Upper Extremity Functional Neuromuscular Stimulation

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Abstract
C5 and C6 quadriplegic individuals lack motor and sensory function in their hands. Hand grasp can be partially restored using functional neuromuscular stimulation, but controlling the synthesized grasp is hindered by the absence of tactile or proprioceptive sensation. Some of the missing information can be recovered using sensory substitution, i.e., supplemental sensory feedback. The utility of supplemental sensory feedback for control of a hand-grasp neuroprosthesis is demonstrated using shoulder position tracking tasks and an object manipulation task. The results show that providing information to the user about shoulder position (which is used to control stimulation levels) or actual grasp force improves performance. A simple, general strategy is also proposed for developing artificial sensory feedback, based on concepts of stimulus type and magnitude. The feedback modality should be chosen to match the psychophysical representation of the impaired modality, and individual feedback stimuli should evoke sensations equivalent in magnitude to those normally evoked in the impaired modality. The strategy is illustrated by using it to develop a feedback system where a variable burst duration, electrocutaneous stimulus is employed as a substitute for the normal perception of grasp force. Cross-modal matching is used to determine the appropriate stimulus transformation functions.

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