Assistive technology : the official journal of RESNA
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Neural prostheses are a developing technology that use electrical activation of the nervous system to restore function to individuals with neurological impairment. Neural prostheses function by electrical initiation of action potentials in nerve fibers that carry the signal to an endpoint where chemical neurotransmitters are released, either to affect an end organ or another neuron. ⋯ Outcomes of motor system neural prostheses include restoration of hand grasp and release in quadriplegia, restoration of standing and stepping in paraplegia, restoration of bladder function (continence, micturition) following spinal cord injury, and electrophrenic respiration in high-level quadriplegia. Neural prostheses restore function and provide greater independence to individuals with disability.
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Functional electrical stimulation (FES) applications in the lower extremity are common in research laboratories, but clinical applications are minimal. This review summarizes current knowledge with respect to clinical application. When electrical stimulation is used in clinical applications for functional movement such as standing and walking, it is typically applied in an open-loop manner; a predetermined stimulus pattern is delivered regardless of the consequences of the actual movement. ⋯ Percutaneous and implanted systems are years away from commercialization and clinical availability. Hybrid systems, based primarily on the reciprocating gait orthosis (RGO), are presently the only clinically available form of walking that includes some form of FES assistance. The costs and benefits of adding FES to the RGO and the long-term user acceptance rate for these systems remain to be determined.