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8. Oxygen consumption while walking with multi-joint neuromuscular electrical stimulation after stroke: a case report

Author

Makowski, Nathaniel S, Kobetic, Rudi, Foglyano, Kevin M, Lombardo, Lisa M, Selkirk, Stephen M, Pinault, Gilles, and Triolo, Ronald J

Subjects
Male, Stroke, Oxygen Consumption, Stroke Rehabilitation, Humans, Electric Stimulation Therapy, Joints, Walking, human activities, Article, Aged
Abstract

This case study evaluated the effect of implanted multijoint neuromuscular electrical stimulation gait assistance on oxygen consumption relative to walking without neuromuscular electrical stimulation after stroke. The participant walked slowly with an asymmetric gait pattern after stroke. He completed repeated 6-min walk tests at a self-selected walking speed with and without hip, knee, and ankle stimulation assistance. His walking speed with neuromuscular electrical stimulation more than doubled from 0.28 ± 0.01 m/sec to 0.58 ± 0.04 m/sec, whereas average step length and cadence increased by 0.12 m and 24 steps/min, respectively. As a result, energy cost of walking with neuromuscular electrical stimulation decreased by 0.19 ml O2/kg per meter as compared with walking without stimulation while oxygen consumption increased by 1.1 metabolic equivalent of tasks (3.9 ml O2/kg per minute). These metabolic demands are similar to those reported for stroke survivors capable of walking at equivalent speeds without stimulation, suggesting the increase in oxygen consumption and decreased energy cost result from improved efficiency of faster walking facilitated by neuromuscular electrical stimulation. Although the effect of neuromuscular electrical stimulation on gait economy has implications for community walking within the user's metabolic reserves, this case study's results should be interpreted with caution and the hypothesis that multijoint neuromuscular electrical stimulation improves metabolic efficiency should be tested in a wide population of stroke survivors with varied deficits.

Published
2020

9. Costs of repair of abdominal aortic aneurysm with different devices in a multicenter randomized trial

Author

Matsumura, Jon S., Stroupe, Kevin T., Lederle, Frank A., Kyriakides, Tassos C., Ge, Ling, Freischlag, Julie A., Ketteler, Erika R., Kingsley, Darra D., Marek, John M., Massen, Richard J., Matteson, Brian D., Pitcher, David J., Langsfeld, Mark, Corson, John D., Goff, James M., Jr., Kasirajan, Karthnik, Paap, Christina, Robertson, Diane C., Salam, Atef, Veeraswamy, Ravi, Milner, Ross, Kasirajan, Karthikeshwar, Guidot, Jane, Lal, Brajesh K., Busuttil, Steven J., Lilly, Michael P., Braganza, Melita, Ellis, Kea, Patterson, Mark A., Jordan, William D., Whitley, David, Taylor, Steve, Passman, Marc, Kerns, Donna, Inman, Cindy, Poirier, Jennifer, Ebaugh, James, Raffetto, Joseph, Chew, David, Lathi, Subhash, Owens, Christopher, Hickson, Kathleen, Dosluoglu, Hasan H., Eschberger, Karen, Kibbe, Melina R., Baraniewski, Henry M., Matsumura, Jon, Endo, Michelle, Busman, Anna, Meadows, Wendy, Evans, Mary, Giglia, Joseph S., El Sayed, Hosam, Reed, Amy B., Ruf, Madeline, Ross, Stephanie, Jean-Claude, Jessie M., Pinault, Gilles, Kang, Preet, White, Nadine, Eiseman, Matthew, Jones, Reba, Timaran, Carlos H., Modrall, Gregory J., Welborn, Burress M., III, Lopez, Jorge, Nguyen, Tammy, Chacko, John K.Y., Granke, Kenneth, Vouyouka, Angela G., Olgren, Erin, Chand, Prakash, Allende, Brenda, Ranella, Michael, Yales, Claudia, Whitehill, Thomas A., Krupski, William C., Nehler, Mark R., Johnson, Stephen P., Jones, Darrell N., Strecker, Pamela, Bhola, Michelle A., Shortell, Cynthia K., Gray, John L., Lawson, Jeffrey H., McCann, Richard, Sebastian, Mark W., Tetterton, Jean Kistler, Blackwell, Carla, Prinzo, Patricia A., Lee, Nina, Padberg, Frank T., Jr., Cerveira, Joaquim J., Zickler, Robert W., Hauck, Karen A., Berceli, Scott A., Lee, Anthony W., Ozaki, Keith C., Nelson, Peter R., Irwin, Anne S., Baum, Randy, Aulivola, Bernadette, Rodriguez, Heron, Littooy, Fred N., Greisler, Howard, OʼSullivan, Mary T., Kougias, Panagiotis, Lin, Peter H., Bush, Ruth L., Guinn, Gene, Cagiannos, Catherine, Pillack, Sherilyn, Guillory, Barbara, Cikrit, Dolores, Lalka, Stephen G., Lemmon, Gary, Nachreiner, Ryan, Rusomaroff, Mitzi, OʼBrien, Elaine, Cullen, Joseph J., Hoballah, Jamal, Sharp, John W., McCandless, Jeanne L., Beach, Vickie, Minion, David, Schwarcz, Thomas H., Kimbrough, Joy, Ashe, Laura, Rockich, Anna, Warner-Carpenter, Jill, Moursi, Mohammed, Eidt, John F., Brock, Sandra, Bianchi, Christian, Bishop, Vicki, Gordon, Ian L., Fujitani, Roy, Kubaska, Stephen M., III, Behdad, Mina, Azadegan, Reza, Agas, Christine Ma, Zalecki, Kathy, Hoch, John R., Carr, Sandra C., Acher, Charles, Schwarze, Margaret, Tefera, Girma, Mell, Matthew, Dunlap, Beth, Rieder, Janice, Stuart, John M., Weiman, Darryl S., Abul-Khoudoud, Omran, Garrett, Edward H., Walsh, Sandra M., Wilson, Karen L., Seabrook, Gary R., Cambria, Robert A., Brown, Kellie R., Lewis, Brian D., Framberg, Susan, Kallio, Christa, Barke, Roderick A., Santilli, Steven M., dʼAudiffret, Alexandre C., Oberle, Nancy, Proebstle, Catherine, Lee Johnson, Lauri, Jacobowitz, Glenn R., Cayne, Neal, Rockman, Caron, Adelman, Mark, Gagne, Paul, Nalbandian, Matthew, Caropolo, Leah J., Pipinos, Iraklis I., Johanning, Jason, Lynch, Thomas, DeSpiegelaere, Holly, Purviance, Georgia, Zhou, Wei, Dalman, Ronald, Lee, Jason T., Safadi, Bassem, Coogan, Sheila M., Wren, Sherry M., Bahmani, Doghdoo D., Maples, Deanna, Thunen, Shawna, Golden, Michael A., Mitchell, Marc E., Fairman, Ronald, Reinhardt, Sally, Wilson, Mark A., Tzeng, Edith, Muluk, Satish, Peterson, Nina M., Foster, Maria, Edwards, James, Moneta, Gregory L., Landry, Gregory, Taylor, Lloyd, Yeager, Richard, Cannady, Eleanor, Treiman, Gerald, Hatton-Ward, Stephanie, Salabsky, Barbara, Owens, Erik, Forbes, Beth A., Rapp, Joseph H., Reilly, Linda M., Perez, Sandra L., Yan, Kimberly, Sarkar, Rajaabrata, Dwyer, Shelley S., Kohler, Ted R., Hatsukami, Thomas S., Glickerman, David G., Sobel, Michael, Burdick, Thomas S., Pedersen, Kimberly, Cleary, Patricia, Kansal, Nikhil, Estes, Melanie, Sobotta, Cinda, Back, Martin, Bandyk, Dennis, Johnson, Brad, Shames, Murray, Reinhard, Rebecca L., Thomas, Sandra C., Hunter, Glenn C., Leon, Luis R., Jr., Westerband, Alex, Guerra, Robert J., Riveros, Macario, Mills, John L., Sr., Hughes, John D., Escalante, Andrea M., Psalms, Shemuel B., Day, Nancy N., Macsata, Robyn, Sidawy, Anton, Weiswasser, Jonathan, Arora, Subodh, Jasper, Brenda J., Dardik, Alan, Gahtan, Vivian, Muhs, Bart E., Sumpio, Bauer E., Gusberg, Richard J., Spector, Marcelo, Pollak, Jeffrey, Aruny, John, Kelly, Lynne E., Wong, James, Vasilas, Penny, Joncas, Carmelene, Gelabert, Hugh A., DeVirgillio, Christian, Rigberg, David A., and Cole, Loretta

Published
2015
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13. Long-term performance and user satisfaction with implanted neuroprostheses for upright mobility after paraplegia: Two to 14-year follow-up

Author

Triolo, Ronald J., Bailey, Stephanie Nogan, Foglyano, Kevin M., Kobetic, Rudi, Lombardo, Lisa M., Miller, Michael E., and Pinault, Gilles

Subjects
Adult, Male, Paraplegia, Neural Prostheses, Posture, Middle Aged, Article, Biomechanical Phenomena, Treatment Outcome, Lower Extremity, Patient Satisfaction, Surveys and Questionnaires, Activities of Daily Living, Humans, Female, Spinal Cord Injuries, Follow-Up Studies, Retrospective Studies
Abstract

To quantify the long-term (2y) effects of lower extremity (LE) neuroprostheses (NPs) for standing, transfers, stepping, and seated stability after spinal cord injury.Single-subject design case series with participants acting as their own concurrent controls, including retrospective data review.Hospital-based clinical biomechanics laboratory with experienced (20y in the field) research biomedical engineers, a physical therapist, and medical monitoring review.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.Technical and clinical performance measurements, along with user satisfaction surveys.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.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 for10min/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 were98%.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.

Published
2017

17. 2188

Author

Makowski, Nathaniel, primary, Kobetic, Rudi, additional, Lombardo, Lisa, additional, Foglyano, Kevin, additional, Pinault, Gilles, additional, Selkirk, Stephen, additional, and Triolo, Ronald, additional

Published
2017
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21. Implanted Pulse Generators in Lower Extremity Neuroprostheses: A 25-Year Review

Author

Leapo, Lizbeth A., Miller, Michael E., Hoyen, Harry A., Pinault, Gilles C., and Triolo, Ronald J.

Abstract

Neuroprosthetic devices can improve quality of life by providing an alternative option for motor function lost after spinal cord injury, stroke, and other central nervous system disorders. The objective of this study is to analyze the outcomes of implanted pulse generators that our research group installed in volunteers with paralysis to assist with lower extremity function over a 25-year period, specifically, to determine survival rates and common modes of malfunction, reasons for removal or revision, and precipitating factors or external events that may have adversely influenced device performance.

Published
2024
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34. The Journal of Rehabilitation Research and Development

Author

Kobetic, Rudi, primary, To, Curtis S., additional, Schnellenberger, John R., additional, Audu, Musa L., additional, Bulea, Thomas C., additional, Gaudio, Richard, additional, Pinault, Gilles, additional, Tashman, Scott, additional, and Triolo, Ronald J., additional

Published
2009
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40. Contributors

Author

Delaney, Conor P., Goldstone, Jerry, Hardacre, Jeffrey M., Kim, Julian A., Lavertu, Pierre, Malangoni, Mark A., Marks, Jeffrey M., McHenry, Christopher R, Ponsky, Lee E., Rosen, Michael J., Siegel, Christopher T., Stein, Sharon L., Abbas, Mujjahid, Abouassaly, Robert, Allemang, Matthew T., Baele, Henry R., Blatnik, Jeffrey A., Bleier, Joshua I.S., Cha, Walter S., Champagne, Bradley J., Cherullo, Edward, Claridge, Jeffrey A., Como, John J., DeBernardo, Robert L., DeJoy, Samuel J., Edwards, Thomas J., Elliott, Heidi L., Gewertz, Bruce L., Hall, Jason F., Holzman, Michael D., Hoyen, Harry A., Joseph, Natalie E., Kanters, Arielle, Kashyap, Vikram S., Kiechle, Jonathan E., Krpata, David M., Kruse, Matthew J., Lipman, Jeremy M., Carol, Yi-Chun, Manwaring, Mark L., Marderstein, Eric L., McBeath, Evan R., McDonald, Amy, Moloo, Husein, Novitsky, Yuri W., Onders, Raymond, Phillips, Melissa S., Pinault, Gilles, Ponsky, Todd, Poulose, Benjamin K., Resnick, Kimberly, Reynolds, Harry L., Jr., Rezaee, Rod, Saber, Alan A., Sanabria, Juan, Sanchez, Edmund Q., Sandoval, Victor M., Schulak, James, Smith, Charles E., Smith, Christopher J., Swanstrom, Lee L, Tabayoyong, William, Visioni, Anthony, Wang, John C., Wilhelm, Scott M., Wong, Virginia, Woodside, Kenneth J., Yih, Jessica Mae, and Zender, Chad A.

Published
2014
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41. NEUROPROSTHETIC IMPLANT IMPROVES WALKING ABILITY IN STROKE PATIENTS.

Author

Makowksi, Nathaniel, Kobetic, Rudi, Lombardo, Lisa, Pinault, Gilles, Selkirk, Stephen, Foglyano, Kevin, and Triolo, Ronald

Subjects
HEALTH of older people, STROKE treatment, NEUROPROSTHESES
Abstract

The article focuses on use of neuroprosthetic implants for treatment of stroke patients including primary use of multichannel implanted neuroprosthetic systems for patients with spinal cord injury, use of neuromuscular electrical stimulation and use of quantitative motion analysis.

Published
2016

42. Neurotherapeutic and neuroprosthetic effects of implanted functional electrical stimulation for ambulation after incomplete spinal cord injury.

Author

Bailey, Stephanie Nogan, Hardin, Elizabeth C., Kobetic, Rudi, Boggs, Lisa M., Pinault, Gilles, and Triolo, Ronald J.

Subjects
*SPINAL cord injuries, *THERAPEUTICS, *ELECTRIC stimulation, *WALKING, *PEOPLE with paralysis, *ELECTROPHYSIOLOGY, *PULSE generators, *EQUIPMENT & supplies
Abstract

The purpose of this single-subject study was to determine the neurotherapeutic and neuroprosthetic effects of an implanted functional electrical stimulation (FES) system designed to facilitate walking in an individual with a long-standing motor and sensory incomplete spinal cord injury. An implanted pulse generator and eight intramuscular stimulating electrodes were installed unilaterally, activating weak or paralyzed hip flexors, hip and knee extensors, and ankle dorsiflexors during 36 sessions of gait training with FES. The neurotherapeutic effects were assessed by a comparison of pre- and posttraining volitional walking. The neuroprosthetic effects were assessed by a comparison of posttraining volitional and FES-assisted walking. Treatment resulted in significant (p < 0.005) volitional improvements in 6-minute walking distance and speed, speed during maximum walk, double support time, and 10 m walking speed. Posttraining FES-assisted walking resulted in significant additional improvements in all these measures, except 10 m walking speed. When the subject was using FES-assisted gait, maximum walking distance, peak knee flexion in swing, peak ankle dorsiflexion in swing, and knee extension moment also significantly increased. Neuroprosthetic gains were sufficient to enable the subject to advance from household ambulation to limited community ambulation. Additionally, the subject could perform multiple walks per day when using FES-assisted gait, which was impossible with volitional effort alone. [ABSTRACT FROM AUTHOR]

Published
2010
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43. Development of hybrid orthosis for standing, walking, and stair climbing after spinal cord injury.

Author

Kobetic, Rudi, To, Curtis S., Schnellenberger, John R., Audu, Musa L., Bulea, Thomas C., Gaudio, Richard, Pinault, Gilles, Tashman, Scott, and Triolo, Ronald J.

Subjects
*PATIENTS with spinal cord injuries, *ORTHOPEDIC braces, *ELECTRIC stimulation, *HUMAN locomotion
Abstract

This study explores the feasibility of a hybrid system of exoskeletal bracing and multichannel functional electrical stimulation (FES) to facilitate standing, walking, and stair climbing after spinal cord injury (SCI). The orthotic components consist of electromechanical joints that lock and unlock automatically to provide upright stability and free movement powered by FES. Preliminary results from a prototype device on nondisabled and SCI volunteers are presented. A novel variable coupling hip-reciprocating mechanism either acts as a standard reciprocating gait orthosis or allows each hip to independently lock or rotate freely. Rotary actuators at each hip are configured in a closed hydraulic circuit and regulated by a finite state postural controller based on real-time sensor information. The knee mechanism locks during stance to prevent collapse and unlocks during swing, while the ankle is constrained to move in the sagittal plane under FES-only control. The trunk is fixed in a rigid corset, and new ankle and trunk mechanisms are under development. Because the exoskeletal control mechanisms were built from off-the-shelf components, weight and cosmesis specifications for clinical use have not been met, although the power requirements are low enough to provide more than 4 hours of continuous operation with standard camcorder batteries. [ABSTRACT FROM AUTHOR]

Published
2009
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44. Implanted Pulse Generators in Lower Extremity Neuroprostheses: A 25-Year Review.

Author

Leapo LA, Miller ME, Hoyen HA, Pinault GC, and Triolo RJ

Abstract

Objectives: Neuroprosthetic devices can improve quality of life by providing an alternative option for motor function lost after spinal cord injury, stroke, and other central nervous system disorders. The objective of this study is to analyze the outcomes of implanted pulse generators that our research group installed in volunteers with paralysis to assist with lower extremity function over a 25-year period, specifically, to determine survival rates and common modes of malfunction, reasons for removal or revision, and precipitating factors or external events that may have adversely influenced device performance., Materials and Methods: Our implantable receiver-stimulator (IRS-8) and implantable stimulator-telemeter (IST-12 and IST-16) device histories were retrospectively reviewed through surgical notes, regulatory documentation, and manufacturing records from 1996 to 2021., Results: Most of the 65 devices (64.6%) implanted in 43 volunteers remain implanted and operational. Seven underwent explantation owing to infection; seven had internal failures, and six were physically broken by external events. Of the 22 devices explanted, 15 were successfully replaced to restore recipients' enhanced functionality. There were no instances of sepsis or major health complications. The five infections that followed all 93 IRS and IST lower extremity research surgeries during this period indicate a pooled infection rate of 5.4%. The Kaplan-Meier analysis of technical malfunctions between the implant date and most recent follow-up shows five-, ten-, and 20-year device survival rates of 92%, 84%, and 71%, respectively., Conclusions: Incidence of malfunction is similar to, whereas infection rates are slightly higher than, other commonly implanted medical devices. Future investigations will focus on infection prevention, modifying techniques on the basis of recipient demographics, lifestyle factors, and education, and integrating similar experience of motor neuroprostheses used in other applications., Competing Interests: Conflict of Interest The authors reported no conflict of interest., (Copyright © 2024 International Neuromodulation Society. All rights reserved.)

Published
2024
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45. Intraoperative demonstration of selective stimulation of the common human femoral nerve with a FINE.

Author

Schiefer MA, Polasek KH, Triolo RJ, Pinault GC, and Tyler DJ

Subjects
Electric Stimulation methods, Equipment Design, Equipment Failure Analysis, Humans, Intraoperative Care, Muscle, Skeletal innervation, Reproducibility of Results, Sensitivity and Specificity, Electric Stimulation instrumentation, Electrodes, Implanted, Femoral Nerve physiology, Muscle Contraction physiology, Muscle, Skeletal physiology
Abstract

We have tested the hypothesis that the Flat Interface Nerve Electrode (FINE) can selectively stimulate each muscle innervated by the common femoral nerve of the human, near the inguinal ligament in a series of intraoperative trials. During routine vascular surgeries, an 8-contact FINE was placed around the common femoral nerve between the inguinal ligament and the first branching point. The efficacy of the FINE to selectively recruit muscles innervated by the femoral nerve was determined from electromyograms (EMGs) recorded in response to electrical stimulation. At least four of the six muscles innervated by the femoral nerve were selectively recruited in all subjects. Of these, at least one muscle was a hip flexor and two muscles were knee extensors. Results from the intraoperative experiments were used to estimate the potential for the electrode to restore knee extension and hip flexion through Functional Electrical Stimulation (FES). Normalized EMGs and biomechanical simulations were used to estimate joint moments and functional efficacy. Estimated knee extension moments exceed the threshold required for the sit-to-stand transition.

Published
2009
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