APPLICATION OF FUNCTIONAL NEUROMUSCULAR STIMULATION TO CHILDREN WITH SPINAL-CORD INJURIES - CANDIDATE SELECTION FOR UPPER AND LOWER-EXTREMITY RESEARCH

This paper summarizes the results of screening for participation in re search programs involving functional neuromuscular stimulation (FNS). It examines the characteristics of a group of children and teenagers w ith spinal cord injuries (SCI) identified as potential candidates for FNS as defined by the rigorous inclusion criteria of the research stud ies. One hundred and thirteen children and teenagers under the age of 20 with cervical, thoracic or lumbar level spinal cord injuries were e xamined for inclusion in an experimental program of FNS to provide sta nding, walking, or prehension. Although biased towards adolescents wit h complete midthoracic and midcervical injuries, the age, sex, injury level, etiology, and neurological status of the sample coincided with previously published reports and consisted predominantly of teenage ma les injured in motor vehicle or sports related accidents. Approximatel y half of the individuals examined were physically appropriate for res earch participation without preparatory intervention. Treatment option s to prepare individuals for FNS were identified in 25% of those consi dered inappropriate at the initial evaluation, indicating that the pot ential user population of clinical systems may be larger than estimate s obtained from research applications. Peripheral denervation was the single most prevalent physical impediment to the application of FNS. A lthough the incidence of lower motor neuron (LMN) involvement was simi lar in subjects with tetraplegia and paraplegia, those with cervical l esions more frequently exhibited other medical complications that inte rfered with the application of FNS. Surgical procedures involving tran sfer of paralyzed but excitable muscles were identified in almost one third of the candidates with tetraplegia who were excluded due to dene rvation. Of those physically appropriate, psychological factors elimin ated several candidates from consideration. Such concerns may also be addressed with suitable intervention in preparation for the clinical a pplication of FNS. Almost 50% of those appropriate for FNS research el ected to participate in the programs, with those declining citing the hospitalization, time and travel commitments as the primary factors in fluencing their decisions. Results suggest that FNS for standing, walk ing and hand grasp may be an option for a significant percentage of th e pediatric SCI population.