Neuromodulation : journal of the International Neuromodulation Society
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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.
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This paper discusses the use of electrical stimulation for cardiac assist and control of bladder and bowel. It describes the state of the art, what progress there will be in the coming 10 years and what problems need to be solved in order to make that progress. The paper speculates that within 10 years, there will be patients whose cardiac function is augmented by the pumping function of skeletal muscle assist devices, and furthermore that within 10 years new implantable devices will be available to improve both bladder and bowel emptying by electrical stimulation. Yet another implantable device may become available which allows treatment of detrusor hyperreflexia without the need for a dorsal sacral rhizotomy.
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Systems that use electrical stimulation to activate paralyzed muscles, called "neuroprostheses", have restored important functional capabilities to many people with neurologic disorders such as spinal cord injury or stroke. However, the clinical benefits derived from neuroprostheses have been limited by the quality of control of posture and movement that has been achieved. ⋯ Three important challenges in FNS control systems research and development are identified: 1) to obtain an improved understanding of the biomechanical system that we are trying to control and how it is controlled by the intact neural system, 2) to develop new control system technology with a particular focus on strategies that mimic those used by biologic systems, and 3) to integrate the knowledge and technologies into useful systems that meet the needs of neuroprosthesis users. The outlook for the future includes many interesting problems; yet more importantly, it includes relevant clinical benefits to be gained through the application of biomechanical models and advanced control systems techniques in neuroprostheses.
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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.