Triolo R J, Betz R R, Mulcahey M J, Gardner E R
Department of Orthopaedic Surgery and Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio.
Paraplegia. 1994 Dec;32(12):824-43. doi: 10.1038/sc.1994.130.
This paper summarizes the results of screening for participation in research programs involving functional neuromuscular stimulation (FNS). It examines the characteristics of a group of children and teenagers with spinal cord injuries (SCI) identified as potential candidates for FNS as defined by the rigorous inclusion criteria of the research studies. One hundred and thirteen children and teenagers under the age of 20 with cervical, thoracic or lumbar level spinal cord injuries were examined for inclusion in an experimental program of FNS to provide standing, walking, or prehension. Although biased towards adolescents with complete midthoracic and midcervical injuries, the age, sex, injury level, etiology, and neurological status of the sample coincided with previously published reports and consisted predominantly of teenage males injured in motor vehicle or sports related accidents. Approximately half of the individuals examined were physically appropriate for research participation without preparatory intervention. Treatment options to prepare individuals for FNS were identified in 25% of those considered inappropriate at the initial evaluation, indicating that the potential user population of clinical systems may be larger than estimates obtained from research applications. Peripheral denervation was the single most prevalent physical impediment to the application of FNS. Although the incidence of lower motor neuron (LMN) involvement was similar in subjects with tetraplegia and paraplegia, those with cervical lesions more frequently exhibited other medical complications that interfered with the application of FNS. Surgical procedures involving transfer of paralyzed but excitable muscles were identified in almost one third of the candidates with tetraplegia who were excluded due to denervation. Of those physically appropriate, psychological factors eliminated several candidates from consideration. Such concerns may also be addressed with suitable intervention in preparation for the clinical application of FNS. Almost 50% of those appropriate for FNS research elected to participate in the programs, with those declining citing the hospitalization, time and travel commitments as the primary factors influencing their decisions. Results suggest that FNS for standing, walking and hand grasp may be an option for a significant percentage of the pediatric SCI population.
本文总结了参与涉及功能性神经肌肉刺激（FNS）研究项目的筛选结果。它研究了一组脊髓损伤（SCI）儿童和青少年的特征，这些儿童和青少年是根据研究的严格纳入标准被确定为FNS潜在候选者的。对113名20岁以下患有颈、胸或腰段脊髓损伤的儿童和青少年进行了检查，以纳入FNS实验项目，该项目旨在实现站立、行走或抓握功能。尽管样本偏向于患有中胸段和中颈段完全损伤的青少年，但其年龄、性别、损伤水平、病因和神经学状态与先前发表的报告一致，主要由在机动车或与运动相关事故中受伤的青少年男性组成。大约一半接受检查的个体在无需准备性干预的情况下身体状况适合参与研究。在初次评估时被认为不适合的个体中，有25%确定了使个体适合FNS的治疗方案，这表明临床系统的潜在用户群体可能比从研究应用中获得的估计值更大。周围神经去神经支配是FNS应用中最普遍的身体障碍。尽管四肢瘫和截瘫患者中低运动神经元（LMN）受累的发生率相似，但颈段损伤患者更频繁地出现其他干扰FNS应用的医学并发症。在因去神经支配而被排除的四肢瘫候选者中，近三分之一接受了涉及转移瘫痪但仍可兴奋肌肉的外科手术。在身体状况适合的个体中，心理因素使几名候选者被排除在考虑之外。通过适当的干预来为FNS的临床应用做准备，这些问题也可能得到解决。几乎50%适合FNS研究的个体选择参与项目，拒绝参与的个体称住院、时间和行程安排是影响他们决定的主要因素。结果表明，对于相当一部分小儿SCI人群，用于站立、行走和手部抓握的FNS可能是一种选择。
