Australian experience with the Freehand System (R) for restoring grasp in quadriplegia

Background: The purpose of the present study was to document the value of a n implanted multichannel neuroprosthesis (Freehand System(R)) for restoring hand grasp in the first Australians to receive this device. Methods: Hand function in C5 quadriplegic patients was assessed via measure ment of pinch forces, a grasp release test and tests of activities of daily living (ADL). Comparisons were made between presurgery scores and scores r ecorded after rehabilitation when the neuroprosthesis was and was not in us e. Results: A significant difference for both lateral pinch (P = 0.003) and pa lmar grasp (P = 0.003) was found between forces recorded with and without t he use of the neuroprosthesis after rehabilitation, but not between forces recorded presurgery and during rehabilitation without the neuroprosthesis. All subjects were able to grasp, move and release more objects within the 3 0-s test period with the neuroprosthesis than without it. Collective result s for the eight ADL tests for all six subjects show that, in 35 of the 48 ( 73%) occasions, less physical assistance and/or adaptive equipment was requ ired when the Freehand system, was employed compared to when it was not use d. In 41 of the 48 (85%) occasions, the six subjects expressed a preference for using the neuroprosthesis to perform these activities of daily Living. Twelve months after rehabilitation, five of the six subjects still used th e neuroprosthesis daily or every second day. Conclusion: The Freehand neuroprosthesis has provided useful hand function with few surgical and technical difficulties in these patients. Regular ong oing use of the device indicates user satisfaction.