Abstract
People with tetraplegia are often lacking grip strength, causing impairment in activities of daily living. For them, improving hand function is a priority because it is important for autonomy and participation in daily life. A tendon transfer surgery may be an option to improve the tenodesis grip, but it is an invasive procedure. Alternatively a similar effect can be produced, using a non-invasive method. We have previously described how myoelectrically controlled functional electrical stimulation (MeCFES) can be efficient for enhancing grip strength, using a one channel research prototype with wired connections to surface electrodes. In this paper we focus on the usability for activities of daily living and how it can fulfill an actual need. We recruited 27 participants with a cervical spinal cord lesion (C5-C7) for this trial. They tested the device in 12 sessions of 2 h each, in which the participants performed self selected activities involving the tenodesis grip. User centered outcomes were validated questionnaires: the Individually Prioritized Problem Assessment (IPPA) and the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST). Furthermore, they were asked if they found the device useful for continued use in daily life. The device facilitated prioritized activities for all participants. The IPPA change score was 4.6 on average (STD:3.5, effect size:1.3), meaning that the system greatly facilitated problematic tasks and the large effect size evinces that this was a meaningful improvement of hand function. It compares to the impact that a mobility device like a wheelchair has on daily living. Fourteen subjects found the system useful, expressing the need for such a neuroprosthesis. Examples of acquiring new abilities while using the device, indicate that the method could have a therapeutic use as well. Furthermore, results from the IPPA questionnaire are indicating what issues people with tetraplegia may hope to solve with a neuroprosthesis for the hand. The satisfaction of the device (QUEST) indicates that further effort in development should address wearability, eliminate wires, and improve the fitting procedure.
Highlights
Cervical spinal cord lesion results in paralysis of most of the body, including the arms and legs, and is called tetraplegia
We have shown that myoelectrically controlled functional electrical stimulation (MeCFES) assisted tenodesis grip can provide functional benefits and possibly sustained improvement of the hand function (Thorsen et al, 2013)
We have demonstrated that a device for myoelectrically controlled functional electrical stimulation can be an efficient assistive device for activities of daily living
Summary
Cervical spinal cord lesion results in paralysis of most of the body, including the arms and legs, and is called tetraplegia. The clinical records should contain the last intact neurological level and the AIS classification (i.e. completeness) of lesion (American Spinal Injury Association, 1992). This is a key to understanding what residual functions may be spared by the lesion. The prevailing level of lesions are C6, C5, and C7 which will, depending on the severity of lesion, impair the hand function to some extent (Winslow and Rozovsky, 2003; Snoek et al, 2004; Thorsen et al, 2014). The ability to perform activities of daily living (ADL) is severely impaired and regaining hand function has a high priority (Snoek et al, 2004; Anderson, 2004)
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