Selecting candidates for a lower limb stimulator implant programme: A patient-centred method

• Published in: Spinal cord 1998-05, Vol.36 (5), p.303-309
• Main Authors: Rushton, D N, Barr, F M D, Donaldson, N de N, Harper, V J, Perkins, T A, Taylor, P N, Tromans, A M
• Format: Article
• Language: English
• Subjects: Adult; Anatomy; Anxiety - etiology; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Bone Density; Cerebrospinal fluid. Meninges. Spinal cord; Depression - etiology; Electric Stimulation Therapy - instrumentation; Female; Human Physiology; Humans; Leg - blood supply; Leg - surgery; Male; Medical sciences; Middle Aged; Muscle Spasticity - physiopathology; Muscles - pathology; Muscles - physiopathology; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; original-article; Paraplegia - physiopathology; Paraplegia - psychology; Paraplegia - therapy; Patient-Centered Care; Personnel Selection; Physical Endurance - physiology; Prostheses and Implants; Regional Blood Flow - physiology; Torque
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sj.sc.3100635

Objective:  To develop an effective selection procedure for lower limb functional neurostimulation (LLFNS) for standing in paraplegia. Design:  The selection procedure and exclusion criteria were based on the previous experience of two clinical centres with experience of LLFNS. Setting:  Two Regional Spinal Injuries units in southern England. Subjects:  254 fully rehabilitated paraplegics living in the community. Intervention:  Patients were invited to participate in the programme, and if suitable to subject themselves to a rigorous staged selection procedure from which they could withdraw at any time. Outcome measure:  Functionally successful home standing using closed-loop surface electrical stimulation. Results:  57/254 patients were suitable on paper and were accessible. 19 of these (CI=10–28) were interested in the project and attended one of the spinal centres for details. Twelve (CI=5–19) of these fulfilled the selection criteria and started on the training programme; and 10 of them completed the muscle training programme successfully. Seven patients (CI=2–12) achieved closed-loop standing in the laboratory and four patients (CI=1–8) did so at home.