March 2, 2001
Volume XXXIV, No. 9

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Pioneering surgery restores function to paralyzed hand

NeuroControl FREEHAND System The drawing illustrates the placement of the internal and external components of the NeuroControl™ FREEHAND® System. The x-rays show the location of the stimulator, the electrodes and leads.

Perhaps many of us take our hands for granted, but to someone who has lost hand function, restoration of that function means a revolutionary improvement in the ability to live independently and pursue life goals.

The first surgery in Texas and in the Southwestern United States to implant the NeuroControl™ FREEHAND® System, which allows a patient to bypass standard brain-to-hand nerve pathways and move his hand using paralyzed muscles plus outside electrical stimulation, was performed Jan. 29 in San Antonio.

The patient, 42-year-old Don Burton of Boerne, is doing well and learning to work with the new device that is allowing him to move his right hand by himself for the first time in eight years.

"This surgery will change the whole future for many patients with spinal cord injury," said Dr. Mark Fredrickson, assistant professor of rehabilitation medicine at the Health Science Center and a staff physician at Audie L. Murphy Memorial Veterans Hospital. "The surgery was performed at the V.A., where Mr. Burton was a patient in the spinal cord injury unit," said Dr. Fredrickson, who organized the new neuroprosthetics team that is working with Burton. The team includes members from the V.A., the UTHSC and University Hospital.

"A sort of joystick is placed on Mr. Burton's left shoulder area and he is learning to control the neuroprosthesis with the movements of his shoulder muscles," Dr. Fredrickson explained. When the device is turned on, this movement sends electrical signals to a programmed external controller that sits near him, perhaps on the arm of his wheelchair when he sits in it. Then, the controller sends those signals to a transmitter that he wears on the right side of his chest. The transmitter sends signals to an internally implanted receiver/stimulator near his right shoulder, and finally, electrical impulses are sent through eight implanted wires in his right arm and hand to the muscle groups needed to move the hand. All of this complicated-sounding activity occurs almost immediately after Don purposely moves his left shoulder in a particular way.

"This surgery isn't for everyone, and only works on patients whose paralyzed muscles can be stimulated electrically," Dr. Fredrickson cautioned, "but we expect that many individuals with damage to the spinal cord at the level of the cervical (neck) vertebrae will be able to gain tremendous control from this device if they are motivated to use it."

The controller is programmable and allows for six different movements including palmar prehension, in which the fingers move toward the palm allowing one to pick up or hold large objects such as glasses, cups, balls and so forth, and lateral prehension, during which the thumb moves toward the first finger, allowing one to hold smaller objects such as a piece of paper, a pen or a fork, for example.

The NeuroControl system was developed by a hand surgeon and a bioengineer at Case Western Reserve University in Cleveland, Ohio. Although the first patient was given the device in 1986 and is still using it successfully, the system wasn't given Food and Drug Administration approval for general use until 1997. "The inventors are now working to develop a cap, like a baseball cap, that would contain the external interface, and this will be available in the future," Dr. Fredrickson said. "Today, Medicare and Medicaid both reimburse patients for the cost of the existing system, which runs about $20,000.

"We had been watching the system closely as it developed, and now that we have a San Antonio team in place, we are hoping to perform many more such procedures in the future," he said. The team includes rehabilitation personnel such as Dr. Fredrickson and occupational therapists Mickey Pedraza and Richard Cherry, as well as hand surgeon Dr. Fred G. Corley, professor of orthopaedics at the Health Science Center and staff physician at the V.A., and Dr. Douglas T. Cromack, clinical assistant professor of plastic and reconstructive surgery at the Health Science Center and staff physician at the V.A.

A similar device helps patients gain control over bowel and bladder function, Dr. Fredrickson said. "We are also evaluating patients for that device and have high hopes for its use," he added.

As for Burton, he's gradually building up the muscles in his right arm and hand that have weakened due to inactivity. And the next time he takes a plane flight and the flight attendant asks passengers to turn off their cell phones and other electronic devices, he may have to shut down his hand until the aircraft is in its flight path.


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