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Implanted neuroprosthesis for assisting arm and hand function after stroke: A case study

Implanted neuroprosthesis for assisting arm and hand function after stroke: A case study.

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Implanted neuroprosthesis for assisting arm and hand function after stroke: A case study

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  1. Implanted neuroprosthesis for assisting arm and hand function after stroke: A case study Jayme S. Knutson, PhD; John Chae, MD; Ronald L. Hart, MS; Michael W. Keith, MD; Harry A. Hoyen, MD; Mary Y. Harley, OTR/L; Terri Z. Hisel, OTR/L; Anne M. Bryden, OTR/L; Kevin L. Kilgore, PhD; Hunter Peckham, PhD

  2. Aim • Describe 1st individual with poststroke hemiplegia to receive implanted neuroprosthesis (NP) for assisting arm and hand function. • Evaluate feasibility of NP as assistive device for poststroke upper-limb function. • Relevance • Such an NP may be viable solution for stroke patients who do not regain arm and hand function with other rehabilitation techniques.

  3. Methods • Participant: • 57 yr old female • 5 yr poststroke with left-side hemiparesis. • NP: • Implantable stimulator-telemeter. • 12 intramuscular stimulating electrodes. • 2 epimysial electro-myogram (EMG)-recording electrodes. • External control unit. • Outcome Assessments: • 41-item NP Satisfaction and Usage Questionnaire. • Modified Ashworth scale. • Upper-limb Fugl-Meyer Assessment (FMA). • Active range of motion at shoulder, elbow, wrist, finger. • Lateral and palmar pinch force. • Grasp-Release Test (GRT). • Arm Motor Abilities Test (AMAT).

  4. Results • EMG control strategy failed to provide easy-to-use NP control for participant. • At 10 mo visit, replaced with push-button control. • NP increased: • Active range of finger extension. • Lateral pinch force. • Number of objects in GRT. • AMAT score. • FMA score. • Participant used NP at home 3–4 d/wk, up to 3 h/d for exercise, household tasks.

  5. Results • Questionnaire • Participant said: • She would have NP implanted again if given chance. • She benefited from NP. • She felt more confident performing activities with NP. • She could do some tasks faster with NP. • NP positively affected her life. • She disagreed that NP positively affected actual homemaking or home maintenance. • She was neutral as to whether NP improved quality of life.

  6. Conclusion • NP enabled participant to perform some bimanual tasks in laboratory and at home. • Even without NP, overall upper-limb motor impairment improved (FMA score). • May be carry-over effect of NP usage. • Flexor spasticity reduced NP effectiveness. • This study clarified obstacles that remain and represents landmark step toward development of advanced enabling technology.

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