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 identify stroke patients who may benefit from an implantable neuroprosthesis that restores arm and hand motion by electrically stimulating paralyzed muscles. The following characteristics must be true of individuals with post-stroke upper extremity hemiparesis for them to be eligible for the existing neuroprosthesis: 1) Surface stimulation restores full active range of motion (AROM) in upper extremity joints with limited voluntary AROM; 2) If muscle hypertonia that causes AROM limitations exists, it can be reduced with medical or surgical treatments to the extent that surface stimulation restores full AROM; 3) The potential candidate can accurately and reliably modulate a command signal using a myoelectric control strategy and/or external joint angle transducers and switches; 4) Surface stimulation remains effective in restoring full AROM when the stimulation is modulated by the subject. Subjects who exhibit these characteristics will be further evaluated to determine which muscles to implant with stimulating and recording electrodes, and what, if any, augmentative surgical procedures are needed. Subjects who then desire to proceed to neuroprosthesis implementation will be prescribed muscle strengthening exercises to do at home with a surface stimulator and will be enrolled in a separate research protocol covering the surgery and post-operative evaluations. Subjects enrolled in this study will have upper extremity hemiparesis due to stroke, with resulting functional deficits of the arm and hand. They may or may not have hypertonic upper extremity muscles. Range of motion and standard stroke impairment assessments, along with surface electrical stimulation of key upper extremity muscles will be used to determine whether treatment of muscle hypertonia is required before further screening evaluations are performed. Three standard hypertonia-reducing options will be available as part of this study: oral medications, neurolysis, and intrathecal baclofen.
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