INRIA, University of Montpellier, CNRS, Montpellier, France.
MXM group, Sophia-Antipolis, France.
J Neuroeng Rehabil. 2020 May 19;17(1):66. doi: 10.1186/s12984-020-00676-4.
We hypothesized that a selective neural electrical stimulation of radial and median nerves enables the activation of functional movements in the paralyzed hand of individuals with tetraplegia. Compared to previous approaches for which up to 12 muscles were targeted through individual muscular stimulations, we focused on minimizing the number of implanted electrodes however providing almost all the needed and useful hand movements for subjects with complete tetraplegia.
We performed acute experiments during scheduled surgeries of the upper limb with eligible subjects. We scanned a set of multicontact neural stimulation cuff electrode configurations, pre-computed through modeling simulations. We reported the obtained isolated and functional movements that were considered useful for the subject (different grasping movements).
In eight subjects, we demonstrated that selective stimulation based on multicontact cuff electrodes and optimized current spreading over the active contacts provided isolated, compound, functional and strong movements; most importantly 3 out of 4 had isolated fingers or thumb flexion, one patient performed a Key Grip, another one the Power and Hook Grips, and the 2 last all the 3 Grips. Several configurations were needed to target different areas within the nerve to obtain all the envisioned movements. We further confirmed that the upper limb nerves have muscle specific fascicles, which makes it possible to activate isolated movements.
The future goal is to provide patients with functional restoration of object grasping and releasing with a minimally invasive solution: only two cuff electrodes above the elbow. Ethics Committee / ANSM clearance prior to the beginning of the study (inclusion period 2016-2018): CPP Sud Méditerranée, #ID-RCB:2014-A01752-45, first acceptance 10th of February 2015, amended 12th of January 2016.
(www.clinicaltrials.gov): #NCT03721861, Retrospectively registered on 26th of October 2018.
我们假设，选择性地对桡神经和正中神经进行电刺激，能够使四肢瘫痪患者瘫痪的手部产生功能性运动。与之前通过单个肌肉刺激来靶向多达 12 块肌肉的方法相比，我们专注于尽量减少植入电极的数量，然而，为完全性四肢瘫痪的患者提供了几乎所有需要和有用的手部运动。
我们在符合条件的上肢上肢手术期间进行了急性实验。我们扫描了一组多接触神经刺激袖带电极配置，通过建模模拟预先计算。我们报告了获得的孤立和功能性运动，这些运动被认为对患者有用（不同的抓握运动）。
在 8 名患者中，我们证明了基于多接触袖带电极的选择性刺激和优化的电流在活动触点上的扩散可以提供孤立、复合、功能性和有力的运动；最重要的是，4 个患者中有 3 个可以单独弯曲手指或拇指，一个患者可以执行 Key Grip，另一个患者可以执行 Power 和 Hook Grip，而最后 2 个患者可以执行所有 3 种 Grip。需要几种配置来靶向神经内的不同区域，以获得所有预期的运动。我们进一步证实，上肢神经具有肌肉特异性束，这使得激活孤立运动成为可能。
未来的目标是为患者提供通过微创解决方案实现物体抓握和释放的功能恢复：仅在上臂肘上方使用两个袖带电极。研究开始前的伦理委员会/ANSM 批准（纳入期 2016-2018 年）：CPPSud Méditerranée，#ID-RCB：2014-A01752-45，首次接受日期为 2015 年 2 月 10 日，2016 年 1 月 12 日修订。
（www.clinicaltrials.gov）：#NCT03721861，于 2018 年 10 月 26 日回溯性注册。
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