Restoring natural sensory feedback in real-time bidirectional hand prostheses

Biomimetic rehabilitation engineering: the importance of somatosensory feedback for brain-machine interfaces

OBJECTIVE

Brain-machine interfaces (BMIs) re-establish communication channels between the nervous system and an external device. The use of BMI technology has generated significant developments in rehabilitative medicine, promising new ways to restore lost sensory-motor functions. However and despite high-caliber basic research, only a few prototypes have successfully left the laboratory and are currently home-deployed.

APPROACH

The failure of this laboratory-to-user transfer likely relates to the absence of BMI solutions for providing naturalistic feedback about the consequences of the BMI's actions. To overcome this limitation, nowadays cutting-edge BMI advances are guided by the principle of biomimicry; i.e. the artificial reproduction of normal neural mechanisms.

MAIN RESULTS

Here, we focus on the importance of somatosensory feedback in BMIs devoted to reproducing movements with the goal of serving as a reference framework for future research on innovative rehabilitation procedures. First, we address the correspondence between users' needs and BMI solutions. Then, we describe the main features of invasive and non-invasive BMIs, including their degree of biomimicry and respective advantages and drawbacks. Furthermore, we explore the prevalent approaches for providing quasi-natural sensory feedback in BMI settings. Finally, we cover special situations that can promote biomimicry and we present the future directions in basic research and clinical applications.

SIGNIFICANCE

The continued incorporation of biomimetic features into the design of BMIs will surely serve to further ameliorate the realism of BMIs, as well as tremendously improve their actuation, acceptance, and use.

Forearm amputees' views of prosthesis use and sensory feedback

STUDY DESIGN

Qualitative descriptive.

INTRODUCTION

The lack of sensory feedback in today's hand prostheses has been in focus recently but the amputees' experiences need to be further investigated.

PURPOSE

To explore forearm amputees' views of prosthesis use and sensory feedback.

METHODS

Thirteen unilateral congenital or traumatic forearm amputees were interviewed. The transcribed text was subjected to content analysis.

RESULTS

Prostheses both facilitate and limit occupational performance. Appearance is important for identity and blending into society. The feeling of agency regarding the prostheses is present but not that of body ownership. Future expectations concerned improved mobility, cosmetics, and sensory feedback.

CONCLUSIONS

This study allows a deeper understanding of the complex relationship between a prosthetic device and the wearer. Today's prostheses allow the wearer to feel agency concerning the artificial limb but the lack of sensory feedback seems to be an important factor still blocking the achievement of body ownership of the prosthesis.

LEVEL OF EVIDENCE

Not applicable.

A neural interface provides long-term stable natural touch perception

Touch perception on the fingers and hand is essential for fine motor control, contributes to our sense of self, allows for effective communication, and aids in our fundamental perception of the world. Despite increasingly sophisticated mechatronics, prosthetic devices still do not directly convey sensation back to their wearers. We show that implanted peripheral nerve interfaces in two human subjects with upper limb amputation provided stable, natural touch sensation in their hands for more than 1 year. Electrical stimulation using implanted peripheral nerve cuff electrodes that did not penetrate the nerve produced touch perceptions at many locations on the phantom hand with repeatable, stable responses in the two subjects for 16 and 24 months. Patterned stimulation intensity produced a sensation that the subjects described as natural and without "tingling," or paresthesia. Different patterns produced different types of sensory perception at the same location on the phantom hand. The two subjects reported tactile perceptions they described as natural tapping, constant pressure, light moving touch, and vibration. Changing average stimulation intensity controlled the size of the percept area; changing stimulation frequency controlled sensation strength. Artificial touch sensation improved the subjects' ability to control grasping strength of the prosthesis and enabled them to better manipulate delicate objects. Thus, electrical stimulation through peripheral nerve electrodes produced long-term sensory restoration after limb loss.

Literature Review on Needs of Upper Limb Prosthesis Users

The loss of one hand can significantly affect the level of autonomy and the capability of performing daily living, working and social activities. The current prosthetic solutions contribute in a poor way to overcome these problems due to limitations in the interfaces adopted for controlling the prosthesis and to the lack of force or tactile feedback, thus limiting hand grasp capabilities. This paper presents a literature review on needs analysis of upper limb prosthesis users, and points out the main critical aspects of the current prosthetic solutions, in terms of users satisfaction and activities of daily living they would like to perform with the prosthetic device. The ultimate goal is to provide design inputs in the prosthetic field and, contemporary, increase user satisfaction rates and reduce device abandonment. A list of requirements for upper limb prostheses is proposed, grounded on the performed analysis on user needs. It wants to (i) provide guidelines for improving the level of acceptability and usefulness of the prosthesis, by accounting for hand functional and technical aspects; (ii) propose a control architecture of PNS-based prosthetic systems able to satisfy the analyzed user wishes; (iii) provide hints for improving the quality of the methods (e.g., questionnaires) adopted for understanding the user satisfaction with their prostheses.

Frontiers of robotic endoscopic capsules: a review

Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd., is an example of disruptive technology and represents an attractive alternative to traditional diagnostic techniques. WCE overcomes conventional endoscopy enabling inspection of the digestive system without discomfort or the need for sedation. Thus, it has the advantage of encouraging patients to undergo gastrointestinal (GI) tract examinations and of facilitating mass screening programmes. With the integration of further capabilities based on microrobotics, e.g. active locomotion and embedded therapeutic modules, WCE could become the key-technology for GI diagnosis and treatment. This review presents a research update on WCE and describes the state-of-the-art of current endoscopic devices with a focus on research-oriented robotic capsule endoscopes enabled by microsystem technologies. The article also presents a visionary perspective on WCE potential for screening, diagnostic and therapeutic endoscopic procedures.

Contact Pressure Level Indication Using Stepped Output Tactile Sensors

In this article, we report on a novel diaphragm-type tactile pressure sensor that produces stepwise output currents depending on varying low contact pressures. When contact pressures are applied to the stepped output tactile sensor (SOTS), the sensor's suspended diaphragm makes contact with the substrate, which completes a circuit by connecting resistive current paths. Then the contact area, and therefore the number of current paths, would determine the stepped output current produced. This mechanism allows SOTS to have high signal-to-noise ratio (>20 dB) in the 3-500 Hz frequency range at contact pressures below 15 kPa. Moreover, since the sensor's operation does not depend on a material's pressure-dependent electrical properties, the SOTS is able to demonstrate high reproducibility and reliability. By forming a 4 × 4 array of SOTS with a surface bump structure, we demonstrated shear sensing as well as surface (1 × 1 cm²) pressure mapping capabilities.

Control of Prosthetic Hands via the Peripheral Nervous System

This paper intends to provide a critical review of the literature on the technological issues on control and sensorization of hand prostheses interfacing with the Peripheral Nervous System (i.e., PNS), and their experimental validation on amputees. The study opens with an in-depth analysis of control solutions and sensorization features of research and commercially available prosthetic hands. Pros and cons of adopted technologies, signal processing techniques and motion control solutions are investigated. Special emphasis is then dedicated to the recent studies on the restoration of tactile perception in amputees through neural interfaces. The paper finally proposes a number of suggestions for designing the prosthetic system able to re-establish a bidirectional communication with the PNS and foster the prosthesis natural control.

Multichannel Electrotactile Feedback With Spatial and Mixed Coding for Closed-Loop Control of Grasping Force in Hand Prostheses

Providing somatosensory feedback to the user of a myoelectric prosthesis is an important goal since it can improve the utility as well as facilitate the embodiment of the assistive system. Most often, the grasping force was selected as the feedback variable and communicated through one or more individual single channel stimulation units (e.g., electrodes, vibration motors). In the present study, an integrated, compact, multichannel solution comprising an array electrode and a programmable stimulator was presented. Two coding schemes (15 levels), spatial and mixed (spatial and frequency) modulation, were tested in able-bodied subjects, psychometrically and in force control with routine grasping and force tracking using real and simulated prosthesis. The results demonstrated that mixed and spatial coding, although substantially different in psychometric tests, resulted in a similar performance during both force control tasks. Furthermore, the ideal, visual feedback was not better than the tactile feedback in routine grasping. To explain the observed results, a conceptual model was proposed emphasizing that the performance depends on multiple factors, including feedback uncertainty, nature of the task and the reliability of the feedforward control. The study outcomes, specific conclusions and the general model, are relevant for the design of closed-loop myoelectric prostheses utilizing tactile feedback.

Microstimulation of the lumbar DRG recruits primary afferent neurons in localized regions of lower limb

Patterned microstimulation of the dorsal root ganglion (DRG) has been proposed as a method for delivering tactile and proprioceptive feedback to amputees. Previous studies demonstrated that large- and medium-diameter afferent neurons could be recruited separately, even several months after implantation. However, those studies did not examine the anatomical localization of sensory fibers recruited by microstimulation in the DRG. Achieving precise recruitment with respect to both modality and receptive field locations will likely be crucial to create a viable sensory neuroprosthesis. In this study, penetrating microelectrode arrays were implanted in the L5, L6, and L7 DRG of four isoflurane-anesthetized cats instrumented with nerve cuff electrodes around the proximal and distal branches of the sciatic and femoral nerves. A binary search was used to find the recruitment threshold for evoking a response in each nerve cuff. The selectivity of DRG stimulation was characterized by the ability to recruit individual distal branches to the exclusion of all others at threshold; 84.7% (n = 201) of the stimulation electrodes recruited a single nerve branch, with 9 of the 15 instrumented nerves recruited selectively. The median stimulation threshold was 0.68 nC/phase, and the median dynamic range (increase in charge while stimulation remained selective) was 0.36 nC/phase. These results demonstrate the ability of DRG microstimulation to achieve selective recruitment of the major nerve branches of the hindlimb, suggesting that this approach could be used to drive sensory input from localized regions of the limb. This sensory input might be useful for restoring tactile and proprioceptive feedback to a lower-limb amputee.

Neural Data-Driven Musculoskeletal Modeling for Personalized Neurorehabilitation Technologies

OBJECTIVES

The development of neurorehabilitation technologies requires the profound understanding of the mechanisms underlying an individual's motor ability and impairment. A major factor limiting this understanding is the difficulty of bridging between events taking place at the neurophysiologic level (i.e., motor neuron firings) with those emerging at the musculoskeletal level (i.e. joint actuation), in vivo in the intact moving human. This review presents emerging model-based methodologies for filling this gap that are promising for developing clinically viable technologies.

METHODS

We provide a design overview of musculoskeletal modeling formulations driven by recordings of neuromuscular activity with a critical comparison to alternative model-free approaches in the context of neurorehabilitation technologies. We present advanced electromyography-based techniques for interfacing with the human nervous system and model-based techniques for translating the extracted neural information into estimates of motor function.

RESULTS

We introduce representative application areas where modeling is relevant for accessing neuromuscular variables that could not be measured experimentally. We then show how these variables are used for designing personalized rehabilitation interventions, biologically inspired limbs, and human-machine interfaces.

CONCLUSION

The ability of using electrophysiological recordings to inform biomechanical models enables accessing a broader range of neuromechanical variables than analyzing electrophysiological data or movement data individually. This enables understanding the neuromechanical interplay underlying in vivo movement function, pathology, and robot-assisted motor recovery.

SIGNIFICANCE

Filling the gap between our understandings of movement neural and mechanical functions is central for addressing one of the major challenges in neurorehabilitation: personalizing current technologies and interventions to an individual's anatomy and impairment.

Restoring motor control and sensory feedback in people with upper extremity amputations using arrays of 96 microelectrodes implanted in the median and ulnar nerves

OBJECTIVE

An important goal of neuroprosthetic research is to establish bidirectional communication between the user and new prosthetic limbs that are capable of controlling >20 different movements. One strategy for achieving this goal is to interface the prosthetic limb directly with efferent and afferent fibres in the peripheral nervous system using an array of intrafascicular microelectrodes. This approach would provide access to a large number of independent neural pathways for controlling high degree-of-freedom prosthetic limbs, as well as evoking multiple-complex sensory percepts.

APPROACH

Utah Slanted Electrode Arrays (USEAs, 96 recording/stimulating electrodes) were implanted for 30 days into the median (Subject 1-M, 31 years post-amputation) or ulnar (Subject 2-U, 1.5 years post-amputation) nerves of two amputees. Neural activity was recorded during intended movements of the subject's phantom fingers and a linear Kalman filter was used to decode the neural data. Microelectrode stimulation of varying amplitudes and frequencies was delivered via single or multiple electrodes to investigate the number, size and quality of sensory percepts that could be evoked. Device performance over time was assessed by measuring: electrode impedances, signal-to-noise ratios (SNRs), stimulation thresholds, number and stability of evoked percepts.

MAIN RESULTS

The subjects were able to proportionally, control individual fingers of a virtual robotic hand, with 13 different movements decoded offline (r = 0.48) and two movements decoded online. Electrical stimulation across one USEA evoked >80 sensory percepts. Varying the stimulation parameters modulated percept quality. Devices remained intrafascicularly implanted for the duration of the study with no significant changes in the SNRs or percept thresholds.

SIGNIFICANCE

This study demonstrated that an array of 96 microelectrodes can be implanted into the human peripheral nervous system for up to 1 month durations. Such an array could provide intuitive control of a virtual prosthetic hand with broad sensory feedback.

Soft implantable microelectrodes for future medicine: prosthetics, neural signal recording and neuromodulation

Implantable devices have provided various potential diagnostic options and therapeutic methods in diverse medical fields. A variety of hard-material-based implantable electrodes have been developed. However, several limitations for their chronic implantation remain, including mechanical mismatches at the interface between the electrode and the soft tissue, and biocompatibility. Soft-material-based implantable devices are suitable candidates for complementing the limitations of hard electrodes. Advances in microtechnology and materials science have largely solved many challenges, such as optimization of shape, minimization of infection, enhancement of biocompatibility and integration with components for diverse functions. Significant strides have also been made in mechanical matching of electrodes to soft tissue. In this review, we provide an overview of recent advances in soft-material-based implantable electrodes for medical applications, categorized according to their implantation site and material composition. We then review specific applications in three categories: neuroprosthetics, neural signal recording, and neuromodulation. Finally, we describe various strategies for the future development and application of implantable, soft-material-based devices.

New Perspectives on Neuroengineering and Neurotechnologies: NSF-DFG Workshop Report

GOAL

To identify and overcome barriers to creating new neurotechnologies capable of restoring both motor and sensory function in individuals with neurological conditions.

METHODS

This report builds upon the outcomes of a joint workshop between the US National Science Foundation and the German Research Foundation on New Perspectives in Neuroengineering and Neurotechnology convened in Arlington, VA, USA, November 13-14, 2014.

RESULTS

The participants identified key technological challenges for recording and manipulating neural activity, decoding, and interpreting brain data in the presence of plasticity, and early considerations of ethical and social issues pertinent to the adoption of neurotechnologies.

CONCLUSIONS

The envisaged progress in neuroengineering requires tightly integrated hardware and signal processing efforts, advances in understanding of physiological adaptations to closed-loop interactions with neural devices, and an open dialog with stakeholders and potential end-users of neurotechnology.

SIGNIFICANCE

The development of new neurotechnologies (e.g., bidirectional brain-computer interfaces) could significantly improve the quality of life of people living with the effects of brain or spinal cord injury, or other neurodegenerative diseases. Focused efforts aimed at overcoming the remaining barriers at the electrode tissue interface, developing implantable hardware with on-board computation, and refining stimulation methods to precisely activate neural tissue will advance both our understanding of brain function and our ability to treat currently intractable disorders of the nervous system.

Reflections on the present and future of upper limb prostheses

Despite progress in research and media attention on active upper limb prostheses, presently the most common commercial upper limb prosthetic devices are not fundamentally different from solutions offered almost one century ago. Limited information transfer for both control and sensory-motor integration and challenges in socket technology have been major obstacles. By analysing the present state-of-the-art and academic achievements, we provide our opinion on the future of upper limb prostheses. We believe that surgical procedures for muscle reinnervation and osseointegration will become increasingly clinically relevant; muscle electrical signals will remain the main clinical means for prosthetic control; and chronic electrode implants, first in muscles (control), then in nerves (sensory feedback), will become viable clinical solutions. After decades of suspended clinically relevant progress, it is foreseeable that a new generation of upper limb prostheses will enter the market in the near future based on such advances, thereby offering substantial clinical benefit for patients.

Intraneural stimulation elicits discrimination of textural features by artificial fingertip in intact and amputee humans

Restoration of touch after hand amputation is a desirable feature of ideal prostheses. Here, we show that texture discrimination can be artificially provided in human subjects by implementing a neuromorphic real-time mechano-neuro-transduction (MNT), which emulates to some extent the firing dynamics of SA1 cutaneous afferents. The MNT process was used to modulate the temporal pattern of electrical spikes delivered to the human median nerve via percutaneous microstimulation in four intact subjects and via implanted intrafascicular stimulation in one transradial amputee. Both approaches allowed the subjects to reliably discriminate spatial coarseness of surfaces as confirmed also by a hybrid neural model of the median nerve. Moreover, MNT-evoked EEG activity showed physiologically plausible responses that were superimposable in time and topography to the ones elicited by a natural mechanical tactile stimulation. These findings can open up novel opportunities for sensory restoration in the next generation of neuro-prosthetic hands.

DOI:http://dx.doi.org/10.7554/eLife.09148.001

Our hands provide us with a wide variety of information about our surroundings, enabling us to detect pain, temperature and pressure. Our sense of touch also allows us to interact with objects by feeling their texture and solidity. However, completely reproducing a sense of touch in artificial or prosthetic hands has proven challenging. While commercial prostheses can mimic the range of movements of natural limbs, even the latest experimental prostheses have only a limited ability to ‘feel’ the objects being manipulated. Oddo, Raspopovic et al. have now brought this ability a step closer by exploiting an artificial fingertip and appropriate neural interfaces through which different textures can be identified.

The initial experiments were performed in four healthy volunteers with intact limbs. Oddo, Raspopovic et al. connected the artificial fingertip to the volunteers via an electrode inserted into a nerve in the arm. When moved over a rough surface, sensors in the fingertip produced patterns of electrical pulses that stimulated the nerve, causing the volunteers to feel like they were touching the surface. The volunteers were even able to tell the difference between the different surface textures the artificial fingertip moved across.

The temporary electrodes used in this group of volunteers are unsuitable for use with prosthetic limbs because they can easily be knocked out of position. Therefore, in a further experiment involving a volunteer who had undergone an arm amputation a number of years previously, Oddo, Raspopovic et al. tested an implanted electrode array that could, in principle, remain in place long-term. This volunteer could also identify the different textures the artificial fingertip touched, with a slightly higher degree of accuracy than the previous group of intact volunteers. Further studies are now required to explore the potential of this approach in larger groups of volunteers.

DOI:http://dx.doi.org/10.7554/eLife.09148.002

Implantable neurotechnologies: electrical stimulation and applications

Neural stimulation using injected electrical charge is widely used both in functional therapies and as an experimental tool for neuroscience applications. Electrical pulses can induce excitation of targeted neural pathways that aid in the treatment of neural disorders or dysfunction of the central and peripheral nervous system. In this review, we summarize the recent trends in the field of electrical stimulation for therapeutic interventions of nervous system disorders, such as for the restoration of brain, eye, ear, spinal cord, nerve and muscle function. Neural prosthetic applications are discussed, and functional electrical stimulation parameters for treating such disorders are reviewed. Important considerations for implantable packaging and enhancing device reliability are also discussed. Neural stimulators are expected to play a profound role in implantable neural devices that treat disorders and help restore functions in injured or disabled nervous system.

A Novel Method to Generate Amplitude-Frequency Modulated Vibrotactile Stimulation

The natural interaction of humans with their environment involves the harmonious coordination of the body, for which multi-modal feedback including vision, proprioception, and tactile perception is essential. Most human-machine interfaces, however, rely on the visual feedback only, and this can lead to considerable cognitive burden. Additional haptic feedback can increase the intuitiveness of the man-machine interaction. Therefore, we propose here a new device able to generate complex vibrotactile stimulation by simultaneously modulating the amplitude and frequency of vibration. Physical measurements were first performed in eight healthy subjects to assess the capability of the device to generate vibrations. The results indicated that the vibration frequency and amplitude can be independently modulated and that the device response to the full-range step-change in the amplitude/frequency commands is almost instantaneous and symmetric. In addition, psychophysical assessments were conducted in four healthy subjects using a standard psychophysical procedure (SIAM). The outcomes indicated that the proposed device can produce approximately 400 vixels (discriminable stimuli), which allow for the generation of a high diversity of vibrotactile patterns. The proposed method allows producing different kinds of stimulation patterns using motor types that are suited for specific applications, with adjustable trade-off between vibration intensity, size, and power consumption.

Toward a Proprioceptive Neural Interface that Mimics Natural Cortical Activity

The dramatic advances in efferent neural interfaces over the past decade are remarkable, with cortical signals used to allow paralyzed patients to control the movement of a prosthetic limb or even their own hand. However, this success has thrown into relief, the relative lack of progress in our ability to restore somatosensation to these same patients. Somatosensation, including proprioception, the sense of limb position and movement, plays a crucial role in even basic motor tasks like reaching and walking. Its loss results in crippling deficits. Historical work dating back decades and even centuries has demonstrated that modality-specific sensations can be elicited by activating the central nervous system electrically. Recent work has focused on the challenge of refining these sensations by stimulating the somatosensory cortex (S1) directly. Animals are able to detect particular patterns of stimulation and even associate those patterns with particular sensory cues. Most of this work has involved areas of the somatosensory cortex that mediate the sense of touch. Very little corresponding work has been done for proprioception. Here we describe the effort to develop afferent neural interfaces through spatiotemporally precise intracortical microstimulation (ICMS). We review what is known of the cortical representation of proprioception, and describe recent work in our lab that demonstrates for the first time, that sensations like those of natural proprioception may be evoked by ICMS in S1. These preliminary findings are an important first step to the development of an afferent cortical interface to restore proprioception.

Insights and Perspectives on Sensory-Motor Integration and Rehabilitation

The present review focuses on the flow and interaction of somatosensory-motor signals in the central and peripheral nervous system. Specifically, where incoming sensory signals from the periphery are processed and interpreted to initiate behaviors, and how ongoing behaviors produce sensory consequences encoded and used to fine-tune subsequent actions. We describe the structure–function relations of this loop, how these relations can be modeled and aspects of somatosensory-motor rehabilitation. The work reviewed here shows that it is imperative to understand the fundamental mechanisms of the somatosensory-motor system to restore accurate motor abilities and appropriate somatosensory feedback. Knowledge of the salient neural mechanisms of sensory-motor integration has begun to generate innovative approaches to improve rehabilitation training following neurological impairments such as stroke. The present work supports the integration of basic science principles of sensory-motor integration into rehabilitation procedures to create new solutions for sensory-motor disorders.

Implantable neurotechnologies: bidirectional neural interfaces--applications and VLSI circuit implementations

A bidirectional neural interface is a device that transfers information into and out of the nervous system. This class of devices has potential to improve treatment and therapy in several patient populations. Progress in very large-scale integration has advanced the design of complex integrated circuits. System-on-chip devices are capable of recording neural electrical activity and altering natural activity with electrical stimulation. Often, these devices include wireless powering and telemetry functions. This review presents the state of the art of bidirectional circuits as applied to neuroprosthetic, neurorepair, and neurotherapeutic systems.

Sensory feedback by peripheral nerve stimulation improves task performance in individuals with upper limb loss using a myoelectric prosthesis

OBJECTIVE

Tactile feedback is critical to grip and object manipulation. Its absence results in reliance on visual and auditory cues. Our objective was to assess the effect of sensory feedback on task performance in individuals with limb loss.

APPROACH

Stimulation of the peripheral nerves using implanted cuff electrodes provided two subjects with sensory feedback with intensity proportional to forces on the thumb, index, and middle fingers of their prosthetic hand during object manipulation. Both subjects perceived the sensation on their phantom hand at locations corresponding to the locations of the forces on the prosthetic hand. A bend sensor measured prosthetic hand span. Hand span modulated the intensity of sensory feedback perceived on the thenar eminence for subject 1 and the middle finger for subject 2. We performed three functional tests with the blindfolded subjects. First, the subject tried to determine whether or not a wooden block had been placed in his prosthetic hand. Second, the subject had to locate and remove magnetic blocks from a metal table. Third, the subject performed the Southampton Hand Assessment Procedure (SHAP). We also measured the subject's sense of embodiment with a survey and his self-confidence.

MAIN RESULTS

Blindfolded performance with sensory feedback was similar to sighted performance in the wooden block and magnetic block tasks. Performance on the SHAP, a measure of hand mechanical function and control, was similar with and without sensory feedback. An embodiment survey showed an improved sense of integration of the prosthesis in self body image with sensory feedback.

SIGNIFICANCE

Sensory feedback by peripheral nerve stimulation improved object discrimination and manipulation, embodiment, and confidence. With both forms of feedback, the blindfolded subjects tended toward results obtained with visual feedback.

Neural interfaces for somatosensory feedback: bringing life to a prosthesis

PURPOSE OF REVIEW

When an individual loses a limb, he/she loses touch with the world and with the people around him/her. Somatosensation is critical to the feeling of connection and control of one's own body. Decades of attempts to replace lost somatosensation by sensory substitutions have been ineffective outside of the laboratory. This review discusses important recent results demonstrating chronic somatosensory restoration through direct peripheral nerve stimulation.

RECENT FINDINGS

Stimulation of peripheral nerves results in somatosensory perception on the phantom limb. Sensations are localized to several independent and functionally relevant locations, such as the fingertips, thenar eminence, ulnar border and dorsal surface. Patterns in stimulation intensity change the perception experience by the user, opening new dimensions on neuromodulation.

SUMMARY

Neural interfaces with sophisticated stimulation paradigms create a user's perception of his/her hand to touch and manipulate objects. The pattern of intensity and frequency of stimulation is critical to the quality and intensity of perceived sensation. Restoring feeling has allowed the individuals to, 'feel [my] hand for the first time since the accident,' and 'feel [my] wife touch my hand'. Individuals using a prosthetic hand with sensation can pull cherries and grapes from the stem, open water bottles and move objects without destroying these objects - all while audio and visually deprived. After regaining sensation, phantom pain is eliminated in individuals that had frequent, sometimes debilitating, pain following limb loss. With over 5 subject-years of experience, this work is leading the evolution of a new era in prostheses. Somatosensory prosthetics as a standard procedure to augment and restore somatosensation are now within our reach.

Control Capabilities of Myoelectric Robotic Prostheses by Hand Amputees: A Scientific Research and Market Overview

Hand amputation can dramatically affect the capabilities of a person. Cortical reorganization occurs in the brain, but the motor and somatosensorial cortex can interact with the remnant muscles of the missing hand even many years after the amputation, leading to the possibility to restore the capabilities of hand amputees through myoelectric prostheses. Myoelectric hand prostheses with many degrees of freedom are commercially available and recent advances in rehabilitation robotics suggest that their natural control can be performed in real life. The first commercial products exploiting pattern recognition to recognize the movements have recently been released, however the most common control systems are still usually unnatural and must be learned through long training. Dexterous and naturally controlled robotic prostheses can become reality in the everyday life of amputees but the path still requires many steps. This mini-review aims to improve the situation by giving an overview of the advancements in the commercial and scientific domains in order to outline the current and future chances in this field and to foster the integration between market and scientific research.

Non-Invasive, Temporally Discrete Feedback of Object Contact and Release Improves Grasp Control of Closed-Loop Myoelectric Transradial Prostheses

Human grasping and manipulation control critically depends on tactile feedback. Without this feedback, the ability for fine control of a prosthesis is limited in upper limb amputees. Although various approaches have been investigated in the past, at present there is no commercially available device able to restore tactile feedback in upper limb amputees. Based on the Discrete Event-driven Sensory feedback Control (DESC) policy we present a device able to deliver short-lasting vibrotactile feedback to transradial amputees using commercially available myoelectric hands. The device (DESC-glove) comprises sensorized thimbles to be placed on the prosthesis digits, a battery-powered electronic board, and vibrating units embedded in an arm-cuff being transiently activated when the prosthesis makes and breaks contact with objects. The consequences of using the DESC-glove were evaluated in a longitudinal study. Five transradial amputees were equipped with the device for one month at home. Through a simple test proposed here for the first time-the virtual eggs test-we demonstrate the effectiveness of the device for prosthetic control in daily life conditions. In the future the device could be easily exploited as an add-on to complement myoelectric prostheses or even embedded in prosthetic sockets to enhance their control by upper limb amputees.

Estimation of the Electrode-Fiber Bioelectrical Coupling From Extracellularly Recorded Single Fiber Action Potentials

Selective peripheral neural interfaces are currently capable of detecting minute electrical signals from nearby nerve fibers as single fiber action potential (SFAP) waveforms. Each detected single unit has a distinct shape originating from the unique bioelectrical coupling that exists between the neuroprosthetic electrode, the nerve fiber and the extracellular milieu. The bioelectrical coupling manifests itself as a series of low-pass Bessel filters acting on the action currents along the nerve fiber. Here, we present a method to estimate the electrode-fiber bioelectrical coupling through a quantitative analysis of the spectral distribution of the single units extracellularly recorded with the thin-film longitudinal intrafascicular electrode (tfLIFE) in an in vivo mammalian peripheral nerve animal model. The bioelectrical coupling estimate is an estimate of the electrode sensitivity function traversed by the nerve fiber, suggesting that it is as a means to directly measure the spatial relationship between the nerve fiber and electrode. It not only reflects a shape change to the SFAP, but has implications for in situ nerve fiber location tracking, in situ diagnostics of nerves and neuroproshetic electrodes, and assessment of the biocompatibility of neural interfaces and the health of the reporting nerve fibers.

Anatomical Network Comparison of Human Upper and Lower, Newborn and Adult, and Normal and Abnormal Limbs, with Notes on Development, Pathology and Limb Serial Homology vs. Homoplasy

How do the various anatomical parts (modules) of the animal body evolve into very different integrated forms (integration) yet still function properly without decreasing the individual's survival? This long-standing question remains unanswered for multiple reasons, including lack of consensus about conceptual definitions and approaches, as well as a reasonable bias toward the study of hard tissues over soft tissues. A major difficulty concerns the non-trivial technical hurdles of addressing this problem, specifically the lack of quantitative tools to quantify and compare variation across multiple disparate anatomical parts and tissue types. In this paper we apply for the first time a powerful new quantitative tool, Anatomical Network Analysis (AnNA), to examine and compare in detail the musculoskeletal modularity and integration of normal and abnormal human upper and lower limbs. In contrast to other morphological methods, the strength of AnNA is that it allows efficient and direct empirical comparisons among body parts with even vastly different architectures (e.g. upper and lower limbs) and diverse or complex tissue composition (e.g. bones, cartilages and muscles), by quantifying the spatial organization of these parts-their topological patterns relative to each other-using tools borrowed from network theory. Our results reveal similarities between the skeletal networks of the normal newborn/adult upper limb vs. lower limb, with exception to the shoulder vs. pelvis. However, when muscles are included, the overall musculoskeletal network organization of the upper limb is strikingly different from that of the lower limb, particularly that of the more proximal structures of each limb. Importantly, the obtained data provide further evidence to be added to the vast amount of paleontological, gross anatomical, developmental, molecular and embryological data recently obtained that contradicts the long-standing dogma that the upper and lower limbs are serial homologues. In addition, the AnNA of the limbs of a trisomy 18 human fetus strongly supports Pere Alberch's ill-named "logic of monsters" hypothesis, and contradicts the commonly accepted idea that birth defects often lead to lower integration (i.e. more parcellation) of anatomical structures.

Tactile Feedback of Object Slip Facilitates Virtual Object Manipulation

Recent advances in myoelectric prosthetic technology have enabled more complex movements and interactions with objects, but the lack of natural haptic feedback makes object manipulation difficult to perform. Our research effort aims to develop haptic feedback systems for improving user performance in object manipulation. Specifically, in this work, we explore the effectiveness of vibratory tactile feedback of slip information for grasping objects without slipping. A user interacts with a virtual environment to complete a virtual grasp and hold task using a Sensable Phantom. Force feedback simulates contact with objects, and vibratory tactile feedback alerts the user when a virtual object is slipping from the grasp. Using this task, we found that tactile feedback significantly improved a user's ability to detect and respond to slip and to recover the slipping object when visual feedback was not available. This advantage of tactile feedback is especially important in conjunction with force feedback, which tends to reduce a subject's grasping forces and therefore encourage more slips. Our results demonstrate the potential of slip feedback to improve a prosthesis user's ability to interact with objects with less visual attention, aiding in performance of everyday manipulation tasks.

Chronic multichannel neural recordings from soft regenerative microchannel electrodes during gait

Reliably interfacing a nerve with an electrode array is one of the approaches to restore motor and sensory functions after an injury to the peripheral nerve. Accomplishing this with current technologies is challenging as the electrode-neuron interface often degrades over time, and surrounding myoelectric signals contaminate the neuro-signals in awake, moving animals. The purpose of this study was to evaluate the potential of microchannel electrode implants to monitor over time and in freely moving animals, neural activity from regenerating nerves. We designed and fabricated implants with silicone rubber and elastic thin-film metallization. Each implant carries an eight-by-twelve matrix of parallel microchannels (of 120 × 110 μm² cross-section and 4 mm length) and gold thin-film electrodes embedded in the floor of ten of the microchannels. After sterilization, the soft, multi-lumen electrode implant is sutured between the stumps of the sciatic nerve. Over a period of three months and in four rats, the microchannel electrodes recorded spike activity from the regenerating sciatic nerve. Histology indicates mini-nerves formed of axons and supporting cells regenerate robustly in the implants. Analysis of the recorded spikes and gait kinematics over the ten-week period suggests firing patterns collected with the microchannel electrode implant can be associated with different phases of gait.

Effects of Different Tactile Feedback on Myoelectric Closed-Loop Control for Grasping Based on Electrotactile Stimulation

Closed-loop control is important for amputees to manipulate myoelectric prostheses intuitively and dexterously. Tactile feedback can help amputees improve myoelectric control performance for grasping objects. To investigate the effects of different tactile feedback, we performed experiments on six amputees and six able-bodied subjects via electrotactile stimulation. Using a virtual environment, six kinds of objects with different weights and stiffnesses were used for grasping tasks. Five feedback conditions (no feedback, pressure feedback, slip feedback, pressure + slip feedback, and vision feedback) were considered. Nine evaluation indexes and three control objectives (rapidity, economy, and stability) were proposed. Under the five feedback conditions, our study investigated four issues: 1) three types of grasping-related failures; 2) four types of grasping-related time measures; 3) average grasping force; 4) standard deviation of the grasping force. Results indicate that: 1) slip feedback is better than pressure feedback; 2) pressure + slip feedback can improve grasping rapidity; 3) slip feedback significantly contributes to grasping economy and stability; and 4) pressure + slip feedback can perform as well as vision feedback.

Flexible Epineural Strip Electrode for Recording in Fine Nerves

This paper demonstrates flexible epineural strip electrodes (FLESE) for recording from small nerves. Small strip-shaped FLESE enables us to easily and closely stick on various sized nerves for less damage in a nerve and optimal recording quality. In addition, in order to enhance the neural interface, the gold electrode contacts were coated with carbon nanotubes, which reduced the impedance of the electrodes. We used the FLESEs to record electrically elicited nerve signals (compound neural action potentials) from the sciatic nerve in rats. Bipolar and differential bipolar configurations for the recording were investigated to optimize the recording configuration of the FLESEs. The successful results from differential bipolar recordings showed that the total length of FLESEs could be further reduced, maintaining the maximum recording ability, which would be beneficial for recording in very fine nerves. Our results demonstrate that new concept of FLESEs could play an important role in electroceuticals in near future.

Nanostructured platinum grass enables superior impedance reduction for neural microelectrodes

Micro-sized electrodes are essential for highly sensitive communication at the neural interface with superior spatial resolution. However, such small electrodes inevitably suffer from high electrical impedance and thus high levels of thermal noise deteriorating the signal to noise ratio. In order to overcome this problem, a nanostructured Pt-coating was introduced as add-on functionalization for impedance reduction of small electrodes. In comparison to platinum black deposition, all used chemicals in the deposition process are free from cytotoxic components. The grass-like nanostructure was found to reduce the impedance by almost two orders of magnitude compared to untreated samples which was lower than what could be achieved with conventional electrode coatings like IrOx or PEDOT. The realization of the Pt-grass coating is performed via a simple electrochemical process which can be applied to virtually any possible electrode type and accordingly shows potential as a universal impedance reduction strategy. Elution tests revealed non-toxicity of the Pt-grass and the coating was found to exhibit strong adhesion to the metallized substrate.

Moving Along: In biomechanics, rehabilitation engineering, and movement analysis, Italian researchers are making great strides

In Italy, biomechanics research and the analysis of human and animal movement have had a very long history, beginning with the exceptional pioneering work of Leonardo da Vinci. In 1489, da Vinci began investigating human anatomy, including an examination of human tendons, muscles, and the skeletal system. He continued this line of inquiry later in life, identifying what he called "the four powers--movement, weight, force, and percussion"--and how he thought they worked in the human body. His approach, by the way, was very modern--analyzing nature through anatomy, developing models for interpretation, and transferring this knowledge to bio-inspired machines.

Deafferented controllers: a fundamental failure mechanism in cortical neuroprosthetic systems

Brain-machine interface (BMI) research assumes that patients with disconnected neural pathways could naturally control a prosthetic device by volitionally modulating sensorimotor cortical activity usually responsible for movement coordination. However, computational approaches to motor control challenge this view. This article examines the predictions of optimal feedback control (OFC) theory on the effects that loss of motor output and sensory feedback have on the normal generation of motor commands. Example simulations of unimpaired, totally disconnected, and deafferented controllers illustrate that by neglecting the dynamic interplay between motor commands, state estimation, feedback and behavior, current BMI systems face translational challenges rooted in a debatable assumption and experimental models of limited validity.