DEMAR team, LIRMM, Inria, University of Montpellier, 161 Rue Ada, 34095 Montpellier Cedex 5, France.
J Neuroeng Rehabil. 2014 Feb 24;11:15. doi: 10.1186/1743-0003-11-15.
Experience of an implanted functional electrical stimulation neuroprosthesis (FES) associating 8-channel epimysial and 4-channel neural stimulations. The primary objective consisted in presenting clinical and technological experiences based on a 9-year follow-up of one patient implanted with this FES device. The secondary objective consisted in assessing resulting functional benefits.
One patient recruited in 1996 within the European Stand Up and Walk Project benefited from a 9-year follow-up with clinical and technological evaluations.
The patient was still using the system nine years later making this a unique case, even when compared to other similar studies. The analysis of muscular response to FES underlined the great variability of stimulation thresholds evolution (-26% to +360%, mean +110%) and quality of the induced contraction. Three muscles out of five scored at least 4/5 on the Medical Research Council scale, all stimulated via neural pathways. The patient used the system once a week for 6 years, up to 2006, due to lack of use, the FES-induced muscular response worsened even though the implant was properly functioning, leading to significant decline in gait performances (best 3.45 m/s on 2.9 m), due to muscle fatigue and loss of muscle mass.
Two major issues arise: first the importance of muscle fatigue, underlining the relevance of muscle strength training, and second technological hurdles raising up the question of neural vs. epimysial FES. This advanced technology proves the concept of restoring lower limb motor functions in patients with spinal cord injury. The main features of the stimulation device remain stable even after long periods of inactivity, yet there is a real need for close clinical and technological monitoring.
带有 8 通道肌内和 4 通道神经刺激的植入式功能性电刺激神经假体（FES）的使用经验。主要目的是基于一名患者接受该 FES 设备 9 年的随访，介绍临床和技术经验。次要目的是评估由此产生的功能益处。
1996 年，欧洲站立和行走项目中招募的一名患者接受了 9 年的临床和技术评估随访。
9 年后，患者仍在使用该系统，这是一个独特的案例，即使与其他类似研究相比也是如此。对 FES 肌肉反应的分析强调了刺激阈值变化的极大可变性（-26%至+360%，平均+110%）和诱发收缩的质量。五个肌肉中有三个肌肉的医学研究委员会评分至少为 4/5，全部通过神经通路进行刺激。由于缺乏使用，患者在 2006 年之前每周使用该系统一次，持续了 6 年，导致 FES 诱导的肌肉反应恶化，尽管植入物正常工作，但由于肌肉疲劳和肌肉质量损失，步态表现显著下降（最佳 3.45m/s 时为 2.9m）。
出现了两个主要问题：首先是肌肉疲劳的重要性，强调了肌肉力量训练的相关性，其次是技术障碍，引发了神经与肌内 FES 的问题。这项先进技术证明了在脊髓损伤患者中恢复下肢运动功能的概念。即使在长时间不活动后，刺激设备的主要功能仍然稳定，但确实需要密切的临床和技术监测。
