Implant provision of key, pinch and power grips in a C6 tetraplegic.

An 11-channel multiplexed stimulator of nerves and muscles in the left forearm was implanted for hand control in January 1986 in a 21 year old woman who, after sustaining a C6 spinal lesion 7 years earlier, had voluntary shoulder and elbow movement but paralysed hands, trunk and legs. The patient controls the stimulation via a microcomputer control box and an RF transdermal link. We have investigated the control of her stimulated hand with a joystick under her contralateral hand which she moves from the shoulder and elbow. Since 1986, we have tried a variety of joystick control schemes involving power and key grips. Currently, for grip adjustment, forward and backward joystick movements correspond to thumb extension and abduction, respectively giving in addition both finger and wrist extension, whereas right and left joystick movements yield fist closure and thumb opposition/adduction and flexion, respectively. Useful grasps are available by moving the joystick forward and then left (key grip), by moving the joystick backward and left (pinch grip), or by moving the joystick back and right (power grip). Thus, three distinct grips may be selected using these three quadrants of joystick movement. An additional control mode was found to be desirable to augment the patient's limited voluntary wrist positioning and provide wrist stability while adjusting finger grip.