Upper Extremity Functional Neuromuscular Stimulation

Functional neuromuscular stimulation (FNS) for restoration of upper extremity function has been under development at various centers around the world for over two decades. Application of this technology to date has been primarily focused on selected C4 through C6 level spinal cord injured subjects in whom both palmar and lateral grasp patterns have been restored. Electrical stimulation to individual arm and hand muscles has been provided through surface, percutaneous, epimysial, or nerve cuff electrodes. Various control schemes have been implemented, including detection of shoulder position or head movement, voice activation, respiratory control, and wheelchair mounted switches. Over thirty systems have been implemented in subjects who have used these systems continuously outside the hospital setting for as long as twelve years. Clinical trials employing a common stimulation system are underway at five centers. Further development and research, technology transfer, and expansion of the use of FNS to other upper extremity CNS disabilities is in progress.