A Preliminary Clinical Study using RF BION® Microstimulators to Facilitate Upper Limb Function in Hemiplegia

A brief background to Functional Electrical Stimulation Functional Electrical Stimulation (FES) has been used to facilitate movement in people who have suffered an upper motor neuron lesion since Liberson designed the first drop-foot stimulator in 1960. Since then the technique has been accepted by only a small number of clinicians and therapists. There are various reasons for this: firstly insufficient research and clinical evidence for its effectiveness although there have been many papers published on the use of FES they have tended to be with small numbers of subjects and often employing weak methodology. Recently more convincing evidence from larger research studies has been published, a systematic review found evidence for improved upper limb motor control with surface FES systems, and systems that allow voluntary control over the activation of stimulation, such as through the same muscle EMG signal, have been shown to result in improved motor learning. The Odstock dropfoot stimulator has probably gained more clinical acceptance than any other FES device with now over 2000 patients using it in the UK. Acceptance in this case has been due not only to research evidence but also to strong clinical support and education of therapists in selection of suitable patients and application of devices. Even when the stimulator is set-up effectively however, wearing an external device that requires careful donning and doffing does not appeal to all patients, regardless of whether it is functionally effective. As rehabilitationists, we are more interested in interventions that can facilitate recovery to restore rather than replace lost movement. This project aims to address the last two issues by using an implantable microstimulator that can remain implanted even if no longer needed and developing a system to facilitate recovery by supporting voluntary movement rather than replacing it.