Thorsen Rune, Dalla Costa Davide, Beghi Ettore, Ferrarin Maurizio
Biomedical Technology Department, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
Neurorehabilitation Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Front Neurosci. 2020 May 5;14:412. doi: 10.3389/fnins.2020.00412. eCollection 2020.
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.
四肢瘫痪患者通常握力不足，导致日常生活活动受损。对他们来说，改善手部功能是首要任务，因为这对自主生活和参与日常生活很重要。肌腱转移手术可能是改善肌腱固定性抓握的一种选择，但这是一种侵入性手术。或者，使用非侵入性方法也可以产生类似效果。我们之前描述过，使用与表面电极有线连接的单通道研究原型，肌电控制功能性电刺激（MeCFES）如何能有效增强握力。在本文中，我们关注其在日常生活活动中的可用性以及它如何满足实际需求。我们招募了27名患有颈脊髓损伤（C5 - C7）的参与者进行该试验。他们在12次每次2小时的 sessions 中测试该设备，参与者在这些 sessions 中进行涉及肌腱固定性抓握的自选活动。以用户为中心的结果是经过验证的问卷：个体优先问题评估（IPPA）和魁北克辅助技术用户满意度评估（QUEST）。此外，他们被问及是否认为该设备对日常生活中的持续使用有用。该设备为所有参与者的优先活动提供了便利。IPPA变化得分平均为4.6（标准差：3.5，效应大小：1.3），这意味着该系统极大地便利了有问题的任务，并且大效应大小表明这是手部功能的有意义改善。这可与轮椅等移动设备对日常生活的影响相比较。14名受试者认为该系统有用，并表示需要这样一种神经假体。使用该设备时获得新能力的例子表明，该方法也可能具有治疗用途。此外，IPPA问卷的结果表明了四肢瘫痪患者可能希望通过手部神经假体解决的问题。对该设备的满意度（QUEST）表明，在开发方面应进一步努力解决可穿戴性问题、消除电线并改进适配程序。
