This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The purpose of this study is to evaluate the performance of an implantable stimulation system designed to provide activation and control of the paralyzed upper extremity in patients with a high level cervical spinal cord injury (C1-C6). This research is an extension of our existing studies to restore hand function in such patients. The existing studies focus on restoring upper extremity function in individuals with C5/6 level injuries or utilize percutaneous electrodes in individuals with C1-C4 level injuries. This study will focus on providing an implantable stimulation system for individuals with high level spinal cord injuries by incorporating nerve cuff electrodes and dual stimulator into the current system in a two-stage process. The technique of restoring functional movement via application of small electrical currents is known as Functional Electrical Stimulation (FES) or Functional Neuromuscular Stimulation (FNS). The FES system to be employed in this study is designed to provide hand grasp/release, forearm pronation/ supination, wrist extension/flexion, elbow flexion/extension, and shoulder rotation. The significance of this work is that FES may provide tetraplegic subjects with manipulative capabilities unavailable by alternative means. Subjects participating in this study will be individuals with high level (C1-C6) tetraplegia. Two 12- channel implantable stimulation systems will be surgically placed in one upper extremity of participating subjects. Nerve cuff electrodes will be used in addition to the standard epimysial and intramuscular electrodes. The four-contact nerve cuff electrodes will initially have a percutaneous connection to an external stimulator. Evaluations will determine whether individual muscles can be activated selectively and maximally using different contacts within each implanted cuff electrode. After they have been evaluated, the patient will have the nerve cuff electrodes connected to an implanted stimulator.
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