Restoring natural sensory feedback in real-time bidirectional hand prostheses

Safety of long-term electrical peripheral nerve stimulation: review of the state of the art

BACKGROUND

Electrical stimulation of peripheral nerves is used in a variety of applications such as restoring motor function in paralyzed limbs, and more recently, as means to provide intuitive sensory feedback in limb prostheses. However, literature on the safety requirements for stimulation is scarce, particularly for chronic applications. Some aspects of nerve interfacing such as the effect of stimulation parameters on electrochemical processes and charge limitations have been reviewed, but often only for applications in the central nervous system. This review focuses on the safety of electrical stimulation of peripheral nerve in humans.

METHODS

We analyzed early animal studies evaluating damage thresholds, as well as more recent investigations in humans. Safety requirements were divided into two main categories: passive and active safety. We made the distinction between short-term (< 30 days) and chronic (> 30 days) applications, as well as between electrode preservation (biostability) and body tissue healthy survival (harmlessness). In addition, transferability of experimental results between different tissues and species was considered.

RESULTS

At present, extraneural electrodes have shown superior long-term stability in comparison to intraneural electrodes. Safety limitations on pulse amplitude (and consequently, charge injection) are dependent on geometrical factors such as electrode placement, size, and proximity to the stimulated fiber. In contrast, other parameters such as stimulation frequency and percentage of effective stimulation time are more generally applicable. Currently, chronic stimulation at frequencies below 30 Hz and percentages of effective stimulation time below 50% is considered safe, but more precise data drawn from large databases are necessary. Unfortunately, stimulation protocols are not systematically documented in the literature, which limits the feasibility of meta-analysis and impedes the generalization of conclusions. We therefore propose a standardized list of parameters necessary to define electrical stimulation and allow future studies to contribute to meta-analyses.

CONCLUSION

The safety of chronic continuous peripheral nerve stimulation at frequencies higher than 30 Hz has yet to be documented. Precise parameter values leading to stimulation-induced depression of neuronal excitability (SIDNE) and neuronal damage, as well as the transition between the two, are still lacking. At present, neural damage mechanisms through electrical stimulation remain obscure.

Morphological/nanostructural control toward intrinsically stretchable organic electronics

The development of intrinsically stretchable electronics poses great challenges in synthesizing elastomeric conductors, semiconductors and dielectric materials.

Developing Next-generation Brain Sensing Technologies - A Review

Advances in sensing technology raise the possibility of creating neural interfaces that can more effectively restore or repair neural function and reveal fundamental properties of neural information processing. To realize the potential of these bioelectronic devices, it is necessary to understand the capabilities of emerging technologies and identify the best strategies to translate these technologies into products and therapies that will improve the lives of patients with neurological and other disorders. Here we discuss emerging technologies for sensing brain activity, anticipated challenges for translation, and perspectives for how to best transition these technologies from academic research labs to useful products for neuroscience researchers and human patients.

Feel-Good Robotics: Requirements on Touch for Embodiment in Assistive Robotics

The feeling of embodiment, i.e., experiencing the body as belonging to oneself and being able to integrate objects into one's bodily self-representation, is a key aspect of human self-consciousness and has been shown to importantly shape human cognition. An extension of such feelings toward robots has been argued as being crucial for assistive technologies aiming at restoring, extending, or simulating sensorimotor functions. Empirical and theoretical work illustrates the importance of sensory feedback for the feeling of embodiment and also immersion; we focus on the the perceptual level of touch and the role of tactile feedback in various assistive robotic devices. We critically review how different facets of tactile perception in humans, i.e., affective, social, and self-touch, might influence embodiment. This is particularly important as current assistive robotic devices – such as prostheses, orthoses, exoskeletons, and devices for teleoperation–often limit touch low-density and spatially constrained haptic feedback, i.e., the mere touch sensation linked to an action. Here, we analyze, discuss, and propose how and to what degree tactile feedback might increase the embodiment of certain robotic devices, e.g., prostheses, and the feeling of immersion in human-robot interaction, e.g., in teleoperation. Based on recent findings from cognitive psychology on interactive processes between touch and embodiment, we discuss technical solutions for specific applications, which might be used to enhance embodiment, and facilitate the study of how embodiment might alter human-robot interactions. We postulate that high-density and large surface sensing and stimulation are required to foster embodiment of such assistive devices.

Artificial tactile and proprioceptive feedback improves performance and confidence on object identification tasks

Somatosensory feedback of the hand is essential for object identification. Without somatosensory feedback, individuals cannot reliably determine the size or compliance of an object. Electrical nerve stimulation can restore localized tactile and proprioceptive feedback with intensity discrimination capability similar to natural sensation. We hypothesized that adding artificial somatosensation improves object recognition accuracy when using a prosthesis. To test this hypothesis, we provided different forms of sensory feedback–tactile, proprioceptive, or both–to two subjects with upper limb loss. The subjects were asked to identify the size or mechanical compliance of different foam blocks placed in the prosthetic hand while visually and audibly blinded. During trials, we did not inform the subjects of their performance, but did ask them about their confidence in correctly identifying objects. Finally, we recorded applied pressures during object interaction. Subjects were free to use any strategy they chose to examine the objects. Object identification was most accurate with both tactile and proprioceptive feedback. The relative importance of each type of feedback, however, depended on object characteristics and task. Sensory feedback increased subject confidence and was directly correlated with accuracy. Subjects applied less pressure to the objects when they had tactile pressure feedback. Artificial somatosensory feedback improves object recognition and the relative importance of tactile versus proprioceptive feedback depends on the test set. We believe this test battery provides an effective means to assess the impact of sensory restoration and the relative contribution of different forms of feedback (tactile vs. kinesthetic) within the neurorehabilitation field.

Innovations in electrical stimulation harness neural plasticity to restore motor function

Novel technology and innovative stimulation paradigms allow for unprecedented spatiotemporal precision and closed-loop implementation of neurostimulation systems. In turn, precise, closed-loop neurostimulation appears to preferentially drive neural plasticity in motor networks, promoting neural repair. Recent clinical studies demonstrate that electrical stimulation can drive neural plasticity in damaged motor circuits, leading to meaningful improvement in users. Future advances in these areas hold promise for the treatment of a wide range of motor systems disorders.

Evaluation of Time-Domain Features of Sensory ENG Signals

In the development of closed-loop prostheses that record from the patient's own nerves to provide sensory feedback, it is first necessary to determine the features of sensory signals that may help to identify different sensations. The aim of this work was to investigate different time-domain features for separation of sensory electroneurographic signals. To do this, sensory signals were elicited in response to mechanical stimulation of the rat hindpaw and these signals were recorded from a cuff electrode array placed on the sciatic nerve. Thirteen features were extracted, including: mean absolute value, variance, waveform length and ten time-domain descriptors that were recently proposed for classification of electromyographic signals. These features were individually fed into a linear discriminant analysis classifier. The results showed that the best overall performing features were the mean absolute value and waveform length. Additionally, six of the ten time-domain descriptors showed a comparable performance to these two features. This indicates that these features could be used as a tool to aid our understanding of the sensory neural signals recorded and further improve classification results. Enhanced classification of electroneurographic signals will provide the opportunity to develop more efficacious sensory-motor prostheses in the future.

Positioning the Nerve Cuff Distally on the Sciatic Nerve Improves the Classification of Ankle-Movement Proprioceptive ENG Signals

Recording of neural signals from intact peripheral nerves in patients with spinal cord injury or stroke survivors offers the possibility for the development of closed-loop sensorimotor prostheses. However, questions remain over the positioning of neural interfaces such that the separability of neural data recorded from the peripheral nerves is improved. Afferent electroneurographic signals were recorded with nerve cuffs placed on the sciatic nerve of rats in response to various mechanical stimuli to the hindpaw. The mean absolute value of the signal was extracted and fed into classifiers. The performance of the classifier was evaluated when information was available from a single cuff placed either distally or proximally on the sciatic nerve. Results confirmed earlier findings that proprioceptive ENG signals, elicited by the movement of the ankle, can be identified and separated in neural recordings made with a cuff electrode. In addition, classification scores improved when the nerve cuff was placed distally on the nerve rather than proximally, taking advantage of the nerve's underlying anatomy.

Comparison of linear frequency and amplitude modulation for intraneural sensory feedback in bidirectional hand prostheses

Recent studies have shown that direct nerve stimulation can be used to provide sensory feedback to hand amputees. The intensity of the elicited sensations can be modulated using the amplitude or frequency of the injected stimuli. However, a comprehensive comparison of the effects of these two encoding strategies on the amputees' ability to control a prosthesis has not been performed. In this paper, we assessed the performance of two trans-radial amputees controlling a myoelectric hand prosthesis while receiving grip force sensory feedback encoded using either linear modulation of amplitude (LAM) or linear modulation of frequency (LFM) of direct nerve stimulation (namely, bidirectional prostheses). Both subjects achieved similar and significantly above-chance performance when they were asked to exploit LAM or LFM in different tasks. The feedbacks allowed them to discriminate, during manipulation through the robotic hand, objects of different compliances and shapes or different placements on the prosthesis. Similar high performances were obtained when they were asked to apply different levels of force in a random order on a dynamometer using LAM or LFM. In contrast, only the LAM strategy allowed the subjects to continuously modulate the grip pressure on the dynamometer. Furthermore, when long-lasting trains of stimulation were delivered, LFM strategy generated a very fast adaptation phenomenon in the subjects, which caused them to stop perceiving the restored sensations. Both encoding approaches were perceived as very different from the touch feelings of the healthy limb (natural). These results suggest that the choice of specific sensory feedback encodings can have an effect on user performance while grasping. In addition, our results invite the development of new approaches to provide more natural sensory feelings to the users, which could be addressed by a more biomimetic strategy in the future.

Micro-channel sieve electrode for concurrent bidirectional peripheral nerve interface. Part A: recording

OBJECTIVE

Advancement in prosthetic limb technology requires corresponding improvements in the capability of the amputee to naturally control the device via original motor pathways while simultaneously receiving haptic feedback via sensory pathways. Recording efferent axonal activity using a peripheral neural interface (PNI) allows a good tradeoff between invasiveness and selectivity while possibly preserving the phenomenology of controlling the original limb. One such PNI, the thin-film transverse intrafascicular multichannel electrode (tfTIME), has been shown to be successful in controlling powered prosthetics. However, the tfTIME is highly susceptible to stimulation artifact; thus, using such a PNI to both record efferent motor signals while concurrently stimulating afferent sensory axons in the same nerve is problematic. The micro-channel sieve electrode could also provide a stable, selective, neural interface with larger signal-to-noise levels that are less susceptible to concurrent stimulation artifact or other external noise effects.

APPROACH

This study uses a computational model to compare recording levels of simulated ENGs across neural drive levels as well as basic control signals derived from the ENGs in both tfTIME and micro-channel sieve PNIs. A motor neuron pool model generated axon firing rates at a given neural drive. The time course of the corresponding extracellular currents of the myelinated motor axons were determined using core conductor axon models. Finite element models determined the contribution of the extracellular current from nodes of Ranvier on potentials recorded using each interface. Contributions from each node were combined to create the final ENG.

MAIN RESULTS

ENGs recorded using the micro-channel sieves were shown to have much higher amplitudes compared to ENGs recorded using the tfTIMEs. Signal amplitudes also varied less as a function of axonal placement and spike timing, resulting in more consistent signals with amplitudes determined predominantly by neural drive.

SIGNIFICANCE

Simulation results suggest that the micro-channel sieve provides higher quality control signals over tfTIME PNIs in decoding ENGs. Coupling these results with concurrent stimulation results of the companion paper (Part B: stimulation) suggests that the micro-channel sieve is an optimal bidirectional PNI.

The critical stability task: quantifying sensory-motor control during ongoing movement in nonhuman primates

Everyday behaviors require that we interact with the environment, using sensory information in an ongoing manner to guide our actions. Yet, by design, many of the tasks used in primate neurophysiology laboratories can be performed with limited sensory guidance. As a consequence, our knowledge about the neural mechanisms of motor control is largely limited to the feedforward aspects of the motor command. To study the feedback aspects of volitional motor control, we adapted the critical stability task (CST) from the human performance literature (Jex H, McDonnell J, Phatak A. IEEE Trans Hum Factors Electron 7: 138-145, 1966). In the CST, our monkey subjects interact with an inherently unstable (i.e., divergent) virtual system and must generate sensory-guided actions to stabilize it about an equilibrium point. The difficulty of the CST is determined by a single parameter, which allows us to quantitatively establish the limits of performance in the task for different sensory feedback conditions. Two monkeys learned to perform the CST with visual or vibrotactile feedback. Performance was better under visual feedback, as expected, but both monkeys were able to utilize vibrotactile feedback alone to successfully perform the CST. We also observed changes in behavioral strategy as the task became more challenging. The CST will have value for basic science investigations of the neural basis of sensory-motor integration during ongoing actions, and it may also provide value for the design and testing of bidirectional brain computer interface systems. NEW & NOTEWORTHY Currently, most behavioral tasks used in motor neurophysiology studies require primates to make short-duration, stereotyped movements that do not necessitate sensory feedback. To improve our understanding of sensorimotor integration, and to engineer meaningful artificial sensory feedback systems for brain-computer interfaces, it is crucial to have a task that requires sensory feedback for good control. The critical stability task demands that sensory information be used to guide long-duration movements.

A microfabricated nerve-on-a-chip platform for rapid assessment of neural conduction in explanted peripheral nerve fibers

Peripheral nerves are anisotropic and heterogeneous neural tissues. Their complex physiology restricts realistic in vitro models, and high resolution and selective probing of axonal activity. Here, we present a nerve-on-a-chip platform that enables rapid extracellular recording and axonal tracking of action potentials collected from tens of myelinated fibers. The platform consists of microfabricated stimulation and recording microchannel electrode arrays. First, we identify conduction velocities of action potentials traveling through the microchannel and propose a robust data-sorting algorithm using velocity selective recording. We optimize channel geometry and electrode spacing to enhance the algorithm reliability. Second, we demonstrate selective heat-induced neuro-inhibition of peripheral nerve activity upon local illumination of a conjugated polymer (P3HT) blended with a fullerene derivative (PCBM) coated on the floor of the microchannel. We demonstrate the nerve-on-a-chip platform is a versatile tool to optimize the design of implantable peripheral nerve interfaces and test selective neuromodulation techniques ex vivo.

Peripheral nerves have a complex physiology and it is therefore difficult to measure axonal activity in vitro. Here the authors make a nerve-on-a-chip platform to align peripheral nerves and permit measurement of conduction amplitude and velocity along several axons in a single experiment.

Dexamethasone Reduces the Foreign Body Reaction to Intraneural Electrode Implants in the Peripheral Nerve of the Rat

Intraneural electrodes must be in intimate contact with nerve fibers to have a proper function, but this interface is compromised due to the foreign body reaction (FBR). The FBR is characterized by a first inflammatory phase followed by a second anti-inflammatory and fibrotic phase, which results in the formation of a tissue capsule around the implant, causing physical separation between the active sites of the electrode and the nerve fibers. We have tested systemically several anti-inflammatory drugs such as dexamethasone (subcutaneous), ibuprofen and maraviroc (oral) to reduce macrophage activation, as well as clodronate liposomes (intraperitoneal) to reduce monocyte/macrophage infiltration, and sildenafil (oral) as an antifibrotic drug to reduce collagen deposition in an FBR model with longitudinal Parylene C intraneural implants in the rat sciatic nerve. Treatment with dexamethasone, ibuprofen, or clodronate significantly reduced the inflammatory reaction in the nerve in comparison to the saline group after 2 weeks of the implant, whereas sildenafil and maraviroc had no effect on infiltration of macrophages in the nerve. However, only dexamethasone was able to significantly reduce the matrix deposition around the implant. Similar positive results were obtained with dexamethasone in the case of polyimide-based intraneural implants, another polymer substrate for the electrode. These results indicate that inflammation triggers the FBR in peripheral nerves, and that anti-inflammatory treatment with dexamethasone may have beneficial effects on lengthening intraneural interface functionality. Anat Rec, 301:1722-1733, 2018. © 2018 Wiley Periodicals, Inc.

EMG and ENG-envelope pattern recognition for prosthetic hand control

BACKGROUND

This paper proposes a new approach for neural control of hand prostheses, grounded on pattern recognition applied to the envelope of neural signals (eENG).

NEW METHOD

The ENG envelope was computed by taking into account the amplitude and the occurrence of the spike in the neural recording. A pattern recognition algorithm applied on muscular signals was defined as a reference and a comparative analysis with traditionally adopted Spike Sorting Algorithms (SSA) for neural signals has been carried out. Method validation was divided in two parts: firstly, neural signals recorded from one amputee subject through intraneural electrodes were offline analyzed to discriminate between the two performed gestures; secondly, algorithm performance decay with the increase of the number of classes was studied through synthetic data.

RESULTS

An accuracy of 98.26% with real data was reached with the pattern recognition applied to eENG. SSA reached an accuracy of 70%. Increasing the number of classes worsens the accuracy of this algorithm. Additionally, computational time for the pattern recognition applied to eENG is very low (32.6 μs for each sample in the data window analyzed).

COMPARISON WITH EXISTING METHOD

The eENG was proved to be more reliable in decoding the user intention than the SSA algorithm and it is computationally efficient.

CONCLUSIONS

It was demonstrated that it is possible to apply the well-known techniques of EMG pattern recognition to a conveniently processed neural signal and can pave the way to the application of neural gesture decoding in upper limb prosthetics.

Integrity Assessment of a Hybrid DBS Probe that Enables Neurotransmitter Detection Simultaneously to Electrical Stimulation and Recording

Deep brain stimulation (DBS) is a successful medical therapy for many treatment resistant neuropsychiatric disorders such as movement disorders; e.g., Parkinson's disease, Tremor, and dystonia. Moreover, DBS is becoming more and more appealing for a rapidly growing number of patients with other neuropsychiatric diseases such as depression and obsessive compulsive disorder. In spite of the promising outcomes, the current clinical hardware used in DBS does not match the technological standards of other medical applications and as a result could possibly lead to side effects such as high energy consumption and others. By implementing more advanced DBS devices, in fact, many of these limitations could be overcome. For example, a higher channels count and smaller electrode sites could allow more focal and tailored stimulation. In addition, new materials, like carbon for example, could be incorporated into the probes to enable adaptive stimulation protocols by biosensing neurotransmitters in the brain. Updating the current clinical DBS technology adequately requires combining the most recent technological advances in the field of neural engineering. Here, a novel hybrid multimodal DBS probe with glassy carbon microelectrodes on a polyimide thin-film device assembled on a silicon rubber tubing is introduced. The glassy carbon interface enables neurotransmitter detection using fast scan cyclic voltammetry and electrophysiological recordings while simultaneously performing electrical stimulation. Additionally, the presented DBS technology shows no imaging artefacts in magnetic resonance imaging. Thus, we present a promising new tool that might lead to a better fundamental understanding of the underlying mechanism of DBS while simultaneously paving our way towards better treatments.

Biomimetic encoding model for restoring touch in bionic hands through a nerve interface

OBJECTIVE

Hand function can be restored in upper-limb amputees by equipping them with anthropomorphic prostheses controlled with signals from residual muscles. The dexterity of these bionic hands is severely limited in large part by the absence of tactile feedback about interactions with objects. We propose that, to the extent that artificial touch mimics its natural counterpart, these sensory signals will be more easily integrated into the motor plan for object manipulation.

APPROACH

We describe an approach to convey tactile feedback through electrical stimulation of the residual somatosensory nerves that mimics the aggregate activity of tactile fibers that would be produced in the nerve of a native hand during object interactions. Specifically, we build a parsimonious model that maps the stimulus-described as time-varying indentation depth, indentation rate, and acceleration-into continuous estimates of the time-varying population firing rate and of the size of the recruited afferent population.

MAIN RESULTS

The simple model can reconstruct aggregate afferent responses to a wide range of stimuli, including those experienced during activities of daily living.

SIGNIFICANCE

We discuss how the proposed model can be implemented with a peripheral nerve interface and anticipate it will lead to improved dexterity for prosthetic hands.

Motor Control and Sensory Feedback Enhance Prosthesis Embodiment and Reduce Phantom Pain After Long-Term Hand Amputation

We quantified prosthesis embodiment and phantom pain reduction associated with motor control and sensory feedback from a prosthetic hand in one human with a long-term transradial amputation. Microelectrode arrays were implanted in the residual median and ulnar arm nerves and intramuscular electromyography recording leads were implanted in residual limb muscles to enable sensory feedback and motor control. Objective measures (proprioceptive drift) and subjective measures (survey answers) were used to assess prosthesis embodiment. For both measures, there was a significant level of embodiment of the physical prosthetic limb after open-loop motor control of the prosthesis (i.e., without sensory feedback), open-loop sensation from the prosthesis (i.e., without motor control), and closed-loop control of the prosthesis (i.e., motor control with sensory feedback). There was also a statistically significant reduction in reported phantom pain after experimental sessions that included open-loop nerve microstimulation, open-loop prosthesis motor control, or closed-loop prosthesis motor control. The closed-loop condition provided no additional significant improvements in phantom pain reduction or prosthesis embodiment relative to the open-loop sensory condition or the open-loop motor condition. This study represents the first long-term (14-month), systematic report of phantom pain reduction and prosthesis embodiment in a human amputee across a variety of prosthesis use cases.

Recovering Motor Activation with Chronic Peripheral Nerve Computer Interface

Interfaces with the peripheral nerve provide the ability to extract motor activation and restore sensation to amputee patients. The ability to chronically extract motor activations from the peripheral nervous system remains an unsolved problem. In this study, chronic recordings with the Flat Interface Nerve Electrode (FINE) are employed to recover the activation levels of innervated muscles. The FINEs were implanted on the sciatic nerves of canines, and neural recordings were obtained as the animal walked on a treadmill. During these trials, electromyograms (EMG) from the surrounding hamstring muscles were simultaneously recorded and the neural recordings are shown to be free of interference or crosstalk from these muscles. Using a novel Bayesian algorithm, the signals from individual fascicles were recovered and then compared to the corresponding target EMG of the lower limb. High correlation coefficients (0.84 ± 0.07 and 0.61 ± 0.12) between the extracted tibial fascicle/medial gastrocnemius and peroneal fascicle/tibialis anterior muscle were obtained. Analysis calculating the information transfer rate (ITR) from the muscle to the motor predictions yielded approximately 5 and 1 bit per second (bps) for the two sources. This method can predict motor signals from neural recordings and could be used to drive a prosthesis by interfacing with residual nerves.

Myocontrol is closed-loop control: incidental feedback is sufficient for scaling the prosthesis force in routine grasping

BACKGROUND

Sensory feedback is critical for grasping in able-bodied subjects. Consequently, closing the loop in upper-limb prosthetics by providing artificial sensory feedback to the amputee is expected to improve the prosthesis utility. Nevertheless, even though amputees rate the prospect of sensory feedback high, its benefits in daily life are still very much debated. We argue that in order to measure the potential functional benefit of artificial sensory feedback, the baseline open-loop performance needs to be established.

METHODS

The myoelectric control of naïve able-bodied subjects was evaluated during modulation of electromyographic signals (EMG task), and grasping with a prosthesis (Prosthesis task). The subjects needed to activate the wrist flexor muscles and close the prosthesis to reach a randomly selected target level (routine grasping). To assess the baseline performance, the tasks were performed with a different extent of implicit feedback (proprioception, prosthesis motion and sound). Finally, the prosthesis task was repeated with explicit visual force feedback. The subjects' ability to scale the prosthesis command/force was assessed by testing for a statistically significant increase in the median of the generated commands/forces between neighboring levels. The quality of control was evaluated by computing the median absolute error (MAE) with respect to the target.

RESULTS

The subjects could successfully scale their motor commands and generated prosthesis forces across target levels in all tasks, even with the least amount of implicit feedback (only muscle proprioception, EMG task). In addition, the deviation of the generated commands/forces from the target levels decreased with additional feedback. However, the increase in implicit feedback, from proprioception to prosthesis motion and sound, seemed to have a more substantial effect than the final introduction of explicit feedback. Explicit feedback improved the performance mainly at the higher target-force levels.

CONCLUSIONS

The study establishes the baseline performance of myoelectric control and prosthesis grasping force. The results demonstrate that even without additional feedback, naïve subjects can effectively modulate force with good accuracy with respect to that achieved when increasing the amount of feedback information.

Patient care for postamputation pain and the complexity of therapies: living experiences

AIM

Limb amputation traumatically alters body image. Sensations rapidly prevail that the limb is still present and 85% of patients portray phantom limb pain. Throughout the testimonies of amputated patients with intense phantom limb pain, we show the difficulty in treating this chronic pain with current pharmacological and nonpharmacological therapies.

PATIENTS & METHODS

We qualitatively analyzed the therapeutic choices of five amputees, the effectiveness of the treatments chosen and the impact on patients' quality-of-life.

RESULTS & CONCLUSION

In general, patients who are refractory to pharmacological treatments are in favor of trying alternative therapies. It is therefore crucial to design a combined and personalized therapeutic plan under the coordination of a multidisciplinary team for the wellbeing of the patient.

Thermosensory micromapping of warm and cold sensitivity across glabrous and hairy skin of male and female hands and feet

The ability of hands and feet to convey skin thermal sensations is an important contributor to our experience of the surrounding world. Surprisingly, the detailed topographical distribution of warm and cold thermosensitivity across hands and feet has not been mapped, although sensitivity maps exist for touch and pain. Using a recently developed quantitative sensory test, we mapped warm and cold thermosensitivity of 103 skin sites over glabrous and hairy skin of hands and feet in male (M; 30.2 ± 5.8 yr) and female (F; 27.7 ± 5.1 yr) adults matched for body surface area (M: 1.77 ± 0.2 m2; F: 1.64 ± 0.1 m2; P = 0.155). Findings indicated that warm and cold thermosensitivity varies by fivefold across glabrous and hairy skin of hands and feet and that hands (warm/cold sensitivity: 1.25/2.14 vote/°C) are twice as sensitive as the feet (warm/cold sensitivity: 0.51/0.99 vote/°C). Opposite to what is known for touch and pain sensitivity, we observed a characteristic distal-to-proximal increase in thermosensitivity over both hairy and glabrous skin (i.e., from fingers and toes to body of hands and feet), and found that hairy skin is more sensitive than glabrous. Finally, we show that body surface area-matched men and women presented small differences in thermosensitivity and that these differences are constrained to glabrous skin only. Our high-density thermosensory micromapping provides the most detailed thermosensitivity maps of hands and feet in young adults available to date. These maps offer a window into peripheral and central mechanisms of thermosensory integration in humans and will help guide future developments in smart skin and sensory neuroprostheses, in wearable, energy-efficient personal comfort systems, and in sport and protective clothing.

NEW & NOTEWORTHY We provide the most detailed thermosensitivity maps across glabrous and hairy skin of hands and feet in men and women available to date. Our maps show that thermosensitivity varies by fivefold across hands and feet, distal regions (e.g., fingers, toes) are less sensitive than proximal (e.g., palm, sole), hands are twice as sensitive as feet, and men and women present small thermosensitivity differences. These findings will help guide developments in sensory neuroprostheses, wearable comfort systems, and sport/protective clothing.

Organic Electronics for Artificial Touch

Artificial restoration of touch is an active area of research in neuroprosthetics. However, most approaches do not consider emulating the biological machinery they intend to replace. Recently, Kim et al. proposed a bioinspired artificial touch transducer that closely mimics the behavior of natural sensory afferents.

Novel neural interface electrode array for the peripheral nerve

Peripheral neural interface (PNI) is becoming an essential technology in the field of robotic prosthesis due to its potential for providing bidirectional neural signal communication between the prosthetic arm and the brain. However, current PNIs inefficiently trade off neural signal selectivity and the invasiveness of the device. We designed and fabricated a new PNI electrode array that has high signal selectivity yet maintains low invasiveness by incorporating a design that allows for three-dimensional spiral insertion around the peripheral nerve. The neural signal acquisition capability was confirmed through impedance measurement in vitro, and the proposed device had an average impedance of 296 ± 52 kΩ at 1000 Hz.

A Multichannel High-Frequency Power-Isolated Neural Stimulator With Crosstalk Reduction

In neuroprostheses applications requiring simultaneous stimulations on a multielectrode array, electric crosstalk, the spatial interaction between electric fields from various electrodes is a major limitation to the performance of multichannel stimulation. This paper presents a multichannel stimulator design that combines high-frequency current stimulation (using biphasic charge-balanced chopped pulse profile) with a switched-capacitor power isolation method. The approach minimizes crosstalk and is particularly suitable for fully integrated realization. A stimulator fabricated in a 0.6 μm CMOS high-voltage technology is presented. It is used to implement a multichannel, high-frequency, power-isolated stimulator. Crosstalk reduction is demonstrated with electrodes in physiological media while the efficacy of the high-frequency stimulator chip is proven in vivo. The stimulator provides fully independent operation on multiple channels and full flexibility in the design of neural modulation protocols.

Improving internal model strength and performance of prosthetic hands using augmented feedback

Background

The loss of an arm presents a substantial challenge for upper limb amputees when performing activities of daily living. Myoelectric prosthetic devices partially replace lost hand functions; however, lack of sensory feedback and strong understanding of the myoelectric control system prevent prosthesis users from interacting with their environment effectively. Although most research in augmented sensory feedback has focused on real-time regulation, sensory feedback is also essential for enabling the development and correction of internal models, which in turn are used for planning movements and reacting to control variability faster than otherwise possible in the presence of sensory delays.

Methods

Our recent work has demonstrated that audio-augmented feedback can improve both performance and internal model strength for an abstract target acquisition task. Here we use this concept in controlling a robotic hand, which has inherent dynamics and variability, and apply it to a more functional grasp-and-lift task. We assessed internal model strength using psychophysical tests and used an instrumented Virtual Egg to assess performance.

Results

Results obtained from 14 able-bodied subjects show that a classifier-based controller augmented with audio feedback enabled stronger internal model (p = 0.018) and better performance (p = 0.028) than a controller without this feedback.

Conclusions

We extended our previous work and accomplished the first steps on a path towards bridging the gap between research and clinical usability of a hand prosthesis. The main goal was to assess whether the ability to decouple internal model strength and motion variability using the continuous audio-augmented feedback extended to real-world use, where the inherent mechanical variability and dynamics in the mechanisms may contribute to a more complicated interplay between internal model formation and motion variability. We concluded that benefits of using audio-augmented feedback for improving internal model strength of myoelectric controllers extend beyond a virtual target acquisition task to include control of a prosthetic hand.

Rapid prototyping of flexible intrafascicular electrode arrays by picosecond laser structuring

OBJECTIVE

Interfacing the peripheral nervous system can be performed with a large variety of electrode arrays. However, stimulating and recording a nerve while having a reasonable amount of channels limits the number of available systems. Translational research towards human clinical trial requires device safety and biocompatibility but would benefit from design flexibility in the development process to individualize probes.

APPROACH

We selected established medical grade implant materials like precious metals and Parylene C to develop a rapid prototyping process for novel intrafascicular electrode arrays using a picosecond laser structuring. A design for a rodent animal model was developed in conjunction with an intrafascicular implantation strategy. Electrode characterization and optimization was performed first in saline solution in vitro before performance and biocompatibility were validated in sciatic nerves of rats in chronic implantation.

MAIN RESULTS

The novel fabrication process proved to be suitable for prototyping and building intrafascicular electrode arrays. Electrochemical properties of the electrode sites were enhanced and tested for long-term stability. Chronic implantation in the sciatic nerve of rats showed good biocompatibility, selectivity and stable stimulation thresholds.

SIGNIFICANCE

Established medical grade materials can be used for intrafascicular nerve electrode arrays when laser structuring defines structure size in the micro-scale. Design flexibility reduces re-design cycle time and material certificates are beneficial support for safety studies on the way to clinical trials.

Bilateral cortical representation of tactile roughness

Roughness is the most important feature for texture discrimination. Here we investigate how the bilateral cortical representation of touch is modulated by tactile roughness by analyzing the neural responses elicited by stimuli with various coarseness levels ranging from fine to medium. A prolonged stimulation was delivered to 10 healthy subjects by passively sliding tactile stimuli under the fingertip while recording the EEG to study the modulation of Somatosensory Evoked Potentials (SEPs) as well as activity in the theta and alpha bands. Elicited long-latency SEPs, namely bilateral P100-N140 and frontal P240 were consistent across stimuli. On the contrary, the temporal lag N140 - P240 was nonlinearly modulated both in contralateral and ipsilateral sides, in agreement with literature. Using a time-frequency analysis approach, we identified a theta band power increase in the [0 0.5]s interval and a partially overlapped power decrease in the alpha band which lasted throughout the stimulation. The estimated time these two phenomena were overlapped was comparable across stimuli, whereas a linear decrease in alpha band amplitude was reported when increasing the stimulus roughness in both contralateral and ipsilateral sides. This study showed that the selected tactile stimuli generated physiological bilateral responses that were modulated in a diversified way according to the stimulus roughness and side. Specifically, we identified sensory processing features (i.e., theta and alpha time overlap) invariant to the stimulus roughness (i.e., associated to a basic cortical mechanism of touch) and roughness-dependent cortical outputs comparable in the contralateral and ipsilateral sides that confirm a bilateral processing of tactile information.

Fascicular nerve stimulation and recording using a novel double-aisle regenerative electrode

OBJECTIVE

As artificial prostheses become more refined, they are most often used as a therapeutic option for hand amputation. By contrast to extra- or intraneural interfaces, regenerative nerve electrodes are designed to enable electrical interfaces with regrowing axonal bundles of injured nerves, aiming to achieve high selectivity for recording and stimulation. However, most of the developed designs pose an obstacle to the regrowth mechanisms due to low transparency and cause impairment to the nerve regeneration.

APPROACH

Here we present the double-aisle electrode, a new type of highly transparent, non-obstructive regenerative electrode. Using a double-side thin-film polyimide planar multi-contact electrode, two nerve fascicles can regenerate without physical impairment through two electrically isolated aisles.

MAIN RESULTS

We show that this electrode can be used to selectively record and stimulate fascicles, acutely as well as chronically, and allow regeneration in nerve gaps of several millimeters without impairment.

SIGNIFICANCE

This multi-aisle regenerative electrode may be suitable for neuroprosthetic applications, such as prostheses, for the restoration of hand function after amputation or severe nerve injuries.

Micro-folded 3D neural electrodes fully integrated in polyimide

Recent neural interfaces are characterized by high functionality and good adaptation to the target tissue. Still, the underlying manufacturing process is mainly planar and so are the device and contact surface. Therefore, three-dimensional structures to contact neuronal tissue are desired to gain higher selectivity. In the present study, local bending structures integrated in flexible electrode arrays based on polyimide are investigated. The bending is achieved by the contraction of a second polyimide (Durimide) that is embedded into grooves with a width of a few micrometers. The angle of the bending can be controlled with a high accuracy from 3 to 20 degrees by changing the geometry of the grooves and the imidization temperature These bending structures can be combined to achieve any desired angle for specific applications.

Home Use of a Neural-connected Sensory Prosthesis Provides the Functional and Psychosocial Experience of Having a Hand Again

The loss of a hand has many psychosocial repercussions. While advanced multi-articulated prostheses can improve function, without sensation, they cannot restore the full experience and connection of a hand. Direct nerve interfaces can restore naturalistic sensation to amputees. Our sensory restoration system produced tactile and proprioceptive sensations on the hand via neural stimulation through chronically implanted electrodes. In this study, upper limb amputees used a sensory-enabled prosthesis in their homes and communities, autonomously and unconstrained to specific tasks. These real-life conditions enabled us to study the impact of sensation on prosthetic usage, functional performance, and psychosocial experience. We found that sensory feedback fundamentally altered the way participants used their prosthesis, transforming it from a sporadically-used tool into a readily and frequently-used hand. Functional performance with sensation improved following extended daily use. Restored sensation improved a wide range of psychosocial factors, including self-efficacy, prosthetic embodiment, self-image, social interaction, and quality of life. This study demonstrates that daily use of a sensory-enabled prosthesis restores the holistic experience of having a hand and more fully reconnects amputees with the world.

Prosthesis with neuromorphic multilayered e-dermis perceives touch and pain

The human body is a template for many state-of-the-art prosthetic devices and sensors. Perceptions of touch and pain are fundamental components of our daily lives that convey valuable information about our environment while also providing an element of protection from damage to our bodies. Advances in prosthesis designs and control mechanisms can aid an amputee's ability to regain lost function but often lack meaningful tactile feedback or perception. Through transcutaneous electrical nerve stimulation (TENS) with an amputee, we discovered and quantified stimulation parameters to elicit innocuous (non-painful) and noxious (painful) tactile perceptions in the phantom hand. Electroencephalography (EEG) activity in somatosensory regions confirms phantom hand activation during stimulation. We invented a multilayered electronic dermis (e-dermis) with properties based on the behavior of mechanoreceptors and nociceptors to provide neuromorphic tactile information to an amputee. Our biologically inspired e-dermis enables a prosthesis and its user to perceive a continuous spectrum from innocuous to noxious touch through a neuromorphic interface that produces receptor-like spiking neural activity. In a Pain Detection Task (PDT), we show the ability of the prosthesis and amputee to differentiate non-painful or painful tactile stimuli using sensory feedback and a pain reflex feedback control system. In this work, an amputee can use perceptions of touch and pain to discriminate object curvature, including sharpness. This work demonstrates possibilities for creating a more natural sensation spanning a range of tactile stimuli for prosthetic hands.

Recent Advances in Tactile Sensing Technology

Research on tactile sensing technology has been actively conducted in recent years to pave the way for the next generation of highly intelligent devices. Sophisticated tactile sensing technology has a broad range of potential applications in various fields including: (1) robotic systems with tactile sensors that are capable of situation recognition for high-risk tasks in hazardous environments; (2) tactile quality evaluation of consumer products in the cosmetic, automobile, and fabric industries that are used in everyday life; (3) robot-assisted surgery (RAS) to facilitate tactile interaction with the surgeon; and (4) artificial skin that features a sense of touch to help people with disabilities who suffer from loss of tactile sense. This review provides an overview of recent advances in tactile sensing technology, which is divided into three aspects: basic physiology associated with human tactile sensing, the requirements for the realization of viable tactile sensors, and new materials for tactile devices. In addition, the potential, hurdles, and major challenges of tactile sensing technology applications including artificial skin, medical devices, and analysis tools for human tactile perception are presented in detail. Finally, the review highlights possible routes, rapid trends, and new opportunities related to tactile devices in the foreseeable future.

Spectrally distinct channelrhodopsins for two-colour optogenetic peripheral nerve stimulation

Technologies for peripheral nerve stimulation have conventionally relied on the anatomic placement of electrodes adjacent to subsets of sensory fibres or motor fibres that selectively target an end effector. Here, we demonstrate the use of optogenetics to directly target the innervating fibres of an end effector by relying on retrograde transfection of adeno-associated virus serotype 6 to restrict axonal opsin expression to the desired fibre targets. By using an in vivo screen in rats, we identify the first channelrhodopsins as well as a halorhodopsin that respond to red light in the peripheral nerve. Combining two channelrhodopsins with spectrally distinct activation profiles allowed us to drive opposing muscle activity via two-colour illumination of the same mixed nerve. We also show halorhodopsin-mediated reductions in electrically evoked muscle tremor spectrally optimized for deep peripheral nerves. Our non-invasive peripheral neurostimulator with targeted multi-fascicle resolution enables scientific and clinical exploration, such as motor control in paralysis, biomimetic sensation feedback for amputees and targeted inhibition of muscle tremor.

Automatic hand phantom map generation and detection using decomposition support vector machines

Background

There is a need for providing sensory feedback for myoelectric prosthesis users. Providing tactile feedback can improve object manipulation abilities, enhance the perceptual embodiment of myoelectric prostheses and help reduce phantom limb pain. Many amputees have referred sensation from their missing hand on their residual limbs (phantom maps). This skin area can serve as a target for providing amputees with non-invasive tactile sensory feedback. One of the challenges of providing sensory feedback on the phantom map is to define the accurate boundary of each phantom digit because the phantom map distribution varies from person to person.

Methods

In this paper, automatic phantom map detection methods based on four decomposition support vector machine algorithms and three sampling methods are proposed, complemented by fuzzy logic and active learning strategies. The algorithms and methods are tested on two databases: the first one includes 400 generated phantom maps, whereby the phantom map generation algorithm was based on our observation of the phantom maps to ensure smooth phantom digit edges, variety, and representativeness. The second database includes five reported phantom map images and transformations thereof. The accuracy and training/ classification time of each algorithm using a dense stimulation array (with 100 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\times $$\end{document}× 100 actuators) and two coarse stimulation arrays (with 3 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\times $$\end{document}× 5 and 4 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\times $$\end{document}× 6 actuators) are presented and compared.

Results

Both generated and reported phantom map images share the same trends. Majority-pooling sampling effectively increases the training size, albeit introducing some noise, and thus produces the smallest error rates among the three proposed sampling methods. For different decomposition architectures, one-vs-one reduces unclassified regions and in general has higher classification accuracy than the other architectures. By introducing fuzzy logic to bias the penalty parameter, the influence of pooling-induced noise is reduced. Moreover, active learning with different strategies was also tested and shown to improve the accuracy by introducing more representative training samples. Overall, dense arrays employing one-vs-one fuzzy support vector machines with majority-pooling sampling have the smallest average absolute error rate (8.78% for generated phantom maps and 11.5% for reported and transformed phantom map images). The detection accuracy of coarse arrays was found to be significantly lower than for dense array.

Conclusions

The results demonstrate the effectiveness of support vector machines using a dense array in detecting refined phantom map shapes, whereas coarse arrays are unsuitable for this task. We therefore propose a two-step approach, using first a non-wearable dense array to detect an accurate phantom map shape, then to apply a wearable coarse stimulation array customized according to the detection results. The proposed methodology can be used as a tool for helping haptic feedback designers and for tracking the evolvement of phantom maps.

A Digital Hardware Realization for Spiking Model of Cutaneous Mechanoreceptor

Inspired by the biology of human tactile perception, a hardware neuromorphic approach is proposed for spiking model of mechanoreceptors to encode the input force. In this way, a digital circuit is designed for a slowly adapting type I (SA-I) and fast adapting type I (FA-I) mechanoreceptors to be implemented on a low-cost digital hardware, such as field-programmable gate array (FPGA). This system computationally replicates the neural firing responses of both afferents. Then, comparative simulations are shown. The spiking models of mechanoreceptors are first simulated in MATLAB and next the digital neuromorphic circuits simulated in VIVADO are also compared to show that obtained results are in good agreement both quantitatively and qualitatively. Finally, we test the performance of the proposed digital mechanoreceptors in hardware using a prepared experimental set up. Hardware synthesis and physical realization on FPGA indicate that the digital mechanoreceptors are able to replicate essential characteristics of different firing patterns including bursting and spiking responses of the SA-I and FA-I mechanoreceptors. In addition to parallel computation, a main advantage of this method is that the mechanoreceptor digital circuits can be implemented in real-time through low-power neuromorphic hardware. This novel engineering framework is generally suitable for use in robotic and hand-prosthetic applications, so progressing the state of the art for tactile sensing.

Audible Feedback Improves Internal Model Strength and Performance of Myoelectric Prosthesis Control

Myoelectric prosthetic devices are commonly used to help upper limb amputees perform activities of daily living, however amputees still lack the sensory feedback required to facilitate reliable and precise control. Augmented feedback may play an important role in affecting both short-term performance, through real-time regulation, and long-term performance, through the development of stronger internal models. In this work, we investigate the potential tradeoff between controllers that enable better short-term performance and those that provide sufficient feedback to develop a strong internal model. We hypothesize that augmented feedback may be used to mitigate this tradeoff, ultimately improving both short and long-term control. We used psychometric measures to assess the internal model developed while using a filtered myoelectric controller with augmented audio feedback, imitating classification-based control but with augmented regression-based feedback. In addition, we evaluated the short-term performance using a multi degree-of-freedom constrained-time target acquisition task. Results obtained from 24 able-bodied subjects show that an augmented feedback control strategy using audio cues enables the development of a stronger internal model than the filtered control with filtered feedback, and significantly better path efficiency than both raw and filtered control strategies. These results suggest that the use of augmented feedback control strategies may improve both short-term and long-term performance.

Update on Peripheral Nerve Electrodes for Closed-Loop Neuroprosthetics

In this paper various types of electrodes for stimulation and recording activity of peripheral nerves for the control of neuroprosthetic limbs are reviewed. First, an overview of interface devices for (feedback-) controlled movement of a prosthetic device is given, after which the focus is on peripheral nervous system (PNS) electrodes. Important electrode properties, i.e., longevity and spatial resolution, are defined based upon the usability for neuroprostheses. The cuff electrode, longitudinal intrafascicular electrodes (LIFE), transverse intrafascicular multichannel electrode (TIME), Utah slanted electrode array (USEA), and the regenerative electrode are discussed and assessed on their longevity and spatial resolution. The cuff electrode seems to be a promising electrode for the control of neuroprostheses in the near future, because it shows the best longevity and good spatial resolution and it has been used on human subjects in multiple studies. The other electrodes may be promising in the future, but further research on their longevity and spatial resolution is needed. A more quantitatively uniform study protocol used for all electrodes would allow for a proper comparison of recording and stimulation performance. For example, the discussed electrodes could be compared in a large in vivo study, using one uniform comparison protocol.