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Taghlabi KM, Cruz-Garza JG, Hassan T, Potnis O, Bhenderu LS, Guerrero JR, Whitehead RE, Wu Y, Luan L, Xie C, Robinson JT, Faraji AH. Clinical outcomes of peripheral nerve interfaces for rehabilitation in paralysis and amputation: a literature review. J Neural Eng 2024; 21:011001. [PMID: 38237175 DOI: 10.1088/1741-2552/ad200f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024]
Abstract
Peripheral nerve interfaces (PNIs) are electrical systems designed to integrate with peripheral nerves in patients, such as following central nervous system (CNS) injuries to augment or replace CNS control and restore function. We review the literature for clinical trials and studies containing clinical outcome measures to explore the utility of human applications of PNIs. We discuss the various types of electrodes currently used for PNI systems and their functionalities and limitations. We discuss important design characteristics of PNI systems, including biocompatibility, resolution and specificity, efficacy, and longevity, to highlight their importance in the current and future development of PNIs. The clinical outcomes of PNI systems are also discussed. Finally, we review relevant PNI clinical trials that were conducted, up to the present date, to restore the sensory and motor function of upper or lower limbs in amputees, spinal cord injury patients, or intact individuals and describe their significant findings. This review highlights the current progress in the field of PNIs and serves as a foundation for future development and application of PNI systems.
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Affiliation(s)
- Khaled M Taghlabi
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
| | - Jesus G Cruz-Garza
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
| | - Taimur Hassan
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- School of Medicine, Texas A&M University, Bryan, TX 77807, United States of America
| | - Ojas Potnis
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- School of Engineering Medicine, Texas A&M University, Houston, TX 77030, United States of America
| | - Lokeshwar S Bhenderu
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- School of Medicine, Texas A&M University, Bryan, TX 77807, United States of America
| | - Jaime R Guerrero
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
| | - Rachael E Whitehead
- Department of Academic Affairs, Houston Methodist Academic Institute, Houston, TX 77030, United States of America
| | - Yu Wu
- Rice Neuroengineering Initiative, Rice University, Houston, TX 77005, United States of America
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, United States of America
| | - Lan Luan
- Rice Neuroengineering Initiative, Rice University, Houston, TX 77005, United States of America
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, United States of America
| | - Chong Xie
- Rice Neuroengineering Initiative, Rice University, Houston, TX 77005, United States of America
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, United States of America
| | - Jacob T Robinson
- Rice Neuroengineering Initiative, Rice University, Houston, TX 77005, United States of America
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, United States of America
| | - Amir H Faraji
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Rice Neuroengineering Initiative, Rice University, Houston, TX 77005, United States of America
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, United States of America
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2
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Donati E, Valle G. Neuromorphic hardware for somatosensory neuroprostheses. Nat Commun 2024; 15:556. [PMID: 38228580 PMCID: PMC10791662 DOI: 10.1038/s41467-024-44723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
In individuals with sensory-motor impairments, missing limb functions can be restored using neuroprosthetic devices that directly interface with the nervous system. However, restoring the natural tactile experience through electrical neural stimulation requires complex encoding strategies. Indeed, they are presently limited in effectively conveying or restoring tactile sensations by bandwidth constraints. Neuromorphic technology, which mimics the natural behavior of neurons and synapses, holds promise for replicating the encoding of natural touch, potentially informing neurostimulation design. In this perspective, we propose that incorporating neuromorphic technologies into neuroprostheses could be an effective approach for developing more natural human-machine interfaces, potentially leading to advancements in device performance, acceptability, and embeddability. We also highlight ongoing challenges and the required actions to facilitate the future integration of these advanced technologies.
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Affiliation(s)
- Elisa Donati
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Zurich, Switzerland.
| | - Giacomo Valle
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA.
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3
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Pellot-Cestero JE, Herring EZ, Graczyk EL, Memberg WD, Kirsch RF, Ajiboye AB, Miller JP. Implanted Electrodes for Functional Electrical Stimulation to Restore Upper and Lower Extremity Function: History and Future Directions. Neurosurgery 2023; 93:965-970. [PMID: 37288972 DOI: 10.1227/neu.0000000000002561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/03/2023] [Indexed: 06/09/2023] Open
Abstract
Functional electrical stimulation (FES) to activate nerves and muscles in paralyzed extremities has considerable promise to improve outcome after neurological disease or injury, especially in individuals who have upper motor nerve dysfunction due to central nervous system pathology. Because technology has improved, a wide variety of methods for providing electrical stimulation to create functional movements have been developed, including muscle stimulating electrodes, nerve stimulating electrodes, and hybrid constructs. However, in spite of decades of success in experimental settings with clear functional improvements for individuals with paralysis, the technology has not yet reached widespread clinical translation. In this review, we outline the history of FES techniques and approaches and describe future directions in evolution of the technology.
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Affiliation(s)
- Joel E Pellot-Cestero
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Eric Z Herring
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Emily L Graczyk
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland , Ohio , USA
| | - William D Memberg
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland , Ohio , USA
| | - Robert F Kirsch
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland , Ohio , USA
| | - A Bolu Ajiboye
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland , Ohio , USA
| | - Jonathan P Miller
- Department of Neurosurgery, School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehab. R&D Service, Cleveland , Ohio , USA
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4
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Valle G. Peripheral neurostimulation for encoding artificial somatosensations. Eur J Neurosci 2022; 56:5888-5901. [PMID: 36097134 PMCID: PMC9826263 DOI: 10.1111/ejn.15822] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/08/2022] [Accepted: 09/08/2022] [Indexed: 01/11/2023]
Abstract
The direct neural stimulation of peripheral or central nervous systems has been shown as an effective tool to treat neurological conditions. The electrical activation of the nervous sensory pathway can be adopted to restore the artificial sense of touch and proprioception in people suffering from sensory-motor disorders. The modulation of the neural stimulation parameters has a direct effect on the electrically induced sensations, both when targeting the somatosensory cortex and the peripheral somatic nerves. The properties of the artificial sensations perceived, as their location, quality and intensity are strongly dependent on the direct modulation of pulse width, amplitude and frequency of the neural stimulation. Different sensory encoding schemes have been tested in patients showing distinct effects and outcomes according to their impact on the neural activation. Here, I reported the most adopted neural stimulation strategies to artificially encode somatosensation into the peripheral nervous system. The real-time implementation of these strategies in bionic devices is crucial to exploit the artificial sensory feedback in prosthetics. Thus, neural stimulation becomes a tool to directly communicate with the human nervous system. Given the importance of adding artificial sensory information to neuroprosthetic devices to improve their control and functionality, the choice of an optimal neural stimulation paradigm could increase the impact of prosthetic devices on the quality of life of people with sensorimotor disabilities.
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Affiliation(s)
- Giacomo Valle
- Laboratory for Neuroengineering, Department of Health Sciences and TechnologyInstitute for Robotics and Intelligent Systems, ETH ZürichZürichSwitzerland
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Valle G, Aiello G, Ciotti F, Cvancara P, Martinovic T, Kravic T, Navarro X, Stieglitz T, Bumbasirevic M, Raspopovic S. Multifaceted understanding of human nerve implants to design optimized electrodes for bioelectronics. Biomaterials 2022; 291:121874. [DOI: 10.1016/j.biomaterials.2022.121874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/23/2022] [Indexed: 11/24/2022]
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6
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Yan D, Jiman AA, Bottorff EC, Patel PR, Meli D, Welle EJ, Ratze DC, Havton LA, Chestek CA, Kemp SWP, Bruns TM, Yoon E, Seymour JP. Ultraflexible and Stretchable Intrafascicular Peripheral Nerve Recording Device with Axon-Dimension, Cuff-Less Microneedle Electrode Array. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 18:e2200311. [PMID: 35491522 PMCID: PMC9167574 DOI: 10.1002/smll.202200311] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/08/2022] [Indexed: 05/03/2023]
Abstract
Peripheral nerve mapping tools with higher spatial resolution are needed to advance systems neuroscience, and potentially provide a closed-loop biomarker in neuromodulation applications. Two critical challenges of microscale neural interfaces are 1) how to apply them to small peripheral nerves, and 2) how to minimize chronic reactivity. A flexible microneedle nerve array (MINA) is developed, which is the first high-density penetrating electrode array made with axon-sized silicon microneedles embedded in low-modulus thin silicone. The design, fabrication, acute recording, and chronic reactivity to an implanted MINA, are presented. Distinctive units are identified in the rat peroneal nerve. The authors also demonstrate a long-term, cuff-free, and suture-free fixation manner using rose bengal as a light-activated adhesive for two time-points. The tissue response is investigated at 1-week and 6-week time-points, including two sham groups and two MINA-implanted groups. These conditions are quantified in the left vagus nerve of rats using histomorphometry. Micro computed tomography (micro-CT) is added to visualize and quantify tissue encapsulation around the implant. MINA demonstrates a reduction in encapsulation thickness over previously quantified interfascicular methods. Future challenges include techniques for precise insertion of the microneedle electrodes and demonstrating long-term recording.
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Affiliation(s)
- Dongxiao Yan
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ahmad A Jiman
- Department of Electrical and Computer Engineering, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Elizabeth C Bottorff
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Paras R Patel
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Dilara Meli
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Elissa J Welle
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - David C Ratze
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Leif A Havton
- Departments of Neurology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- James J Peters Veterans Affairs Medical Center, Bronx, NY, 10468, USA
| | - Cynthia A Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Stephen W P Kemp
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, 48105, USA
| | - Tim M Bruns
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Euisik Yoon
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
- Center for Nanomedicine, Institute for Basic Science (IBS) and Graduate Program of Nano Biomedical Engineering (Nano BME), Advanced Science Institute, Yonsei University, Seoul, South Korea
| | - John P Seymour
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Neurosurgery, UTHealth, Houston, TX, 77030, USA
- Department of Electrical and Computer Engineering, Rice University, Houston, TX, 77030, USA
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7
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Vėbraitė I, Hanein Y. Soft Devices for High-Resolution Neuro-Stimulation: The Interplay Between Low-Rigidity and Resolution. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:675744. [PMID: 35047928 PMCID: PMC8757739 DOI: 10.3389/fmedt.2021.675744] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/14/2021] [Indexed: 12/27/2022] Open
Abstract
The field of neurostimulation has evolved over the last few decades from a crude, low-resolution approach to a highly sophisticated methodology entailing the use of state-of-the-art technologies. Neurostimulation has been tested for a growing number of neurological applications, demonstrating great promise and attracting growing attention in both academia and industry. Despite tremendous progress, long-term stability of the implants, their large dimensions, their rigidity and the methods of their introduction and anchoring to sensitive neural tissue remain challenging. The purpose of this review is to provide a concise introduction to the field of high-resolution neurostimulation from a technological perspective and to focus on opportunities stemming from developments in materials sciences and engineering to reduce device rigidity while optimizing electrode small dimensions. We discuss how these factors may contribute to smaller, lighter, softer and higher electrode density devices.
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Affiliation(s)
- Ieva Vėbraitė
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Yael Hanein
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
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8
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Koppaka S, Hess-Dunning A, Tyler DJ. Directed stimulation with interfascicular interfaces for peripheral nerve stimulation. J Neural Eng 2021; 18. [PMID: 34706351 DOI: 10.1088/1741-2552/ac33e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023]
Abstract
Objective.Computational models have shown that directional electrical contacts placed within the epineurium, between the fascicles, and not penetrating the perineurium, can achieve selectivity levels similar to point source contacts placed within the fascicle. The objective of this study is to test, in a murine model, the hypothesis that directed interfascicular contacts are selective.Approach.Multiple interfascicular electrodes with directional contacts, exposed on a single face, were implanted in the sciatic nerves of 32 rabbits. Fine-wire intramuscular wire electrodes were implanted to measure electromyographic (EMG) activity from medial and lateral gastrocnemius, soleus, and tibialis anterior muscles.Main results.The recruitment data demonstrated that directed interfascicular interfaces, which do not penetrate the perineurium, selectively activate different axon populations.Significance.Interfascicular interfaces that are inside the nerve, but do not penetrate the perineurium are an alternative to intrafascicular interfaces and may offer additional selectivity compared to extraneural approaches.
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Affiliation(s)
- Smruta Koppaka
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America.,Louis Stokes Cleveland VA Medical Center, Rehabilitation R&D, Cleveland, OH, United States of America.,Advanced Platform Technology (APT) Center, Cleveland, OH, United States of America
| | - Allison Hess-Dunning
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America.,Louis Stokes Cleveland VA Medical Center, Rehabilitation R&D, Cleveland, OH, United States of America.,Advanced Platform Technology (APT) Center, Cleveland, OH, United States of America
| | - Dustin J Tyler
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America.,Louis Stokes Cleveland VA Medical Center, Rehabilitation R&D, Cleveland, OH, United States of America.,Advanced Platform Technology (APT) Center, Cleveland, OH, United States of America
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9
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Chortos A. Extrusion
3D
printing of conjugated polymers. JOURNAL OF POLYMER SCIENCE 2021. [DOI: 10.1002/pol.20210609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Alex Chortos
- Department of Mechanical Engineering Purdue University West Lafayette Indiana USA
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10
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Raspopovic S, Valle G, Petrini FM. Sensory feedback for limb prostheses in amputees. NATURE MATERIALS 2021; 20:925-939. [PMID: 33859381 DOI: 10.1038/s41563-021-00966-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Commercial prosthetic devices currently do not provide natural sensory information on the interaction with objects or movements. The subsequent disadvantages include unphysiological walking with a prosthetic leg and difficulty in controlling the force exerted with a prosthetic hand, thus creating health issues. Restoring natural sensory feedback from the prosthesis to amputees is an unmet clinical need. An optimal device should be able to elicit natural sensations of touch or proprioception, by delivering the complex signals to the nervous system that would be produced by skin, muscles and joints receptors. This Review covers the various neurotechnological approaches that have been proposed for the development of the optimal sensory feedback restoration device for arm and leg amputees.
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Affiliation(s)
- Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland.
| | - Giacomo Valle
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
| | - Francesco Maria Petrini
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
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11
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Carnicer-Lombarte A, Chen ST, Malliaras GG, Barone DG. Foreign Body Reaction to Implanted Biomaterials and Its Impact in Nerve Neuroprosthetics. Front Bioeng Biotechnol 2021; 9:622524. [PMID: 33937212 PMCID: PMC8081831 DOI: 10.3389/fbioe.2021.622524] [Citation(s) in RCA: 133] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/19/2021] [Indexed: 12/04/2022] Open
Abstract
The implantation of any foreign material into the body leads to the development of an inflammatory and fibrotic process-the foreign body reaction (FBR). Upon implantation into a tissue, cells of the immune system become attracted to the foreign material and attempt to degrade it. If this degradation fails, fibroblasts envelop the material and form a physical barrier to isolate it from the rest of the body. Long-term implantation of medical devices faces a great challenge presented by FBR, as the cellular response disrupts the interface between implant and its target tissue. This is particularly true for nerve neuroprosthetic implants-devices implanted into nerves to address conditions such as sensory loss, muscle paralysis, chronic pain, and epilepsy. Nerve neuroprosthetics rely on tight interfacing between nerve tissue and electrodes to detect the tiny electrical signals carried by axons, and/or electrically stimulate small subsets of axons within a nerve. Moreover, as advances in microfabrication drive the field to increasingly miniaturized nerve implants, the need for a stable, intimate implant-tissue interface is likely to quickly become a limiting factor for the development of new neuroprosthetic implant technologies. Here, we provide an overview of the material-cell interactions leading to the development of FBR. We review current nerve neuroprosthetic technologies (cuff, penetrating, and regenerative interfaces) and how long-term function of these is limited by FBR. Finally, we discuss how material properties (such as stiffness and size), pharmacological therapies, or use of biodegradable materials may be exploited to minimize FBR to nerve neuroprosthetic implants and improve their long-term stability.
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Affiliation(s)
- Alejandro Carnicer-Lombarte
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Shao-Tuan Chen
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - George G. Malliaras
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Damiano G. Barone
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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12
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Aristovich K, Donega M, Fjordbakk C, Tarotin I, Chapman CAR, Viscasillas J, Stathopoulou TR, Crawford A, Chew D, Perkins J, Holder D. Model-based geometrical optimisation and in vivo validation of a spatially selective multielectrode cuff array for vagus nerve neuromodulation. J Neurosci Methods 2021; 352:109079. [PMID: 33516735 DOI: 10.1016/j.jneumeth.2021.109079] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Neuromodulation by electrical stimulation of the human cervical vagus nerve may be limited by adverse side effects due to stimulation of off-target organs. It may be possible to overcome this by spatially selective stimulation of peripheral nerves. Preliminary studies have shown this is possible using a cylindrical multielectrode human-sized nerve cuff in vagus nerve selective neuromodulation. NEW METHOD The model-based optimisation method for multi-electrode geometric design is presented. The method was applied for vagus nerve cuff array and suggested two rings of 14 electrodes, 3 mm apart, with 0.4 mm electrode width and separation and length 0.5-3 mm, with stimulation through a pair in the same radial position on the two rings. The electrodes were fabricated using PDMS-embedded stainless steel foil and PEDOT: pTS coating. RESULTS In the cervical vagus nerve in anaesthetised sheep, it was possible to selectively reduce the respiratory breath rate (RBR) by 85 ± 5% without affecting heart rate, or selectively reduce heart rate (HR) by 20 ± 7% without affecting respiratory rate. The cardiac- and pulmonary-specific sites on the nerve cross-sectional perimeter were localised with a radial separation of 105 ± 5 degrees (P < 0.01, N = 24 in 12 sheep). CONCLUSIONS Results suggest organotopic or function-specific organisation of neural fibres in the cervical vagus nerve. The optimised electrode array demonstrated selective electrical neuromodulation without adverse side effects. It may be possible to translate this to improved treatment by electrical autonomic neuromodulation for currently intractable conditions.
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Affiliation(s)
- Kirill Aristovich
- Medical Physics and Biomedical Engineering, University College London, UK.
| | - Matteo Donega
- Neuromodulation, Galvani Bioelectronics, Stevenage, UK
| | | | - Ilya Tarotin
- Medical Physics and Biomedical Engineering, University College London, UK
| | | | | | | | | | - Daniel Chew
- Neuromodulation, Galvani Bioelectronics, Stevenage, UK
| | | | - David Holder
- Medical Physics and Biomedical Engineering, University College London, UK
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13
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Page DM, George JA, Wendelken SM, Davis TS, Kluger DT, Hutchinson DT, Clark GA. Discriminability of multiple cutaneous and proprioceptive hand percepts evoked by intraneural stimulation with Utah slanted electrode arrays in human amputees. J Neuroeng Rehabil 2021; 18:12. [PMID: 33478534 PMCID: PMC7819250 DOI: 10.1186/s12984-021-00808-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electrical stimulation of residual afferent nerve fibers can evoke sensations from a missing limb after amputation, and bionic arms endowed with artificial sensory feedback have been shown to confer functional and psychological benefits. Here we explore the extent to which artificial sensations can be discriminated based on location, quality, and intensity. METHODS We implanted Utah Slanted Electrode Arrays (USEAs) in the arm nerves of three transradial amputees and delivered electrical stimulation via different electrodes and frequencies to produce sensations on the missing hand with various locations, qualities, and intensities. Participants performed blind discrimination trials to discriminate among these artificial sensations. RESULTS Participants successfully discriminated cutaneous and proprioceptive sensations ranging in location, quality and intensity. Performance was significantly greater than chance for all discrimination tasks, including discrimination among up to ten different cutaneous location-intensity combinations (15/30 successes, p < 0.0001) and seven different proprioceptive location-intensity combinations (21/40 successes, p < 0.0001). Variations in the site of stimulation within the nerve, via electrode selection, enabled discrimination among up to five locations and qualities (35/35 successes, p < 0.0001). Variations in the stimulation frequency enabled discrimination among four different intensities at the same location (13/20 successes, p < 0.0005). One participant also discriminated among individual stimulation of two different USEA electrodes, simultaneous stimulation on both electrodes, and interleaved stimulation on both electrodes (20/24 successes, p < 0.0001). CONCLUSION Electrode location, stimulation frequency, and stimulation pattern can be modulated to evoke functionally discriminable sensations with a range of locations, qualities, and intensities. This rich source of artificial sensory feedback may enhance functional performance and embodiment of bionic arms endowed with a sense of touch.
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Affiliation(s)
| | - Jacob A George
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, 84112, USA.
| | - Suzanne M Wendelken
- Department of Anesthesiology, Maine Medical Center, Portland, ME, 04102, USA
| | - Tyler S Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, 84112, USA
| | | | | | - Gregory A Clark
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, 84112, USA
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Strauss I, Niederhoffer T, Giannotti A, Panarese AM, Bernini F, Gabisonia K, Ottaviani MM, Petrini FM, Recchia FA, Raspopovic S, Micera S. Q-PINE: A quick to implant peripheral intraneural electrode. J Neural Eng 2020; 17. [DOI: 10.1088/1741-2552/abc52a] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022]
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George JA, Page DM, Davis TS, Duncan CC, Hutchinson DT, Rieth LW, Clark GA. Long-term performance of Utah slanted electrode arrays and intramuscular electromyographic leads implanted chronically in human arm nerves and muscles. J Neural Eng 2020; 17:056042. [PMID: 33045689 DOI: 10.1088/1741-2552/abc025] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We explore the long-term performance and stability of seven percutaneous Utah Slanted Electrode Arrays (USEAs) and intramuscular recording leads (iEMGs) implanted chronically in the residual arm nerves and muscles of three human participants as a means to permanently restore sensorimotor function after transradial amputations. APPROACH We quantify the number of functional recording and functional stimulating electrodes over time. We also calculate the signal-to-noise ratio (SNR) of USEA and iEMG recordings and quantify the stimulation current necessary to evoke detectable sensory percepts. Furthermore, we quantify the consistency of the sensory modality, receptive field location, and receptive field size of USEA-evoked percepts. MAIN RESULTS In the most recent subject, involving USEAs with technical improvements, neural recordings persisted for 502 d (entire implant duration) and the number of functional recording electrodes for one USEA increased over time. However, for six out of seven USEAs across the three participants, the number of functional recording electrodes decreased within the first 2 months after implantation. The SNR of neural recordings and electromyographic recordings stayed relatively consistent over time. Sensory percepts were consistently evoked over the span of 14 months, were not significantly different in size, and highlighted the nerves' fascicular organization. The percentage of percepts with consistent modality or consistent receptive field location between sessions (∼1 month apart) varied between 0%-86.2% and 9.1%-100%, respectively. Stimulation thresholds and electrode impedances increased initially but then remained relatively stable over time. SIGNIFICANCE This work demonstrates improved performance of USEAs, and provides a basis for comparing the longevity and stability of USEAs to that of other neural interfaces. USEAs provide a rich repertoire of neural recordings and sensory percepts. Although their performance still generally declines over time, functionality can persist long-term. Future work should leverage the results presented here to further improve USEA design or to develop adaptive algorithms that can maintain a high level of performance.
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Affiliation(s)
- Jacob A George
- Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, United States of America
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Falcone JD, Liu T, Goldman L, David D P, Rieth L, Bouton CE, Straka M, Sohal HS. A novel microwire interface for small diameter peripheral nerves in a chronic, awake murine model. J Neural Eng 2020; 17:046003. [DOI: 10.1088/1741-2552/ab9b6d] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Kolarcik CL, Castro CA, Lesniak A, Demetris AJ, Fisher LE, Gaunt RA, Weber DJ, Cui XT. Host tissue response to floating microelectrode arrays chronically implanted in the feline spinal nerve. J Neural Eng 2020; 17:046012. [PMID: 32434161 DOI: 10.1088/1741-2552/ab94d7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Neural interfacing technologies could significantly improve quality of life for people living with the loss of a limb. Both motor commands and sensory feedback must be considered; these complementary systems are segregated from one another in the spinal nerve. APPROACH The dorsal root ganglion-ventral root (DRG-VR) complex was targeted chronically with floating microelectrode arrays designed to record from motor neuron axons in the VR or stimulate sensory neurons in the DRG. Hematoxylin and eosin and Nissl/Luxol fast blue staining were performed. Characterization of the tissue response in regions of interest and pixel-based image analyses were used to quantify MAC387 (monocytes/macrophages), NF200 (axons), S100 (Schwann cells), vimentin (fibroblasts, endothelial cells, astrocytes), and GLUT1 (glucose transport proteins) reactivity. Implanted roots were compared to non-implanted roots and differences between the VR and DRG examined. MAIN RESULTS The tissue response associated with chronic array implantation in this peripheral location is similar to that observed in central nervous system locations. Markers of inflammation were increased in implanted roots relative to control roots with MAC387 positive cells distributed throughout the region corresponding to the device footprint. Significant decreases in neuronal density and myelination were observed in both the VR, which contains only neuronal axons, and the DRG, which contains both neuronal axons and cell bodies. Notably, decreases in NF200 in the VR were observed only at implant times less than ten weeks. Observations related to the blood-nerve barrier and tissue integrity suggest that tissue remodeling occurs, particularly in the VR. SIGNIFICANCE This study was designed to assess the viability of the DRG-VR complex as a site for neural interfacing applications and suggests that continued efforts to mitigate the tissue response will be critical to achieve the overall goal of a long-term, reliable neural interface.
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Affiliation(s)
- Christi L Kolarcik
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America. Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegic Mellon University, Pittsburgh, PA, United States of America. McGowan Institute for Regenerative Medicine, Pittsburgh, PA, United States of America. Systems Neuroscience Center, Pittsburgh, PA, United States of America. Live Like Lou Center for ALS Research, Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States of America
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Vu PP, Chestek CA, Nason SR, Kung TA, Kemp SW, Cederna PS. The future of upper extremity rehabilitation robotics: research and practice. Muscle Nerve 2020; 61:708-718. [PMID: 32413247 PMCID: PMC7868083 DOI: 10.1002/mus.26860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 01/14/2023]
Abstract
The loss of upper limb motor function can have a devastating effect on people's lives. To restore upper limb control and functionality, researchers and clinicians have developed interfaces to interact directly with the human body's motor system. In this invited review, we aim to provide details on the peripheral nerve interfaces and brain-machine interfaces that have been developed in the past 30 years for upper extremity control, and we highlight the challenges that still remain to transition the technology into the clinical market. The findings show that peripheral nerve interfaces and brain-machine interfaces have many similar characteristics that enable them to be concurrently developed. Decoding neural information from both interfaces may lead to novel physiological models that may one day fully restore upper limb motor function for a growing patient population.
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Affiliation(s)
- Philip P. Vu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cynthia A. Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Robotics Institute, University of Michigan, Ann Arbor, Michigan
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan
| | - Samuel R. Nason
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Theodore A. Kung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Stephen W.P. Kemp
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paul S. Cederna
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
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Cutrone A, Micera S. Implantable Neural Interfaces and Wearable Tactile Systems for Bidirectional Neuroprosthetics Systems. Adv Healthc Mater 2019; 8:e1801345. [PMID: 31763784 DOI: 10.1002/adhm.201801345] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/22/2019] [Indexed: 12/12/2022]
Abstract
Neuroprosthetics and neuromodulation represent a promising field for several related applications in the central and peripheral nervous system, such as the treatment of neurological disorders, the control of external robotic devices, and the restoration of lost tactile functions. These actions are allowed by the neural interface, a miniaturized implantable device that most commonly exploits electrical energy to fulfill these operations. A neural interface must be biocompatible, stable over time, low invasive, and highly selective; the challenge is to develop a safe, compact, and reliable tool for clinical applications. In case of anatomical impairments, neuroprosthetics is bound to the need of exploring the surrounding environment by fast-responsive and highly sensitive artificial tactile sensors that mimic the natural sense of touch. Tactile sensors and neural interfaces are closely interconnected since the readouts from the first are required to convey information to the neural implantable apparatus. The role of these devices is pivotal hence technical improvements are essential to ensure a secure system to be eventually adopted in daily life. This review highlights the fundamental criteria for the design and microfabrication of neural interfaces and artificial tactile sensors, their use in clinical applications, and future enhancements for the release of a second generation of devices.
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Affiliation(s)
- Annarita Cutrone
- The Biorobotics Institute, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
| | - Silvestro Micera
- The Biorobotics Institute, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne, CH-1202, Switzerland
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20
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A review for the peripheral nerve interface designer. J Neurosci Methods 2019; 332:108523. [PMID: 31743684 DOI: 10.1016/j.jneumeth.2019.108523] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022]
Abstract
Informational density and relative accessibility of the peripheral nervous system make it an attractive site for therapeutic intervention. Electrode-based electrophysiological interfaces with peripheral nerves have been under development since the 1960s and, for several applications, have seen widespread clinical implementation. However, many applications require a combination of neural target resolution and stability which has thus far eluded existing peripheral nerve interfaces (PNIs). With the goal of aiding PNI designers in development of devices that meet the demands of next-generation applications, this review seeks to collect and present practical considerations and best practices which emerge from the literature, including both lessons learned during early PNI development and recent ideas. Fundamental and practical principles guiding PNI design are reviewed, followed by an updated and critical account of existing PNI designs and strategies. Finally, a brief survey of in vitro and in vivo PNI characterization methods is presented.
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Stiller AM, González-González MA, Boothby JM, Sherman SE, Benavides J, Romero-Ortega M, Pancrazio JJ, Black BJ. Mechanical considerations for design and implementation of peripheral intraneural devices. J Neural Eng 2019; 16:064001. [DOI: 10.1088/1741-2552/ab4114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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22
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Classification of naturally evoked compound action potentials in peripheral nerve spatiotemporal recordings. Sci Rep 2019; 9:11145. [PMID: 31366940 PMCID: PMC6668407 DOI: 10.1038/s41598-019-47450-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 07/10/2019] [Indexed: 01/21/2023] Open
Abstract
Peripheral neural signals have the potential to provide the necessary motor, sensory or autonomic information for robust control in many neuroprosthetic and neuromodulation applications. However, developing methods to recover information encoded in these signals is a significant challenge. We introduce the idea of using spatiotemporal signatures extracted from multi-contact nerve cuff electrode recordings to classify naturally evoked compound action potentials (CAP). 9 Long-Evan rats were implanted with a 56-channel nerve cuff on the sciatic nerve. Afferent activity was selectively evoked in the different fascicles of the sciatic nerve (tibial, peroneal, sural) using mechano-sensory stimuli. Spatiotemporal signatures of recorded CAPs were used to train three different classifiers. Performance was measured based on the classification accuracy, F1-score, and the ability to reconstruct original firing rates of neural pathways. The mean classification accuracies, for a 3-class problem, for the best performing classifier was 0.686 ± 0.126 and corresponding mean F1-score was 0.605 ± 0.212. The mean Pearson correlation coefficients between the original firing rates and estimated firing rates found for the best classifier was 0.728 ± 0.276. The proposed method demonstrates the possibility of classifying individual naturally evoked CAPs in peripheral neural signals recorded from extraneural electrodes, allowing for more precise control signals in neuroprosthetic applications.
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23
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Chen C, Ruan S, Bai X, Lin C, Xie C, Lee IS. Patterned iridium oxide film as neural electrode interface: Biocompatibility and improved neurite outgrowth with electrical stimulation. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 103:109865. [PMID: 31349419 DOI: 10.1016/j.msec.2019.109865] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 01/19/2023]
Abstract
Iridium (Ir) thin film was deposited on patterned titanium substrate by direct-current (DC) magnetron sputtering, and then activated in sulfuric acid (H2SO4) through repetitive potential sweeps to form iridium oxide (IrOx) as neural electrode interface. The resultant IrOx film showed a porous and open morphology with aligned microstructure, exhibited superior electrochemical performance and excellent stability. The IrOx film supported neural stem cells (NSCs) attachment, proliferation and improved processes without causing toxicity. The patterned IrOx films offered a unique system to investigate the synergistic effects of topographical cue and electrical stimulation on neurite outgrowth. Electrical stimulation, when applied through patterned IrOx films, was found to further increase the neurite extension of neuron-like cells and significantly reorient the neurite alignment towards to the direction of stimulation. These results indicate that IrOx film, as electrode-tissue interface is highly stable and biocompatible with excellent electrochemical properties.
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Affiliation(s)
- Cen Chen
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, PR China; School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, PR China; Institute of Natural Sciences, Yonsei University, Seoul 03722, Republic of Korea
| | - Shichao Ruan
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, PR China
| | - Xue Bai
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, PR China
| | - Chenming Lin
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, PR China
| | - Chungang Xie
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, PR China
| | - In-Seop Lee
- Institute of Natural Sciences, Yonsei University, Seoul 03722, Republic of Korea.
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Hope J, Aristovich K, Chapman CAR, Volschenk A, Vanholsbeeck F, McDaid A. Extracting impedance changes from a frequency multiplexed signal during neural activity in sciatic nerve of rat: preliminary study in vitro. Physiol Meas 2019; 40:034006. [DOI: 10.1088/1361-6579/ab0c24] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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25
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Wireless bioresorbable electronic system enables sustained nonpharmacological neuroregenerative therapy. Nat Med 2018; 24:1830-1836. [PMID: 30297910 DOI: 10.1038/s41591-018-0196-2] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 08/10/2018] [Indexed: 01/17/2023]
Abstract
Peripheral nerve injuries represent a significant problem in public health, constituting 2-5% of all trauma cases1. For severe nerve injuries, even advanced forms of clinical intervention often lead to incomplete and unsatisfactory motor and/or sensory function2. Numerous studies report the potential of pharmacological approaches (for example, growth factors, immunosuppressants) to accelerate and enhance nerve regeneration in rodent models3-10. Unfortunately, few have had a positive impact in clinical practice. Direct intraoperative electrical stimulation of injured nerve tissue proximal to the site of repair has been demonstrated to enhance and accelerate functional recovery11,12, suggesting a novel nonpharmacological, bioelectric form of therapy that could complement existing surgical approaches. A significant limitation of this technique is that existing protocols are constrained to intraoperative use and limited therapeutic benefits13. Herein we introduce (i) a platform for wireless, programmable electrical peripheral nerve stimulation, built with a collection of circuit elements and substrates that are entirely bioresorbable and biocompatible, and (ii) the first reported demonstration of enhanced neuroregeneration and functional recovery in rodent models as a result of multiple episodes of electrical stimulation of injured nervous tissue.
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26
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Aristovich K, Donegá M, Blochet C, Avery J, Hannan S, Chew DJ, Holder D. Imaging fast neural traffic at fascicular level with electrical impedance tomography: proof of principle in rat sciatic nerve. J Neural Eng 2018; 15:056025. [DOI: 10.1088/1741-2552/aad78e] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Byun D, Cho SJ, Lee BH, Min J, Lee JH, Kim S. Recording nerve signals in canine sciatic nerves with a flexible penetrating microelectrode array. J Neural Eng 2018; 14:046023. [PMID: 28612758 DOI: 10.1088/1741-2552/aa7493] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Previously, we presented the fabrication and characterization of a flexible penetrating microelectrode array (FPMA) as a neural interface device. In the present study, we aim to prove the feasibility of the developed FPMA as a chronic intrafascicular recording tool for peripheral applications. APPROACH For recording from the peripheral nerves of medium-sized animals, the FPMA was integrated with an interconnection cable and other parts that were designed to fit canine sciatic nerves. The uniformity of tip exposure and in vitro electrochemical properties of the electrodes were characterized. The capability of the device to acquire in vivo electrophysiological signals was evaluated by implanting the FPMA assembly in canine sciatic nerves acutely as well as chronically for 4 weeks. We also examined the histology of implanted tissues to evaluate the damage caused by the device. MAIN RESULTS Throughout recording sessions, we observed successful multi-channel recordings (up to 73% of viable electrode channels) of evoked afferent and spontaneous nerve unit spikes with high signal quality (SNR > 4.9). Also, minor influences of the device implantation on the morphology of nerve tissues were found. SIGNIFICANCE The presented results demonstrate the viability of the developed FPMA device in the peripheral nerves of medium-sized animals, thereby bringing us a step closer to human applications. Furthermore, the obtained data provide a driving force toward a further study for device improvements to be used as a bidirectional neural interface in humans.
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Affiliation(s)
- Donghak Byun
- School of Mechanical Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
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28
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Giagka V, Serdijn WA. Realizing flexible bioelectronic medicines for accessing the peripheral nerves - technology considerations. Bioelectron Med 2018; 4:8. [PMID: 32232084 PMCID: PMC7098212 DOI: 10.1186/s42234-018-0010-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/13/2018] [Indexed: 11/13/2022] Open
Abstract
Patients suffering from conditions such as paralysis, diabetes or rheumatoid arthritis could in the future be treated in a personalised manner using bioelectronic medicines (BEms) (Nat Rev Drug Discov 13:399–400, 2013, Proc Natl Acad Sci USA 113:8284–9, 2016, J Intern Med 282:37–45, 2017). To deliver this personalised therapy based on electricity, BEms need to target various sites in the human body and operate in a closed-loop manner. The specific conditions and anatomy of the targeted sites pose unique challenges in the development of BEms. With a focus on BEms based on flexible substrates for accessing small peripheral nerves, this paper discusses several system-level technology considerations related to the development of such devices. The focus is mainly on miniaturisation and long-term operation. We present an overview of common substrate and electrode materials, related processing methods, and discuss assembly, miniaturisation and long-term stability issues.
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Affiliation(s)
- Vasiliki Giagka
- 1Section Bioelectronics, Department of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, The Netherlands.,2Technologies for Bioelectronics Group, Department of System Integration and Interconnection Technologies, Fraunhofer Institute for Reliability and Microintegration IZM, Berlin, Germany
| | - Wouter A Serdijn
- 1Section Bioelectronics, Department of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, The Netherlands
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de la Oliva N, Mueller M, Stieglitz T, Navarro X, Del Valle J. On the use of Parylene C polymer as substrate for peripheral nerve electrodes. Sci Rep 2018; 8:5965. [PMID: 29654317 PMCID: PMC5899141 DOI: 10.1038/s41598-018-24502-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/05/2018] [Indexed: 12/31/2022] Open
Abstract
Parylene C is a highly flexible polymer used in several biomedical implants. Since previous studies have reported valuable biocompatible and manufacturing characteristics for brain and intraneural implants, we tested its suitability as a substrate for peripheral nerve electrodes. We evaluated 1-year-aged in vitro samples, where no chemical differences were observed and only a slight deviation on Young’s modulus was found. The foreign body reaction (FBR) to longitudinal Parylene C devices implanted in the rat sciatic nerve for 8 months was characterized. After 2 weeks, a capsule was formed around the device, which continued increasing up to 16 and 32 weeks. Histological analyses revealed two cell types implicated in the FBR: macrophages, in contact with the device, and fibroblasts, localized in the outermost zone after 8 weeks. Molecular analysis of implanted nerves comparing Parylene C and polyimide devices revealed a peak of inflammatory cytokines after 1 day of implant, returning to low levels thereafter. Only an increase of CCL2 and CCL3 was found at chronic time-points for both materials. Although no molecular differences in the FBR to both polymers were found, the thick tissue capsule formed around Parylene C puts some concern on its use as a scaffold for intraneural electrodes.
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Affiliation(s)
- Natàlia de la Oliva
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Matthias Mueller
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Albert-Ludwig-University Freiburg, Freiburg, Germany
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Albert-Ludwig-University Freiburg, Freiburg, Germany
| | - Xavier Navarro
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - Jaume Del Valle
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain. .,Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Bellaterra, 08193, Barcelona, Spain.
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The foreign body response and morphometric changes associated with mesh-style peripheral nerve cuffs. Acta Biomater 2018; 67:79-86. [PMID: 29223703 DOI: 10.1016/j.actbio.2017.11.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/27/2017] [Accepted: 11/30/2017] [Indexed: 01/25/2023]
Abstract
Nerve cuffs have been used to anchor and protect penetrating electrodes in peripheral nerves and have been used as non-penetrating electrodes for neural recording and nerve stimulation. The material of choice for such applications is silicone, an inert synthetic biomaterial which elicits a minimal chronic foreign body response (FBR). While histological studies of solid silicone cuffs are available, to the best of our knowledge a comparison to other cuff designs is not well documented. Here, we describe the FBR and morphological changes that accompany nerve cuff implantation in the rat sciatic nerve by comparing a metallic mesh with and without a parylene coating to one made of silicone. Two months after implantation, we observed that such implants, irrespective of the cuff type, were associated with a persistent inflammatory response consisting of activated macrophages attached to the implant surfaces, which extended into the endoneurial space of the encapsulated nerve. We also observed foreign body giant cells in the epineurial space that were more prevalent in the mesh cohorts. The mesh cuff groups showed significant changes in several morphometric parameters that were not seen in the silicon group including reductions in nerve fiber packing density and a greater reduction of large diameter fibers. High magnification microscopy also showed greater evidence of foamy macrophages in the endoneurial space of the mesh implanted cohorts. Although the precise mechanisms are unknown, the results showed that mesh style nerve cuffs show a greater inflammatory response and had greater reductions in morphometric changes in the underlying nerve compared to silicone in the absence of a penetrating injury. STATEMENT OF SIGNIFICANCE While traditional silicone cuffs have been in use for decades, the inflammatory and morphometric effects of these cuffs on the underlying nerve have not been deeply studied. Further, manipulation of the foreign body response to nerve cuffs by using various materials and/or designs has not been well reported. Therefore, we report the inflammatory response around nerve cuffs of various materials and designs, as well as report morphometric parameters of the underlying nerve. These data provide important information regarding the potential for quantitative morphometric changes associated with the use of nerve cuffs, and, importantly, suggests that these changes are associated with the degree of inflammation associated with the cuff.
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Wendelken S, Page DM, Davis T, Wark HAC, Kluger DT, Duncan C, Warren DJ, Hutchinson DT, Clark GA. Restoration of motor control and proprioceptive and cutaneous sensation in humans with prior upper-limb amputation via multiple Utah Slanted Electrode Arrays (USEAs) implanted in residual peripheral arm nerves. J Neuroeng Rehabil 2017; 14:121. [PMID: 29178940 PMCID: PMC5702130 DOI: 10.1186/s12984-017-0320-4] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 10/20/2017] [Indexed: 01/08/2023] Open
Abstract
Background Despite advances in sophisticated robotic hands, intuitive control of and sensory feedback from these prostheses has been limited to only 3-degrees-of-freedom (DOF) with 2 sensory percepts in closed-loop control. A Utah Slanted Electrode Array (USEA) has been used in the past to provide up to 81 sensory percepts for human amputees. Here, we report on the advanced capabilities of multiple USEAs implanted in the residual peripheral arm nerves of human amputees for restoring control of 5 DOF and sensation of up to 131 proprioceptive and cutaneous hand sensory percepts. We also demonstrate that USEA-restored sensory percepts provide a useful source of feedback during closed-loop virtual prosthetic hand control. Methods Two 100-channel USEAs were implanted for 4–5 weeks, one each in the median and ulnar arm nerves of two human subjects with prior long-duration upper-arm amputations. Intended finger and wrist positions were decoded from neuronal firing patterns via a modified Kalman filter, allowing subjects to control many movements of a virtual prosthetic hand. Additionally, USEA microstimulation was used to evoke numerous sensory percepts spanning the phantom hand. Closed-loop control was achieved by stimulating via an electrode of the ulnar-nerve USEA while recording and decoding movement via the median-nerve USEA. Results Subjects controlled up to 12 degrees-of-freedom during informal, ‘freeform’ online movement decode sessions, and experienced up to 131 USEA-evoked proprioceptive and cutaneous sensations spanning the phantom hand. Independent control was achieved for a 5-DOF real-time decode that included flexion/extension of the thumb, index, middle, and ring fingers, and the wrist. Proportional control was achieved for a 4-DOF real-time decode. One subject used a USEA-evoked hand sensation as feedback to complete a 1-DOF closed-loop virtual-hand movement task. There were no observed long-term functional deficits due to the USEA implants. Conclusions Implantation of high-channel-count USEAs enables multi-degree-of-freedom control of virtual prosthetic hand movement and restoration of a rich selection of both proprioceptive and cutaneous sensory percepts spanning the hand during the short 4–5 week post-implant period. Future USEA use in longer-term implants and in closed-loop may enable restoration of many of the capabilities of an intact hand while contributing to a meaningful embodiment of the prosthesis. Electronic supplementary material The online version of this article (10.1186/s12984-017-0320-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suzanne Wendelken
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA
| | - David M Page
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA
| | - Tyler Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, 84132, USA
| | - Heather A C Wark
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84102, USA
| | - David T Kluger
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA
| | - Christopher Duncan
- Division of Phys. Med. and Rehabilitation, University of Utah, Salt Lake City, UT, 84132, USA
| | - David J Warren
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA
| | | | - Gregory A Clark
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA.
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de la Oliva N, Navarro X, Del Valle J. Time course study of long-term biocompatibility and foreign body reaction to intraneural polyimide-based implants. J Biomed Mater Res A 2017; 106:746-757. [PMID: 29052368 DOI: 10.1002/jbm.a.36274] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/06/2017] [Accepted: 10/17/2017] [Indexed: 12/26/2022]
Abstract
The foreign body reaction (FBR) against an implanted device is characterized by the formation of a fibrotic tissue around the implant. In the case of interfaces for peripheral nerves, used to stimulate specific group of axons and to record different nerve signals, the FBR induces a matrix deposition around the implant creating a physical separation between nerve fibers and the interface that may reduce its functionality over time. In order to understand how the FBR to intraneural interfaces evolves, polyimide non-functional devices were implanted in rat peripheral nerve. Functional tests (electrophysiological, pain and locomotion) and histological evaluation demonstrated that implanted devices did not cause any alteration in nerve function, in myelinated axons or in nerve architecture. The inflammatory response due to the surgical implantation decreased after 2 weeks. In contrast, inflammation was higher and more prolonged in the device implanted nerves with a peak after 2 weeks. With regard to tissue deposition, a tissue capsule appeared soon around the devices, acquiring maximal thickness at 2 weeks and being remodeled subsequently. Immunohistochemical analysis revealed two different cell types implicated in the FBR in the nerve: macrophages as the first cells in contact with the interface and fibroblasts that appear later at the edge of the capsule. Our results describe how the FBR against a polyimide implant in the peripheral nerve occurs and which are the main cellular players. Increasing knowledge of these responses will help to improve strategies to decrease the FBR against intraneural implants and to extend their usability. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 746-757, 2018.
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Affiliation(s)
- Natàlia de la Oliva
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Institute of Neurosciences, Bellaterra, 08193, Barcelona, Spain
| | - Xavier Navarro
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Institute of Neurosciences, Bellaterra, 08193, Barcelona, Spain
| | - Jaume Del Valle
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Institute of Neurosciences, Bellaterra, 08193, Barcelona, Spain.,Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Bellaterra, 08193, Barcelona, Spain
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Vasudevan S, Patel K, Welle C. Rodent model for assessing the long term safety and performance of peripheral nerve recording electrodes. J Neural Eng 2016; 14:016008. [PMID: 27934777 DOI: 10.1088/1741-2552/14/1/016008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In the US alone, there are approximately 185 000 cases of limb amputation annually, which can reduce the quality of life for those individuals. Current prosthesis technology could be improved by access to signals from the nervous system for intuitive prosthesis control. After amputation, residual peripheral nerves continue to convey motor signals and electrical stimulation of these nerves can elicit sensory percepts. However, current technology for extracting information directly from peripheral nerves has limited chronic reliability, and novel approaches must be vetted to ensure safe long-term use. The present study aims to optimize methods to establish a test platform using rodent model to assess the long term safety and performance of electrode interfaces implanted in the peripheral nerves. APPROACH Floating Microelectrode Arrays (FMA, Microprobes for Life Sciences) were implanted into the rodent sciatic nerve. Weekly in vivo recordings and impedance measurements were performed in animals to assess performance and physical integrity of electrodes. Motor (walking track analysis) and sensory (Von Frey) function tests were used to assess change in nerve function due to the implant. Following the terminal recording session, the nerve was explanted and the health of axons, myelin and surrounding tissues were assessed using immunohistochemistry (IHC). The explanted electrodes were visualized under high magnification using scanning electrode microscopy (SEM) to observe any physical damage. MAIN RESULTS Recordings of axonal action potentials demonstrated notable session-to-session variability. Impedance of the electrodes increased upon implantation and displayed relative stability until electrode failure. Initial deficits in motor function recovered by 2 weeks, while sensory deficits persisted through 6 weeks of assessment. The primary cause of failure was identified as lead wire breakage in all of animals. IHC indicated myelinated and unmyelinated axons near the implanted electrode shanks, along with dense cellular accumulations near the implant site. Scanning electron microscopy (SEM) showed alterations of the electrode insulation and deformation of electrode shanks. SIGNIFICANCE We describe a comprehensive testing platform with applicability to electrodes that record from the peripheral nerves. This study assesses the long term safety and performance of electrodes in the peripheral nerves using a rodent model. Under this animal test platform, FMA electrodes record single unit action potentials but have limited chronic reliability due to structural weaknesses. Future work will apply these methods to other commercially-available and novel peripheral electrode technologies.
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Affiliation(s)
- Srikanth Vasudevan
- Division of Biomedical Physics, Office of Science and Engineering Laboratory, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
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