Selective neural electrical stimulation restores hand and forearm movements in individuals with complete tetraplegia

Abstract

Background: We hypothesized that a selective neural electrical stimulation of radial and median nerves enables the activation of functional movements in the paralyzed hand of individuals with tetraplegia. Compared to previous approaches for which up to 12 muscles were targeted through individual muscular stimulations, we focused on minimizing the number of implanted electrodes however providing almost all the needed and useful hand movements for subjects with complete tetraplegia. Methods: We performed acute experiments during scheduled surgeries of the upper limb with eligible subjects. We scanned a set of multicontact neural stimulation cuff electrode configurations, pre-computed through modeling simulations. We reported the obtained isolated and functional movements that were considered useful for the subject (different grasping movements). Results: In eight subjects, we demonstrated that selective stimulation based on multicontact cuff electrodes and optimized current spreading over the active contacts provided isolated, compound, functional and strong movements; most importantly 3 out of 4 had isolated fingers or thumb flexion, one patient performed a Key Grip, another one the Power and Hook Grips, and the 2 last all the 3 Grips. Several configurations were needed to target different areas within the nerve to obtain all the envisioned movements. We further confirmed that the upper limb nerves have muscle specific fascicles, which makes it possible to activate isolated movements. Conclusions: The future goal is to provide patients with functional restoration of object grasping and releasing with a minimally invasive solution: Only two cuff electrodes above the elbow. Ethics Committee/ANSM clearance prior to the beginning of the study (inclusion period 2016-2018): CPP Sud Méditerraneé, #ID-RCB:2014-A01752-45, first acceptance 10th of February 2015, amended 12th of January 2016. Trial registration: (www.clinicaltrials.gov): # NCT03721861, Retrospectively registered on 26th of October 2018.