Peckham04Review

Peckham04Review - 8 Mar 2005 13:30 AR AR248-BE07-04.tex...

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Unformatted text preview: 8 Mar 2005 13:30 AR AR248-BE07-04.tex XMLPublish SM (2004/02/24) P1: KUV AR REVIEWS IN ADVANCE10.1146/annurev.bioeng.6.040803.140103 (Some corrections may occur before final publication online and in print) R E V I E W S I N A D V A N C E Annu. Rev. Biomed. Eng. 2005. 7:4.14.34 doi: 10.1146/annurev.bioeng.6.040803.140103 Copyright c 2005 by Annual Reviews. All rights reserved F UNCTIONAL E LECTRICAL S TIMULATION FOR N EUROMUSCULAR A PPLICATIONS P. Hunter Peckham Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106; Department of Veterans Affairs, Cleveland, Ohio 44106; MetroHealth Medical Center, Cleveland, Ohio 44109; email: pxp2@case.edu Jayme S. Knutson Department of Veterans Affairs, Cleveland, Ohio 44106; email: jsk12@case.edu Key Words motor neuroprosthesis, spinal cord injury, stroke rehabilitation, bladder stimulator, phrenic nerve pacing Abstract Paralyzed or paretic muscles can be made to contract by applying elec- trical currents to the intact peripheral motor nerves innervating them. When electrically elicited muscle contractions are coordinated in a manner that provides function, the technique is termed functional electrical stimulation (FES). In more than 40 years of FES research, principles for safe stimulation of neuromuscular tissue have been established, and methods for modulating the strength of electrically induced muscle contractions have been discovered. FES systems have been developed for restoring function in the upper extremity, lower extremity, bladder and bowel, and respiratory system. Some of these neuroprostheses have become commercialized products, and others are available in clinical research settings. Technological developments are ex- pected to produce new systems that have no external components, are expandable to multiple applications, are upgradable to new advances, and are controlled by a combi- nation of signals, including biopotential signals from nerve, muscle, and the brain. CONTENTS INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 PHYSIOLOGICAL AND TECHNOLOGICAL PRINCIPLES OF FES . . . . . . . . . . 4.2 Electrical Activation of the Neuromuscular System . . . . . . . . . . . . . . . . . . . . . . . . 4.2 Configurations of Neuroprosthetic Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5 CLINICAL APPLICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 Upper Extremity Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 Lower Extremity Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.11 Bladder and Bowel Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.15 Respiratory Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.184....
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