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Functional Electrical Stimulation for Hand Function in Quadriplegia

Functional Electrical Stimulation-assisted Hand Exercise for People with Chronic Quadriplegia

Chief Investigator: Associate Professor Mary Galea
Associate Investigator: Associate Professor Douglas Brown
Lead Organisation: The University of Melbourne
VNI Funding: $452,177
Project Start Date: 02-Jan-08

Project Summary:
The loss of hand function is one of the most devastating consequences of spinal cord injury, as it can lead to severe impact on a person’s independence in activities of daily living (ADL). Just over half of the new admissions to the Victorian Spinal Cord Service are caused by neck injuries. ,The most common levels of injury are those affecting the upper or cervical spinal cord at C5-6. People with this level of injury, whilst able to move their arms and forearms, have little or no voluntary use of their hands. People that are able to extend their wrist can use a passive or tenodesis grip that is only strong enough to lift very light objects. Partial restoration of function can be achieved using implantable neuroprostheses. However, only a small proportion of these people are eligible for this intervention. Functional electrical stimulation (FES) with surface stimulators can be used as an alternative method for exercising the paralysed hand muscles and helping to restore neural control. There is some evidence that the application of surface FES to assist grasping and release movements in quadriplegic people results in improvements in grasp strength and in ADL.

The FES technology has now been refined through development of a muscle-stimulator garment. This garment uses a wireless-triggered stimulator cuff that is worn on the forearm. The opening and closing of the hand, for grasp and release of objects, is controlled by tooth clicks. Participants will have task-specific practice of hand activities using a newly-developed, instrumented workstation in their homes. These activities will be supervised by a therapist via the internet. In this controlled, double-blind study we will test the hypothesis that 6 weeks of daily FES-assisted exercise therapy will produce clinically significant improvements in hand function and that this will be associated with measurable neurophysiological changes. This study will test a new concept in rehabilitation of hand function for people with quadriplegia. The use of innovative, state-of the art technology and remote monitoring of participant performance, will improve access to rehabilitation services for people who currently have no such access. This is of great significance for countries such as Australia, where the population is scattered over large distances. This study will have two important outcomes. Firstly, we will determine the effectiveness of a non-invasive therapy that is likely to lead to ’real’ improvements in hand function. This will lead to improved independence for people with quadriplegia. Secondly, we will use new assessment tools developed by the International Spinal Research Trust (ISRT) designed to detect changes in physiological parameters indicating recovery from SCI.