Rehabilitation Professionals' Perspectives on Human Rights, Disability, and Science: A Qualitative Study.

Objective: To investigate the attitudes and knowledge of rehabilitation professionals concerning human rights within the context of disability, science, and technology access.

Design: A qualitative study using in-depth semi-structured interviews.

Setting: A large, urban, academically-affiliated rehabilitation research center.

Seeking sufficient and appropriate care during the first year after spinal cord injury: a qualitative study.

Study Design: Longitudinal qualitative study, based on a constructivist grounded theory and transformative approach.

Objectives: This study investigated experiences of individuals with spinal cord injury (SCI) while navigating rehabilitation, resources for recovery, and community reintegration during the first year after injury.

Setting: An acute inpatient rehabilitation facility in the Midwest United States.

Clinical Outcomes of "Paralyzed" Nerve Transfer for Treating Spinal Cord Injury: A Proof of Concept in a Human Model.

Functional electrical stimulation (FES) is an option to restore function in individuals after high cervical spinal cord injury (SCI) who have limited available options for tendon or nerve transfer. To be considered for FES implantation, patients must possess upper motor neuron (UMN) type denervation in potential recipient muscles, which can be confirmed by response to surface electrical stimulation during clinical evaluation. Lower motor neuron (LMN) denervated muscles will not respond to electrical stimulation and, therefore, are unavailable for use in an FES system.

Definitions of recovery and reintegration across the first year: A qualitative study of perspectives of persons with spinal cord injury and caregivers.

Study Design: Longitudinal, qualitative cohort study.

Objectives: To understand how people with newly acquired spinal cord injury (PWS) and their support person (SP) define recovery and successful community reintegration (CR) across the first 12 months post-injury (mpi) and their satisfaction with the rate of recovery and reintegration experienced.

Setting: Academic and Veterans hospitals in Midwest USA.

Risk-benefit value of upper extremity function by an implanted electrical stimulation device targeting chronic cervical spinal cord injury.

Study Design: A cross-sectional stated-preference survey using direct-assessment questions.

Objective: To determine the relative value placed on different outcomes to be used in a pivotal trial for the upper extremity configuration of the Networked Neuroprosthesis (NNP) as well as the tolerance of the expected adverse event profile.

Setting: Academic medical center in the United States.

Neuromodulation for Functional Electrical Stimulation.

This article describes the application of neuromodulation in different ways to motor recovery, to replace lost function, or to improve function of organ systems for those who have experienced spinal cord injury or stroke. Multiple devices have been developed and are currently available for use whereas others are still in the experimental stage. Multiple uses of neuromodulation are described.

Voluntary activation of biceps-to-triceps and deltoid-to-triceps transfers in quadriplegia.

The biceps or the posterior deltoid can be transferred to improve elbow extension function for many individuals with C5 or C6 quadriplegia. Maximum strength after elbow reconstruction is variable; the patient's ability to voluntarily activate the transferred muscle to extend the elbow may contribute to the variability. We compared voluntary activation during maximum isometric elbow extension following biceps transfer (n = 5) and deltoid transfer (n = 6) in three functional postures.

Posture-Dependent Corticomotor Excitability Differs Between the Transferred Biceps in Individuals With Tetraplegia and the Biceps of Nonimpaired Individuals.

Background: Following biceps transfer to enable elbow extension in individuals with tetraplegia, motor re-education may be facilitated by greater corticomotor excitability. Arm posture modulates corticomotor excitability of the nonimpaired biceps. If arm posture also modulates excitability of the transferred biceps, posture may aid in motor re-education.

Upper Extremity Assessment in Tetraplegia: The Importance of Differentiating Between Upper and Lower Motor Neuron Paralysis.

Scientific advances are increasing the options for improved upper limb function in people with cervical level spinal cord injury (SCI). Some of these interventions rely on identifying an aspect of paralysis that is not uniformly assessed in SCI: the integrity of the lower motor neuron (LMN). SCI can damage both the upper motor neuron and LMN causing muscle paralysis.

Posture-dependent changes in corticomotor excitability of the biceps after spinal cord injury and tendon transfer.

Following tendon transfer of the biceps to triceps after cervical spinal cord injuries (SCI), individuals must learn to activate the transferred biceps muscle to extend the elbow. Corticomotor excitability of the transferred biceps may play a role in post-operative elbow extension strength. In this study, we evaluated whether corticomotor excitability of the transferred biceps is related to an individuals' ability to extend the elbow, and whether posture and muscle length affects corticomotor excitability after SCI and tendon transfer similarly to the nonimpaired biceps.

Implanted neuroprosthesis for restoring arm and hand function in people with high level tetraplegia.

Objective: To develop and apply an implanted neuroprosthesis to restore arm and hand function to individuals with high level tetraplegia.

Design: Case study.

Setting: Clinical research laboratory.

Implanted neuroprosthesis for assisting arm and hand function after stroke: a case study.

Loss of arm and hand function is common after stroke. An implantable, 12-channel, electromyogram (EMG)-controlled functional electrical stimulation neuroprosthesis (NP) may be a viable assistive device for upper-limb hemiplegia. In this study, a research participant 4.

Technology for spinal cord injury rehabilitation and its application to youth.

Spinal cord injury (SCI) often results in a sudden, devastating loss of function. SCI is particularly challenging for the pediatric and adolescent populations who, under normal circumstances, are still achieving developmental milestones, but following SCI face additional barriers posed by paralysis and the accompanying secondary complications. Advancing technology in rehabilitation is changing the course of how people with spinal cord injury participate in rehabilitation.

Standard task set for evaluating rehabilitation interventions for individuals with arm paralysis.

We have developed a set of upper-limb functional tasks to guide the design and test the performance of rehabilitation technologies that restore arm motion in people with high tetraplegia. Our goal was to develop a short set of tasks that would be representative of a much larger set of activities of daily living (ADLs), while also being feasible for a user of a unilateral, implanted functional electrical stimulation (FES) system. To compile this list of tasks, we reviewed existing clinical outcome measures related to arm and hand function and were further informed by surveys of patient desires.

Surgical restoration of arm and hand function in people with tetraplegia.

Improved hand and arm function is the most sought after function for people living with a cervical spinal cord injury (SCI). Surgical techniques have been established to increase upper extremity function for tetraplegics, focusing on restoring elbow extension, wrist movement, and hand opening and closing. Additionally, more innovative treatments that have been developed (implanted neuroprostheses and nerve transfers) provide more options for improving function and quality of life.

Measurement issues related to upper limb interventions in persons who have tetraplegia.

Measurement of upper limb function in persons with tetraplegia poses significant issues for clinicians and researchers. It is crucial that measures detect the small but significant improvements in hand function that may or may not occur as a result of our interventions. Before determining how we measure changes from upper limb interventions, we must establish what outcomes are of greatest interest, and for whom.

An implanted upper-extremity neuroprosthesis using myoelectric control.

Purpose: The purpose of this study was to evaluate the potential of a second-generation implantable neuroprosthesis that provides improved control of hand grasp and elbow extension for individuals with cervical level spinal cord injury. The key feature of this system is that users control their stimulated function through electromyographic (EMG) signals.

Methods: The second-generation neuroprosthesis consists of 12 stimulating electrodes, 2 EMG signal recording electrodes, an implanted stimulator-telemeter device, an external control unit, and a transmit/receive coil.

An implanted myoelectrically-controlled neuroprosthesis for upper extremity function in spinal cord injury.

A second generation implantable neuroprosthesis has been developed which provides improved control of grasp-release, forearm pronation, and elbow extension for individuals with cervical level spinal cord injury. In addition to the capacity to stimulate twelve muscles, the key technological feature of the advanced system is the capability to transmit data out of the body. This allows the use of myoelectric signal recording via implanted electrodes, thus minimizing the required external components.

Triceps denervation as a predictor of elbow flexion contractures in C5 and C6 tetraplegia.

Objective: To determine whether the existence of elbow flexion contractures in persons with C5 or C6 tetraplegia is related to a lack of residual voluntary triceps function and triceps denervation (ie, lower motoneuron damage).

Design: A retrospective study of impairment data from 74 arms to identify the incidence of elbow flexion contractures and the contributing factors toward this deformity.

Setting: Five spinal cord injury (SCI) rehabilitation centers in the United States, 1 in England, and 1 in Australia.

Durability of implanted electrodes and leads in an upper-limb neuroprosthesis.

Implanted neuroprosthetic systems have been successfully used to provide upper-limb function for over 16 years. A critical aspect of these implanted systems is the safety, stability, and-reliability of the stimulating electrodes and leads. These components are (1) the stimulating electrode itself, (2) the electrode lead, and (3) the lead-to-device connector.

Satisfaction with upper-extremity surgery in individuals with tetraplegia.

Objective: To measure the satisfaction of individuals with tetraplegia with their upper-extremity reconstructive surgery.

Design: Survey.

Setting: Two Spinal Cord Injury Model Systems centers.

The influence of elbow position on the range of motion of the wrist following transfer of the brachioradialis to the extensor carpi radialis brevis tendon.

Background: In patients who have an injury of the cervical spinal cord, the brachioradialis tendon may be transferred to the extensor carpi radialis brevis tendon to restore voluntary wrist extension. We hypothesized that the active range of motion of the wrist depends on the position of the elbow after this transfer because the brachioradialis changes length substantially during elbow flexion, which implies the maximum force that the muscle can produce varies with elbow position. The objectives of this study were to determine whether the position of the elbow influences the range of motion of the wrist following transfer of the brachioradialis to the extensor carpi radialis brevis tendon and to evaluate the effect of surgical tensioning.

An advanced neuroprosthesis for restoration of hand and upper arm control using an implantable controller.

An advanced neuroprosthesis that provides control of grasp-release, forearm pronation, and elbow extension to persons with cervical level spinal cord injury is described. The neuroprosthesis includes implanted and external components. The implanted components are a 10-channel stimulator-telemeter, leads and electrodes, and a joint angle transducer; the external components are a control unit and transmitter-receiver coil.