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Exploratory study of perceived quality of life with implanted standing neuroprostheses.

ABSTRACT: Individuals with spinal cord injury (SCI) need options for negotiating architectural barriers, completing essential transfers, and accessing items on high shelves or in cupboards that cannot be reached from the wheelchair or safely managed with reachers. Case Western Reserve University (CWRU) and the Department of Veterans Affairs (VA) have developed an assistive technology device to assist individuals with SCI to stand and transfer. The 8-channel implanted CWRU-VA system enables persons with SCI to exercise, stand, and maneuver in the vicinity of their wheelchairs. Interventions that decrease barriers to mobility and participation can have a significant effect on an individual's perceived quality of life (QOL). This study uses a qualitative research methodology comprised of a series of semi-structured interviews to determine the effects on perceived QOL of an implanted 8-channel functional electrical stimulation (FES) system for standing after SCI. The results reveal that individuals with SCI currently using an implanted FES standing system perceived significant improvements in QOL related to the neuroprosthesis. Implanted neuroprostheses for standing have the potential to improve QOL for veterans living with SCI.

SUBMITTER: Rohde LM

PROVIDER: S-EPMC4465790 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Exploratory study of perceived quality of life with implanted standing neuroprostheses.

Rohde Loretta M LM Bonder Bette R BR Triolo Ronald J RJ

Journal of rehabilitation research and development 20120101 2

Individuals with spinal cord injury (SCI) need options for negotiating architectural barriers, completing essential transfers, and accessing items on high shelves or in cupboards that cannot be reached from the wheelchair or safely managed with reachers. Case Western Reserve University (CWRU) and the Department of Veterans Affairs (VA) have developed an assistive technology device to assist individuals with SCI to stand and transfer. The 8-channel implanted CWRU-VA system enables persons with SC ...[more]

PMID: 22773528

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Project description:Microelectrode arrays implanted in the brain are increasingly used for the research and treatment of intractable neurological disease. However, local neuronal loss and glial encapsulation are known to interfere with effective integration and communication between implanted devices and brain tissue, where these observations are typically based on assessments of broad neuronal and astroglial markers. However, both neurons and astrocytes comprise heterogeneous cellular populations that can be further divided into subclasses based on unique functional and morphological characteristics. In this study, we investigated whether or not device insertion causes alterations in specific subtypes of these cells. We assessed the expression of both excitatory and inhibitory markers of neurotransmission (vesicular glutamate and GABA transporters, VGLUT1 and VGAT, respectively) surrounding single-shank Michigan-style microelectrode arrays implanted in the motor cortex of adult rats by use of quantitative immunohistochemistry. We found a pronounced shift from significantly elevated VGLUT1 within the initial days following implantation to relatively heightened VGAT by the end of the 4-wk observation period. Unexpectedly, we observed VGAT positivity in a subset of reactive astrocytes during the first week of implantation, indicating heterogeneity in early-responding encapsulating glial cells. We coupled our VGLUT1 data with the evaluation of a second marker of excitatory neurons (CamKii?); the results closely paralleled each other and underscored a progression from initially heightened to subsequently weakened excitatory tone in the neural tissue proximal to the implanted electrode interface (within 40 ?m). Our results provide new evidence for subtype-specific remodeling surrounding brain implants that inform observations of suboptimal integration and performance.NEW & NOTEWORTHY We report novel changes in the local expression of excitatory and inhibitory synaptic markers surrounding microelectrode arrays implanted in the motor cortex of rats, where a progressive shift toward increased inhibitory tone was observed over the 4-wk observation period. The result was driven by declining glutamate transporter expression (VGLUT1) in parallel with increasing GABA transporter expression (VGAT) over time, where a reactive VGAT+ astroglial subtype made an unexpected contribution to our findings.

Project description:OBJECTIVE:To quantify the long-term (>2y) 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 (>20y in the field) research biomedical engineers, a physical therapist, and medical monitoring review. PARTICIPANTS:Long-term (6.2±2.7y) at-home users (N=22; 19 men, 3 women) of implanted NPs for trunk and LE function with chronic (14.4±7.1y) 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, 3 functional standing tasks, 2 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. More than half (60%) of the participants were still using their implanted NPs for exercise and function for >10min/d on nearly half or more of the days monitored; however, 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%, whereas those for the second-generation IPG along with the intramuscular and nerve cuff electrodes were >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.

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Exploratory study of perceived quality of life with implanted standing neuroprostheses.

Publications

Exploratory study of perceived quality of life with implanted standing neuroprostheses.

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