An Implanted Neuroprosthesis for High Tetraplegia

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Abstract
Individuals with high tetraplegia (ASIA classification C4 or higher) have few options to restore upper extremity function. One promising alternative for restoring function to paralyzed muscles is the use of functional electrical stimulation (FES). Initial FES applications for individuals with high tetraplegia have been limited. A major difficulty encountered in the application of FES in high tetraplegia has been the inability to achieve shoulder stabilization and mobilization primarily due to the denervation of key muscles. Another major difficulty has been the limited alternatives to provide control of the stimulated limb. As a result of these difficulties, the functional outcomes of these initial systems have been limited. Advances in technology and surgical techniques have been made that may provide methods for overcoming these limitations. Muscle denervation can be addressed through neurotization techniques to improve voluntary function and increase the response of paralyzed muscles to electrical stimulation. Neuroprosthetic technology has developed stimulators with more channels, implanted control sources, and newly designed electrodes for better muscle recruitment. New alternatives for control, such as electromyographic and electrooculographic signals, allow the development of control algorithms that can be simple to learn by the user with sophisticated control of multiple functions. The combination of these advances may allow the development of an implanted FES system for high tetraplegic individuals that provides control of upper extremity movement to perform functional activities at home and in the community.

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