Category: Technology (e.g. robotics, assistive technology, mHealth); Spinal Cord Injury; Neuroplasticity (includes neuroscience)
Objective :
To assess the therapeutic value of providing object manipulation practice enhanced by brain-computer interface (BCI)-controlled neuromuscular electrical stimulation (NMES) in chronic, complete tetraplegia.
Design : Open-label, investigational device, before-after trial.
Setting : Academic medical center.
Participants (or Animals, Specimens, Cadavers) : 22 year-old male with C5 ASIA A chronic spinal cord injury (SCI) and left motor cortex Utah array (Blackrock Microsystems) participating in NCT01997125.
Interventions : Brain-computer interface (BCI)-controlled, neuromuscular electrical stimulation (NMES) enabled (NeuroLife®, Battelle Memorial Institute) object manipulation of Grasp and Release Test objects over 60 sessions spanning 776 days.
Main Outcome Measure(s) : Change in performance on Action Research Arm Test (ARAT) total score. Secondary outcomes included change in Graded and Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) subscale scores, Box and Block Test (BBT) score, and independence for activities of daily living (ADLs) on the Quadriplegia Index of Function (QIF).
Results : After BCI-NMES-enabled object manipulation practice, the participant demonstrated a 17-point gain in ARAT score, a clinically significant improvement in residual motor ability. His change reflected both new ability to manipulate objects (ball, cup, bar, ring, marble) and improved coordination yielding faster performance. BBT transfer rate similarly improved from 12.0+1.7 to 20.7+1.5. Neurologic level (GRASSP strength or sensation) did not change with this intervention, but functional level on GRASSP prehension tasks improved from C6 to C8. Participation had an impact in his daily life, increasing the number of QIF ADLs he could perform (9 to 17) and reducing home care utilization (10 to 4 hours/day).
Conclusions :
Functional task practice augmented with BCI-NMES improved residual right upper limb function and ADL ability for an individual with chronic, complete SCI. BCI-NMES should be explored as a therapy for individuals with chronic, cervical SCI to facilitate independence and reduce the cost of paralysis to patients and society.
Collin Dunlap
– Biomedical Engineering Graduate Research Assistant, The Ohio State University, Columbus, Ohio
Sam Colachis
– Researcher, Medical Devices and Neuromodulation Group, Battelle Memorial Institute, Columbus, OhioKaitlyn Eipel
– Graduate Student, Rutgers University Biomedical Sciences Program, Columbus, OhioNick Annetta
– Research Scientist, Medical Devices and Neuromodulation Group, Battelle Memorial Institute, Columbus, OhioPatrick Ganzer
– Principal Research Scientist, Medical Devices and Neuromodulation Group, Battelle Memorial Institute, Columbus, OhioMichael Schwemmer
– Principal Research Statistician, Health and Analytics Group, Battelle Memorial Institute, Columbus, OhioNicholas Skomrock
– Research Statistician III, Health and Analytics Group, Battelle Memorial Institute, Columbus, OhioDavid Friedenberg
– Senior Research Statistician, Health and Analytics Group, Battelle Memorial Institute, Columbus, Ohio
Gaurav Sharma
– Senior Research Scientist, Medical Devices and Neuromodulation Group, Battelle Memorial Institute, Columbus, OhioW. Jerry Mysiw
– Professor & Chair, Dept. of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, Ohio
Marcia Bockbrader
– Assistant Professor, Research Physiatrist, The Ohio State University, Columbus, Ohio