Neuromodulation : journal of the International Neuromodulation Society
-
Command and control interfaces permit the intention and situation of the user to influence the operation of the neural prosthesis. The wishes of the user are communicated via command interfaces to the neural prosthesis and the situation of the user by feedback control interfaces. Both these interfaces have been reviewed separately and are discussed in light of the current state of the art and projections for the future. ⋯ Such systems will demand more information to function effectively in order not to unreasonably increase user attention overhead. This will increase the need for bioelectric and biomechanical signals in a comprehensible form via elegant feedback control interfaces. Implementing such systems will also increase the computational demand on such neural prostheses.
-
This paper reviews the current state of the art and identifies the major challenges facing the future development and clinical application of neuroprostheses to provide limb movement. It gives insight into the current status of functional electrical stimulation (FES) for motor control, identifies problems, and proposes possible directions of development in cervical cord injury, thoracic spinal cord injury, and stroke. ⋯ The discussion on lower extremity applications describes current and possible future solutions of the major impediments to the development of FES systems for individuals with paraplegia after spinal cord injury and surface and implantable setups for stroke survivors with hemiplegia. Particular attention is given to sensor issues and requirements for walking with FES after stroke.
-
In this paper we present an overview of current research into clinical and therapeutic applications of electrical neuromuscular stimulation (NMS). As this is now such a huge subject we have focused our attention on the therapeutic rather than orthotic uses of stimulation and limited the field almost exclusively to upper limb applications in hemiplegia. ⋯ We discuss recent research aimed at resolving these issues and based on this we make some suggestions for future research. To resolve these issues we propose: 1) neurophysiologic research into the mechanism through which NMS interacts with the nervous system; 2) large multicenter randomized controlled trials using rigorous methodology that compare different applications of NMs; 3) continued technical development that is closely linked to clinical applications.
-
Since their initial development, the performance gains in functional electrical stimulation (FES) systems have been modest. Conceptually, the replacement of normal neural function by artificial electronic systems is attractive, considering the continued technologic advancements in electronics, communication, and control. It is likely that efficacious FES systems will require complete implantation and activation of large numbers of motor units. ⋯ While an engineer might be pleased to design a system that functions, as intended, 99% of the time, if a user falls down 1 time out of every 100, this is likely to be unacceptable. The minimal threshold of functional utility for FES systems is unclear, and will not be addressed here. Rather, we consider the issues of what features and capabilities are desirable for next generation implantable systems, and to what degree these desires approach engineering feasibility.