounted controller. Main Outcome Measure: A survey was mailed to study participants, who were asked to respond to statements such as “If I had it to do over, I would have the hand system implanted again,” using a 5-level Likert scale (“strongly agree” to “strongly disagree”). Results: Eighty-seven percent of participants were very satisfied with the Neuroprosthesis, 88% reported a positive impact on their life, 87% reported improvements in activities of daily living, and 81% reported improved independence. Participants reported using the Neuroprosthesis a median of 5.5 days per week; 15 participants used the Neuroprosthesis 7 days per week, and 5 participants reported not using the device. Conclusions: The Neuroprosthesis was used by most participants. The Neuroprosthesis performed satisfactorily, increased users' ability to perform activities of daily living and independence, and improved their quality of life.