Novel rehabilitation paradigm for restoration of hand functions after tetraplegia

Neural Regeneration Research, 2016 · DOI: 10.4103/1673-5374.187025 · Published: July 1, 2016

Spinal Cord Injury Neurology Neurorehabilitation

Simple Explanation

This letter discusses a case report where researchers bypassed a spinal cord injury to stimulate forearm muscles, enabling a person with tetraplegia to perform hand movements and daily tasks. This was achieved by implanting micro-recording electrode arrays in the motor cortex, processing the electrical signals, and sending them to a neuromuscular stimulator sleeve. The participant trained 3 times weekly for 15 months and showed improvement, demonstrating the potential of neuromuscular electrical stimulation to improve motor impairment. The system allowed the patient to carry out specific tasks similar to holding a bottle, pouring, and stirring. The neural bypass system may promote neuroplasticity by strengthening spared axons at the injury level. The patient was still experiencing the general motor/sensory characteristics of a person with C5–6 SCI; after month 8, his motor skills improved and presented as C8T1 SCI.

Study Duration

15 months

Participants

One 24-year-old male with tetraplegia (C5–6)

Evidence Level

Case report

Key Findings

1
The participant was able to perform six hand movements and daily functional tasks using neuromuscular electrical stimulation after the spinal cord injury was bypassed.
2
The participant demonstrated improvement in motor impairment, moving from C5–6 to C7–T1 following 15 months of training.
3
After 8 months of implantation, the patient's motor skills improved, suggesting the need for long-term rehabilitation.

Research Summary

The letter discusses a case report where a neural bypass system was used to restore hand functions in a person with tetraplegia. Micro-recording electrode arrays were implanted in the motor cortex to capture electrical signals, which were then processed and sent to a neuromuscular stimulator sleeve. The participant showed improvement in motor skills after 15 months of training, highlighting the potential of long-term rehabilitation approaches. The approach allows the patient to carry out specific tasks similar to holding a bottle, pouring, and stirring. The findings suggest a shift towards long-term interdisciplinary approaches for restoring motor function following chronic SCI, but the trial is specific to one patient, and broader application requires refinement.

Practical Implications

Rehabilitation strategies

Emphasizes the potential for long-term, intensive rehabilitation approaches for individuals with chronic SCI.

Neuroplasticity Promotion

Suggests that neural bypass systems can promote neuroplasticity, strengthening spared axons at the level of the injury.

Technology Advancement

Highlights the need for developing less invasive and more adaptable technologies, such as external EEG micro-electrode arrays and portable wireless units.

Study Limitations

1
The trial is specific to one patient, limiting general applicability.
2
The need for invasive brain surgery to place intracranial recording electrodes.
3
The high resolution surface NMES with 130 electrodes for 3–4 hours per visit may limit the general application of the current trial.

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