Personalised approach to restoration of arm function in people with high-level tetraplegia

This project aims to develop efficient methods for personalising assistive technology to restore arm function in people with high-level spinal cord injury. We will use a combination of electrical stimulation to elicit forces in muscles no longer under voluntary control, and mobile arm supports to compensate for insufficient muscle force where necessary. We will use computational models specific to an individual's functional limitations to produce patient-specific interventions. The project will be in three phases: building a model to predict the effects of electrical stimulation on a paralysed arm with arm support, development of methodologies using this model to optimise the arm support and stimulation system, and testing of stimulation controllers designed using this approach. The project brings together experts in biomechanics and musculoskeletal modelling, spinal cord injury rehabilitation and assistive technologies.

Patients and carers

Spinal cord injury is a life-changing condition that impacts on a person's independence, dignity and quality of life. Patients living with paralysis of their arms are dependent on carers for many activities of daily living and have severely reduced opportunities for participation in social and work-related activities. This project aims to develop personalised interventions to give back independent movement to people who cannot use their arms following spinal cord injury. This will enable a substantial increase in the independence and participation of people with spinal cord injury through provision of a long-term assistive device. In the case of incomplete injuries, the ability to take part in exercise and rehabilitation of the upper limb may also lead to improvement in the function of the neuromuscular system. Increasing the independence and participation in this group will also lead to a reduction in the burden placed on carers by severe arm disability.

Societal benefits

There are around 40,000 people living with spinal cord injury in the UK, and over half of these have paralysis of the upper limbs, as well as the lower. SCI imposes a significant burden not only on the people who suffer them, but also on society at large. The costs of SCI to the economy in terms of lost capacity for work, the burden of care and the longer term consequences of lack of participation are significant. Designing interventions where currently there are no treatment options could reduce the burden of care and offer potentially large societal benefits.

Clinical staff and the NHS

One of the outputs of the project will be patient-specific models of the upper limb neuromuscular system. These could be used to improve treatments not just for spinal cord injury, but upper limb functional problems associated with other conditions such as stroke, multiple sclerosis and joint disease. For example, it could help therapists design targeted task-specific practice that could accelerate gains in arm function.

Industrial beneficiaries

Patient-specific models of the upper limb neuromuscular system could also be used as a virtual testing platform for the development of new devices, which will benefit device manufacturers by leading to accelerated design and testing of assistive devices. For example, it could lead to the development of robotic devices to assist upper limb function, or customised prosthetic and orthotic devices. Such devices would be of great benefit both to patients and to the commercial entities that produce them.