TetraGrip - a four channel upper limb FES device for people with C5/C6 tetraplegia: device design and clinical outcome.

The TetraGrip is an inertial measurement unit-controlled surface upper limb FES device developed for improving hand functions of people with tetraplegia. The reliability of the control system and the repeatability and reproducibility of the device were assessed by analysing the results obtained when 14 able-bodied volunteers used the device. These volunteers were able to generate the control signals effectively once they had sufficient training. The two tetraplegic volunteers participated in a 12-week long clinical study (exercise, 4 weeks; functional tasks, 8 weeks), where they used the device to perform functional tasks. Outcome measures used were the grasp release test, the grip strength test, and the box and block test. Both tetraplegic volunteers showed improvement in performing the tasks specified in all outcome measures. The TetraGrip performed as intended when the able-bodied volunteers used it, and it improved the hand functions of both volunteers with tetraplegia. However, a larger clinical study is necessary to assess the performance of the device with a wider range of people with tetraplegia such as those with C5 complete/incomplete.

Extended-interval gentamicin administration in neonates: a simplified approach.

OBJECTIVE: Gentamicin dosing is highly variable and remains complicated in the neonatal population. Traditional dosing in our unit resulted in an excessive number of elevated trough serum gentamicin levels. We hypothesized that one uniform gentamicin dose for neonates of all gestational ages will reduce the incidence of elevated trough levels from 50 to 10%. STUDY DESIGN: Our prospective, randomized, controlled trial enrolled eligible neonates into two groups, according to gestational age (⩽34 6/7 (group I) and >35 0/7 weeks (group II)). Patients in the study arm received a dose of gentamicin 5 mg kg(-1) intravenous (i.v.) every 36 h, whereas patients in the control arm received traditional dosage. Patients were monitored for resolution of infection, serum gentamicin levels and adverse effects. We confirmed our findings in a follow-up study. Fisher's exact and Mann-Whitney tests were used for statistical analysis. RESULTS: We enrolled 96 neonates, 50 in group I (n=25 per arm) and 46 in group II (n=23 per arm). Elevated trough levels were reduced by 66% in group I (P=0.61) and 100% in group II (P=0.0015). In the study arm of both groups, 48/49 neonates had Cmin serum gentamicin concentration (SGC) <2 mg l(-1) and the majority had a trough SGC <1 mg l(-1) (P<0.0001). The study dose resulted in maximum gentamicin levels in the goal range and a 50% reduction in dosage modifications. There were no treatment failures or adverse effects. Our follow-up study phase confirmed these results. CONCLUSION: A standardized gentamicin dosage of 5 mg kg(-1) i.v. every 36 h to neonates of all gestational ages was safe and resulted in SGCs in goal therapeutic ranges. The implications of this simplified gentamicin dosage are to reduce health-care costs by less frequent dosing of gentamicin and reducing medication errors in physician prescribing from complicated dosing schemes.

Upper limb functional electrical stimulation devices and their man-machine interfaces.

Functional Electrical Stimulation (FES) is a technique that uses electricity to activate the nerves of a muscle that is paralysed due to hemiplegia, multiple sclerosis, Parkinson's disease or spinal cord injury (SCI). FES has been widely used to restore upper limb functions in people with hemiplegia and C5-C7 tetraplegia and has improved their ability to perform their activities of daily living (ADL). At the time of writing, a detailed literature review of the existing upper limb FES devices and their man-machine interfaces (MMI) showed that only the NESS H200 was commercially available. However, the rigid arm splint doesn't fit everyone and prevents the use of a tenodesis grip. Hence, a robust and versatile upper limb FES device that can be used by a wider group of people is required.