Implanted Neuroprosthesis for Assisting Arm and Hand Function After Stroke: A Case Study.

Implanted neuroprosthesis for assisting arm and hand function after stroke: A case study.

J Rehabil Res Dev. 2012 Dec; 49(10): 1505-16
Knutson JS, Chae J, Hart RL, Keith MW, Hoyen HA, Harley MY, Hisel TZ, Bryden AM, Kilgore KL, Peckham H

Loss of arm and hand function is common after stroke. An implantable, 12-channel, electromyogram (EMG)-controlled functional electrical stimulation neuroprosthesis (NP) may be a viable assistive device for upper-limb hemiplegia. In this study, a research participant 4.8 yr poststroke underwent presurgical screening, surgical installation of the NP, training, and assessment of upper-limb impairment, activity limitation, and satisfaction over a 2.3 yr period. The NP increased active range of finger extension from 3 to 96 degrees, increased lateral pinch force from 16 to 29 N, increased the number of objects from 1 to 4 out of 6 that the participant could grasp and place in a Grasp-Release Test, and increased the Arm Motor Abilities Test score by 0.3 points. The upper-limb Fugl-Meyer score increased from 27 at baseline to 36 by the end of the study. The participant reported using the NP at home 3-4 d/wk, up to 3 h/d for exercise and household tasks. The effectiveness of the NP to assist with activities of daily living was dependent on the degree of flexor tone, which varied with task and level of fatigue. The EMG-based control strategy was not successfully implemented; button presses were used instead. Further advancements in technology may improve ease of use and address limitations caused by muscle spasticity. HubMed – rehab

Prosthetic fitting, use, and satisfaction following lower-limb amputation: A prospective study.

J Rehabil Res Dev. 2012 Dec; 49(10): 1493-504
Webster JB, Hakimi KN, Williams RM, Turner AP, Norvell DC, Czerniecki JM

Providing a satisfactory, functional prosthesis following lower-limb amputation is a primary goal of rehabilitation. The objectives of this study were to describe the rate of successful prosthetic fitting over a 12 mo period; describe prosthetic use after amputation; and determine factors associated with greater prosthetic fitting, function, and satisfaction. The study design was a multicenter prospective cohort study of individuals undergoing their first major lower-limb amputation because of vascular disease and/or diabetes. At 4 mo, unsuccessful prosthetic fitting was significantly associated with depression, prior arterial reconstruction, diabetes, and pain in the residual limb. At 12 mo, 92% of all subjects were fit with a prosthetic limb and individuals with transfemoral amputation were significantly less likely to have a prosthesis fit. Age older than 55 yr, diagnosis of a major depressive episode, and history of renal dialysis were associated with fewer hours of prosthetic walking. Subjects who were older, had experienced a major depressive episode, and/or were diagnosed with chronic obstructive pulmonary disease had greater functional restriction. Thus, while most individuals achieve successful prosthetic fitting by 1 yr following a first major nontraumatic lower-limb amputation, a number of medical variables and psychosocial factors are associated with prosthetic fitting, utilization, and function. HubMed – rehab

Beyond componentry: How principles of motor learning can enhance locomotor rehabilitation of individuals with lower limb loss-A review.

J Rehabil Res Dev. 2012 Dec; 49(10): 1431-42
Sawers A, Hahn ME, Kelly VE, Czerniecki JM, Kartin D

Relatively little attention has been given to the use of well-established motor learning strategies to enable individuals with lower limb loss to effectively and safely learn to walk with their prostheses in the home and community. Traditionally, such outcomes have been pursued by focusing on the design and function of a patient’s prosthesis, rather than on how he or she should learn to use it. The use of motor learning strategies may enhance physical rehabilitation outcomes among individuals with lower limb loss. This review explores these motor learning strategies and ways in which they can be applied to the physical rehabilitation of individuals with lower limb loss and highlights some of the challenges to their implementation, as well as unanswered research questions. HubMed – rehab