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Citation
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Triolo RJ, Bailey SN, Foglyano KM, Kobetic R, Lombardo LM, Miller ME, Pinault G. Arch. Phys. Med. Rehabil. 2018; 99(2): 289-298. |
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Abstract
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OBJECTIVE: To quantify the long-term (LT) (>2 years) effects of lower extremity (LE) neuroprostheses (NPs) for standing, transfers, stepping and seated stability after spinal cord injury.
DESIGN: Single-subject design case series with participants acting as their own concurrent controls, including retrospective data review. SETTING: Hospital-based clinical biomechanics laboratory with experienced (>20 years in the field) research biomedical engineers, physical therapist and medical monitoring review. PARTICIPANTS: Twenty-two (19 male, 3 female) LT (6.2 ± 2.7 years) at-home users of implanted NPs for trunk and LE function with chronic (14.4 ± 7.1 years) spinal cord injury resulting in full or partial paralysis. INTERVENTIONS: Technical and clinical performance measurements, along with user satisfaction surveys. MAIN OUTCOME MEASURES: Knee extension moment, maximum standing time, body weight supported by lower extremities, three functional standing tasks, two satisfaction surveys, NP usage, and stability of implanted components.
RESULTS: Stimulated knee extension strength and functional capabilities were maintained with 94% of implant recipients reporting being "very" or "moderately" satisfied with their system. Greater than half (60%) of the participants were still using their implanted NPs for exercise and function for more than 10 minutes per day on nearly half or more of the days monitored, although maximum standing times and percentage body weight through LEs decreased slightly over the follow-up interval. Stimulus thresholds were uniformly stable. Six-year survival rates for the first-generation implanted pulse generator (IPG) and epimysial electrodes were close to 90%, while those for the second-generation IPG along with the intramuscular and nerve cuff electrodes were greater than 98%.
CONCLUSIONS: Objective and subjective measures of the technical and clinical performances of implanted LE NPs generally remained consistent for 22 participants after an average of 6 years of unsupervised use at home. These findings suggest that implanted LE NPs can provide lasting benefits that recipients value.
Copyright © 2017. Published by Elsevier Inc.
Language: en |