The feasibility of wrist and forearm control in individuals with C5/C6 tetraplegia using functional neuromuscular stimulation

 
 
 
 

The feasibility of wrist and forearm control in individuals with C5/C6 tetraplegia using functional neuromuscular stimulation

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Title: The feasibility of wrist and forearm control in individuals with C5/C6 tetraplegia using functional neuromuscular stimulation
Author: Lemay, Michel Andre
Description: This research investigated the feasibility of providing wrist flexion/extension control to C5 tetraplegics, and forearm pronosupination to C5 and C6 tetraplegics, using Functional Neuromuscular Stimulation (FNS). Both movements were investigated experimentally in tetraplegics and through the use of a biomechanical model of the upper extremity (elbow flexion/extension, forearm pronosupination, and wrist flexion/extension + radial/ulnar deviation). Wrist flexion/extension control was investigated in three C4/C5 tetraplegics. One underwent an extensor carpi ulnaris (ECU) to extensor carpi radialis brevis (ECRB) tendon transfer to substitute for the denervated ECRB. We measured the movements available from the wrist muscles, the movements produced at the wrist by finger muscles during grasp, and the wrist joint's passive properties. Furthermore, we evaluated three wrist position controllers. The passive and finger muscle movements are significant compared with the movement produced by single wrist muscles and will affect the range of wrist angle obtainable and the stability of the wrist during grasp. Feedback regulation increases wrist stability in the presence of disturbances, with possibly less wri st muscle activation. The tendon transfer and controller results were reproduced in the biomechanical model. Forearm pronosupination was investigated in four C5 tetraplegic subjects. We measured the voluntary pronation/supination movements in all four individuals, and the pronation movements produced by electrical activation of the pronator quadratus (PQ) in two subjects (three forearms). We also measured the passive, voluntary, and voluntary against electrically activated PQ ranges of motion in three tetraplegics (five forearms). With the forearm neutral, the voluntary supination movements were larger than the FNS pronation movements in all the arms tested. Both the voluntary supination (5 forearms) and the electrical stimulation pronation movement (1 forearm) decreased with increased supination. Finally, the subjects could voluntarily pronate/supinate through a large range of motion (range 87°-125°), and were able to voluntarily overcome a stimulated PQ. Using the biomechanical model, we investigated the roles of gravity and of the brachioradialis in producing pronation movement. The analysis revealed that the brachioradialis can pronate the forearm if gravity is aligned to cause pronation once the forearm has been brought to a neutral position by the brachioradialis.
Permanent Link: http://rave.ohiolink.edu/etdc/view?acc_num=case1058205177
http://hdl.handle.net/2374.OX/16911
Date: 1995

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