Future directions and challenges

The intense scientific research and developmental work in the field of FES that has occurred over the last half century has realized meaningful clinical applications to ameliorate functional deficiencies of serious neurological injuries. Several neuropros-thetic devices have gone through regulatory review and have reached the clinical world. Further development and refinement of this technology will likely enhance the lives of a greater number of patients with disability.

Technological advancements that are currently ongoing relate to the interface to nerve structures and implant stimulator design. The nerve interface is key to the stimulation or inhibition process. Considerable progress has been made in the design of nerve-based electrodes that provide close contact to the nerve. Advanced stimulator designs are now also being realized. A newly emerging technology, called the BIONĀ®, now entering clinical trials in some applications, allows a small single-channel device to be implanted through a cannula into the desired location for activation of the nerve. Multiple units can be controlled through a single encompassing external transmitting coil powered by an external processor, thus enabling some clinical applications to be realized without surgery. The advances in these technologies and the physiological interventions that they enable will make it possible to realize even greater impact in the lives and function of people with neurological disability.

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