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Campos DP, Mendes Junior JJA, Junior PB, Lazzaretti AE, Sartori LG, Krueger E. Non-invasive muscle-machine interface open source project: wearable hand myoelectrical orthosis (MES-FES). Assist Technol 2024:1-10. [PMID: 39324974 DOI: 10.1080/10400435.2024.2382857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 09/27/2024] Open
Abstract
The paper describes the development of an open-source, low-cost, wearable hand myoelectrical orthosis (neuro-orthosis) device for people with hand disabilities. The device uses functional electrical stimulation (FES) driven by myoelectrical signals (MES) to assist hand movements, enabling users to perform daily activities with greater ease and independence. The device comprises a forearm-wearable device developed using the 3D additive manufacturing principle, allowing user customization. Fixed non-disposable electrodes are attached to the myoelectrical orthosis, aiding the correct positioning for the user. The whole control system is stand-alone, and parameters can be controlled by Bluetooth communication, making the device wireless. The paper describes the MES-FES device's design, development, and testing, including its technical specifications, usability, and effectiveness. The open-source project aims to provide an accessible and affordable solution for people with spinal cord lesions while contributing to the growing research on noninvasive muscle-machine interfaces.
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Affiliation(s)
- Daniel Prado Campos
- COENC-AP/PPGEB, Universidade Tecnológica Federal do Paraná (UTFPR), Apucarana, Brazil
- Laboratório de Engenharia Neural e de Reabilitação, Universidade Estadual de Londrina - Departamento de Anatomia, Londrina, Brazil
| | | | - Paulo Broniera Junior
- Instituto Senai de Tecnologia da Informação e Comunicação (ISTIC), Laboratório de Sistemas Eletrônicos -Embarcados e de Potência, Londrina, Brazil
| | - André Eugenio Lazzaretti
- DAELN-CT/CPGEI, Universidade Tecnológica Federal do Paraná (UTFPR), Sete de Setembro, Curitiba, Brazil
| | - Larissa Gomes Sartori
- Laboratório de Engenharia Neural e de Reabilitação, Universidade Estadual de Londrina - Departamento de Anatomia, Londrina, Brazil
| | - Eddy Krueger
- Laboratório de Engenharia Neural e de Reabilitação, Universidade Estadual de Londrina - Departamento de Anatomia, Londrina, Brazil
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Losanno E, Ceradini M, Agnesi F, Righi G, Del Popolo G, Shokur S, Micera S. A Virtual Reality-Based Protocol to Determine the Preferred Control Strategy for Hand Neuroprostheses in People With Paralysis. IEEE Trans Neural Syst Rehabil Eng 2024; 32:2261-2269. [PMID: 38865234 DOI: 10.1109/tnsre.2024.3413192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Hand neuroprostheses restore voluntary movement in people with paralysis through neuromodulation protocols. There are a variety of strategies to control hand neuroprostheses, which can be based on residual body movements or brain activity. There is no universally superior solution, rather the best approach may vary from patient to patient. Here, we propose a protocol based on an immersive virtual reality (VR) environment that simulates the use of a hand neuroprosthesis to allow patients to experience and familiarize themselves with various control schemes in clinically relevant tasks and choose the preferred one. We used our VR environment to compare two alternative control strategies over 5 days of training in four patients with C6 spinal cord injury: (a) control via the ipsilateral wrist, (b) control via the contralateral shoulder. We did not find a one-fits-all solution but rather a subject-specific preference that could not be predicted based only on a general clinical assessment. The main results were that the VR simulation allowed participants to experience the pros and cons of the proposed strategies and make an educated choice, and that there was a longitudinal improvement. This shows that our VR-based protocol is a useful tool for personalization and training of the control strategy of hand neuroprostheses, which could help to promote user comfort and thus acceptance.
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Lambrecht JM, Cady SR, Peterson EJ, Dunning JL, Dinsmoor DA, Pape F, Graczyk EL, Tyler DJ. A distributed, high-channel-count, implanted bidirectional system for restoration of somatosensation and myoelectric control. J Neural Eng 2024; 21:036049. [PMID: 38861967 DOI: 10.1088/1741-2552/ad56c9] [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: 01/31/2024] [Accepted: 06/11/2024] [Indexed: 06/13/2024]
Abstract
Objective. We intend to chronically restore somatosensation and provide high-fidelity myoelectric control for those with limb loss via a novel, distributed, high-channel-count, implanted system.Approach.We have developed the implanted Somatosensory Electrical Neurostimulation and Sensing (iSens®) system to support peripheral nerve stimulation through up to 64, 96, or 128 electrode contacts with myoelectric recording from 16, 8, or 0 bipolar sites, respectively. The rechargeable central device has Bluetooth® wireless telemetry to communicate to external devices and wired connections for up to four implanted satellite stimulation or recording devices. We characterized the stimulation, recording, battery runtime, and wireless performance and completed safety testing to support its use in human trials.Results.The stimulator operates as expected across a range of parameters and can schedule multiple asynchronous, interleaved pulse trains subject to total charge delivery limits. Recorded signals in saline show negligible stimulus artifact when 10 cm from a 1 mA stimulating source. The wireless telemetry range exceeds 1 m (direction and orientation dependent) in a saline torso phantom. The bandwidth supports 100 Hz bidirectional update rates of stimulation commands and data features or streaming select full bandwidth myoelectric signals. Preliminary first-in-human data validates the bench testing result.Significance.We developed, tested, and clinically implemented an advanced, modular, fully implanted peripheral stimulation and sensing system for somatosensory restoration and myoelectric control. The modularity in electrode type and number, including distributed sensing and stimulation, supports a wide variety of applications; iSens® is a flexible platform to bring peripheral neuromodulation applications to clinical reality. ClinicalTrials.gov ID NCT04430218.
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Affiliation(s)
- Joris M Lambrecht
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States of America
| | - Sedona R Cady
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States of America
| | | | - Jeremy L Dunning
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States of America
| | | | - Forrest Pape
- Medtronic plc, Minneapolis, MN, United States of America
| | - Emily L Graczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- Louis Stokes Cleveland Department of Veterans Affairs Medical 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 Department of Veterans Affairs Medical Center, Cleveland, OH, United States of America
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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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Kilgore KL, Anderson KD, Peckham PH. Neuroprosthesis for individuals with spinal cord injury. Neurol Res 2023; 45:893-905. [PMID: 32727296 PMCID: PMC9415059 DOI: 10.1080/01616412.2020.1798106] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 07/14/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Individuals who sustain a traumatic spinal cord injury (SCI) often have a loss of multiple body systems. Significant functional improvement can be gained by individual SCI through the use of neuroprostheses based on electrical stimulation. The most common actions produced are grasp, overhead reach, trunk posture, standing, stepping, bladder/bowel/sexual function, and respiratory functions. METHODS We review the fundamental principles of electrical stimulation, which are established, allowing stimulation to be safely delivered through implanted devices for many decades. We review four common clinical applications for SCI, including grasp/reach, standing/stepping, bladder/bowel function, and respiratory functions. Systems used to implement these functions have many common features, but are also customized based on the functional goals of each approach. Further, neuroprosthetic systems are customized based on the needs of each user. RESULTS & CONCLUSION The results to date show that implanted neuroprostheses can have a significant impact on the health, function, and quality of life for individuals with SCI. A key focus for the future is to make implanted neuroprostheses broadly available to the SCI population.
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Affiliation(s)
- Kevin L. Kilgore
- – MetroHealth System, Cleveland, Ohio
- – Case Western Reserve University, Cleveland, Ohio
- – VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Kimberly D. Anderson
- – MetroHealth System, Cleveland, Ohio
- – Case Western Reserve University, Cleveland, Ohio
| | - P. Hunter Peckham
- – MetroHealth System, Cleveland, Ohio
- – Case Western Reserve University, Cleveland, Ohio
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Readioff R, Siddiqui ZK, Stewart C, Fulbrook L, O’Connor RJ, Chadwick EK. Use and evaluation of assistive technologies for upper limb function in tetraplegia. J Spinal Cord Med 2022; 45:809-820. [PMID: 33606599 PMCID: PMC9662059 DOI: 10.1080/10790268.2021.1878342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT More than half of all spinal cord injuries (SCI) occur at the cervical level leading to loss of upper limb function, restricted activity and reduced independence. Several technologies have been developed to assist with upper limb functions in the SCI population. OBJECTIVE There is no clear clinical consensus on the effectiveness of the current assistive technologies for the cervical SCI population, hence this study reviews the literature in the years between 1999 and 2019. METHODS A systematic review was performed on the state-of-the-art assistive technology that supports and improves the function of impaired upper limbs in cervical SCI populations. Combinations of terms, covering assistive technology, SCI, and upper limb, were used in the search, which resulted in a total of 1770 articles. Data extractions were performed on the selected studies which involved summarizing details on the assistive technologies, characteristics of study participants, outcome measures, and improved upper limb functions when using the device. RESULTS A total of 24 articles were found and grouped into five categories, including neuroprostheses (invasive and non-invasive), orthotic devices, hybrid systems, robots, and arm supports. Only a few selected studies comprehensively reported characteristics of the participants. There was a wide range of outcome measures and all studies reported improvements in upper limb function with the devices. CONCLUSIONS This study highlighted that assistive technologies can improve functions of the upper limbs in SCI patients. It was challenging to draw generalizable conclusions because of factors, such as heterogeneity of recruited participants, a wide range of outcome measures, and the different technologies employed.
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Affiliation(s)
- Rosti Readioff
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK,Correspondence to: Rosti Readioff, Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, LeedsLS2 9JT, UK. ; @Dr_Rosti
| | - Zaha Kamran Siddiqui
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Caroline Stewart
- School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, UK,The Orthotic Research and Locomotor Assessment Unit (ORLAU), the Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, UK
| | - Louisa Fulbrook
- The Orthotic Research and Locomotor Assessment Unit (ORLAU), the Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, UK
| | - Rory J. O’Connor
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Hasse BA, Sheets DEG, Holly NL, Gothard KM, Fuglevand AJ. Restoration of complex movement in the paralyzed upper limb. J Neural Eng 2022; 19. [PMID: 35728568 DOI: 10.1088/1741-2552/ac7ad7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Functional electrical stimulation (FES) involves artificial activation of skeletal muscles to reinstate motor function in paralyzed individuals. While FES applied to the upper limb has improved the ability of tetraplegics to perform activities of daily living, there are key shortcomings impeding its widespread use. One major limitation is that the range of motor behaviors that can be generated is restricted to a small set of simple, preprogrammed movements. This limitation stems from the substantial difficulty in determining the patterns of stimulation across many muscles required to produce more complex movements. Therefore, the objective of this study was to use machine learning to flexibly identify patterns of muscle stimulation needed to evoke a wide array of multi-joint arm movements. APPROACH Arm kinematics and electromyographic activity from 29 muscles were recorded while a 'trainer' monkey made an extensive range of arm movements. Those data were used to train an artificial neural network that predicted patterns of muscle activity associated with a new set of movements. Those patterns were converted into trains of stimulus pulses that were delivered to upper limb muscles in two other temporarily paralyzed monkeys. RESULTS Machine-learning based prediction of EMG was good for within-subject predictions but appreciably poorer for across-subject predictions. Evoked responses matched the desired movements with good fidelity only in some cases. Means to mitigate errors associated with FES-evoked movements are discussed. SIGNIFICANCE Because the range of movements that can be produced with our approach is virtually unlimited, this system could greatly expand the repertoire of movements available to individuals with high level paralysis.
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Affiliation(s)
- Brady A Hasse
- Department of Physiology, The University of Arizona College of Medicine Tucson, 1501 N Campbell Avenue, Tucson, Arizona, 85724-5051, UNITED STATES
| | - Drew E G Sheets
- Department of Organismal Biology & Anatomy, University of Chicago Biological Sciences Division, Anatomy, 1027 E 57th Street Chicago, IL 60637, Chicago, Illinois, 60637-5416, UNITED STATES
| | - Nicole L Holly
- Physiology, The University of Arizona College of Medicine Tucson, 1501 N Campbell Avenue, Tucson, Arizona, 85724-5051, UNITED STATES
| | - Katalin M Gothard
- Physiology, The University of Arizona College of Medicine Tucson, 1501 N Campbell Ave, Tucson, Arizona, 85724-5051, UNITED STATES
| | - Andrew J Fuglevand
- Department of Physiology, University of Arizona, Arizona Health Sciences Center, 1501 N. Campbell Ave, Tucson, Arizona, 85724-5051, UNITED STATES
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Gstoettner C, Festin C, Prahm C, Bergmeister KD, Salminger S, Sturma A, Hofer C, Russold MF, Howard CL, McDonnall D, Farina D, Aszmann OC. Feasibility of a Wireless Implantable Multi-electrode System for High-bandwidth Prosthetic Interfacing: Animal and Cadaver Study. Clin Orthop Relat Res 2022; 480:1191-1204. [PMID: 35202032 PMCID: PMC9263498 DOI: 10.1097/corr.0000000000002135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Currently used prosthetic solutions in upper extremity amputation have limited functionality, owing to low information transfer rates of neuromuscular interfacing. Although surgical innovations have expanded the functional potential of the residual limb, available interfaces are inefficacious in translating this potential into improved prosthetic control. There is currently no implantable solution for functional interfacing in extremity amputation which offers long-term stability, high information transfer rates, and is applicable for all levels of limb loss. In this study, we presented a novel neuromuscular implant, the the Myoelectric Implantable Recording Array (MIRA). To our knowledge, it is the first fully implantable system for prosthetic interfacing with a large channel count, comprising 32 intramuscular electrodes. QUESTIONS/PURPOSES The purpose of this study was to evaluate the MIRA in terms of biocompatibility, functionality, and feasibility of implantation to lay the foundations for clinical application. This was achieved through small- and large-animal studies as well as test surgeries in a human cadaver. METHODS We evaluated the biocompatibility of the system's intramuscular electromyography (EMG) leads in a rabbit model. Ten leads as well as 10 pieces of a biologically inert control material were implanted into the paravertebral muscles of four animals. After a 3-month implantation, tissue samples were taken and histopathological assessment performed. The probes were scored according to a protocol for the assessment of the foreign body response, with primary endpoints being inflammation score, tissue response score, and capsule thickness in µm. In a second study, chronic functionality of the full system was evaluated in large animals. The MIRA was implanted into the shoulder region of six dogs and three sheep, with intramuscular leads distributed across agonist and antagonist muscles of shoulder flexion. During the observation period, regular EMG measurements were performed. The implants were removed after 5 to 6 months except for one animal, which retained the implant for prolonged observation. Primary endpoints of the large-animal study were mechanical stability, telemetric capability, and EMG signal quality. A final study involved the development of test surgeries in a fresh human cadaver, with the goal to determine feasibility to implant relevant target muscles for prosthetic control at all levels of major upper limb amputation. RESULTS Evaluation of the foreign body reaction revealed favorable biocompatibility and a low-grade tissue response in the rabbit study. No differences regarding inflammation score (EMG 4.60 ± 0.97 [95% CI 4.00 to 5.20] versus control 4.20 ± 1.48 [95% CI 3.29 to 5.11]; p = 0.51), tissue response score (EMG 4.00 ± 0.82 [95% CI 3.49 to 4.51] versus control 4.00 ± 0.94 [95% CI 3.42 to 4.58]; p > 0.99), or thickness of capsule (EMG 19.00 ± 8.76 µm [95% CI 13.57 to 24.43] versus control 29.00 ± 23.31 µm [95% CI 14.55 to 43.45]; p = 0.29) were found compared with the inert control article (high-density polyethylene) after 3 months of intramuscular implantation. Throughout long-term implantation of the MIRA in large animals, telemetric communication remained unrestricted in all specimens. Further, the implants retained the ability to record and transmit intramuscular EMG data in all animals except for two sheep where the implants became dislocated shortly after implantation. Electrode impedances remained stable and below 5 kΩ. Regarding EMG signal quality, there was little crosstalk between muscles and overall average signal-to-noise ratio was 22.2 ± 6.2 dB. During the test surgeries, we found that it was possible to implant the MIRA at all major amputation levels of the upper limb in a human cadaver (the transradial, transhumeral, and glenohumeral levels). For each level, it was possible to place the central unit in a biomechanically stable environment to provide unhindered telemetry, while reaching the relevant target muscles for prosthetic control. At only the glenohumeral level, it was not possible to reach the teres major and latissimus dorsi muscles, which would require longer lead lengths. CONCLUSION As assessed in a combination of animal model and cadaver research, the MIRA shows promise for clinical research in patients with limb amputation, where it may be employed for all levels of major upper limb amputation to provide long-term stable intramuscular EMG transmission. CLINICAL RELEVANCE In our study, the MIRA provided high-bandwidth prosthetic interfacing through intramuscular electrode sites. Its high number of individual EMG channels may be combined with signal decoding algorithms for accessing spinal motor neuron activity after targeted muscle reinnervation, thus providing numerous degrees of freedom. Together with recent innovations in amputation surgery, the MIRA might enable improved control approaches for upper limb amputees, particularly for patients with above-elbow amputation where the mismatch between available control signals and necessary degrees of freedom for prosthetic control is highest.
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Affiliation(s)
- Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Cosima Prahm
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- BG Trauma Clinic, Eberhard Karls University, Department for Plastic and Reconstructive Surgery, Tübingen, Germany
| | - Konstantin D. Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Bioengineering, Imperial College London, London, UK
| | - Christian Hofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Otto Bock Healthcare Products GmbH, Vienna, Austria
| | | | | | | | - Dario Farina
- Department of Bioengineering, Imperial College London, London, UK
| | - Oskar C. Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
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Pandarinath C, Bensmaia SJ. The science and engineering behind sensitized brain-controlled bionic hands. Physiol Rev 2022; 102:551-604. [PMID: 34541898 PMCID: PMC8742729 DOI: 10.1152/physrev.00034.2020] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022] Open
Abstract
Advances in our understanding of brain function, along with the development of neural interfaces that allow for the monitoring and activation of neurons, have paved the way for brain-machine interfaces (BMIs), which harness neural signals to reanimate the limbs via electrical activation of the muscles or to control extracorporeal devices, thereby bypassing the muscles and senses altogether. BMIs consist of reading out motor intent from the neuronal responses monitored in motor regions of the brain and executing intended movements with bionic limbs, reanimated limbs, or exoskeletons. BMIs also allow for the restoration of the sense of touch by electrically activating neurons in somatosensory regions of the brain, thereby evoking vivid tactile sensations and conveying feedback about object interactions. In this review, we discuss the neural mechanisms of motor control and somatosensation in able-bodied individuals and describe approaches to use neuronal responses as control signals for movement restoration and to activate residual sensory pathways to restore touch. Although the focus of the review is on intracortical approaches, we also describe alternative signal sources for control and noninvasive strategies for sensory restoration.
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Affiliation(s)
- Chethan Pandarinath
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, Illinois
- Committee on Computational Neuroscience, University of Chicago, Chicago, Illinois
- Grossman Institute for Neuroscience, Quantitative Biology, and Human Behavior, University of Chicago, Chicago, Illinois
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Anwer S, Waris A, Gilani SO, Iqbal J, Shaikh N, Pujari AN, Niazi IK. Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies. Healthcare (Basel) 2022; 10:healthcare10020190. [PMID: 35206805 PMCID: PMC8872602 DOI: 10.3390/healthcare10020190] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
Stroke has been one of the leading causes of disability worldwide and is still a social health issue. Keeping in view the importance of physical rehabilitation of stroke patients, an analytical review has been compiled in which different therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR. This literature review mainly focuses on the randomized controlled studies, reviews, and statistical meta-analyses associated with motor rehabilitation after stroke. Moreover, with the increasing prevalence rate and the adverse socio-economic consequences of stroke, a statistical analysis covering its economic factors such as treatment, medication and post-stroke care services, and risk factors (modifiable and non-modifiable) have also been discussed. This review suggests that if the prevalence rate of the disease remains persistent, a considerable increase in the stroke population is expected by 2025, causing a substantial economic burden on society, as the survival rate of stroke is high compared to other diseases. Compared to all the other therapies, VR has now emerged as the modern approach towards rehabilitation motor activity of impaired limbs. A range of randomized controlled studies and experimental trials were reviewed to analyse the effectiveness of VR as a rehabilitative treatment with considerable satisfactory results. However, more clinical controlled trials are required to establish a strong evidence base for VR to be widely accepted as a preferred rehabilitation therapy for stroke.
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Affiliation(s)
- Saba Anwer
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Asim Waris
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Syed Omer Gilani
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Javaid Iqbal
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Nusratnaaz Shaikh
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
| | - Amit N. Pujari
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK;
- School of Engineering, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Imran Khan Niazi
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
- Center of Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
- Center for Sensory-Motor Interaction, Department of Health Science & Technology, Aalborg University, 9000 Alborg, Denmark
- Correspondence:
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11
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Fattal C, Teissier J, Geffrier A, Fonseca L, William L, Andreu D, Guiraud D, Azevedo-Coste C. Restoring hand functions in people with tetraplegia through multi-contact, fascicular and auto-pilot stimulation: a proof-of-concept demonstration. J Neurotrauma 2022; 39:627-638. [PMID: 35029125 DOI: 10.1089/neu.2021.0381] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Two multi-contact epineural electrodes were placed around radial and median nerves of 2 subjects with high tetraplegia C4, AIS A, group 0 of the International Classification for Surgery of the Hand in Tetraplegia. The purpose was to study the safety and capability of these electrodes to generate synergistic motor activation and functional movements and to test control interfaces that allow subjects to trigger pre-programmed stimulation sequences. The device consists of a pair of neural cuff electrodes and percutaneous cables with two extracorporeal connection cables inserted during a surgical procedure and maintained for 28 days. Continuity tests of the electrodes, selectivity of movements induced, motor capacities for grasping and gripping, conformity of the control order, tolerance and acceptability were assessed. Neither of the 2 participants showed general and local comorbidity. Acceptability was optimal. None of the stimulation configurations generated contradictory movements. The success rate in task execution by the electro-stimulated hand exceeded the target of 50% (54% and 51% for patient 1 and 2 respectively). The compliance rate of the control orders in both patients was > 90% using motion IMU-based detection and 100% using EMG-based detection in patient 1. These results support the relevance of neural stimulation of the tetraplegic upper limb with a more selective approach, using multi-contact epineural electrodes with 9 and 6 contact points for the median and radial nerve respectively.
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Affiliation(s)
- Charles Fattal
- Rehabilitation Center Bouffard-Vercelli, Perpignan, France
- INRIA, University of Montpellier, Montpellier, France
| | | | | | - Lucas Fonseca
- INRIA, University of Montpellier, Montpellier, France
| | - Lucie William
- INRIA, University of Montpellier, Montpellier, France
| | | | - David Guiraud
- INRIA, University of Montpellier, Montpellier, France
- Neurinnov SAS, Montpellier, France
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12
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Karamian BA, Siegel N, Nourie B, Serruya MD, Heary RF, Harrop JS, Vaccaro AR. The role of electrical stimulation for rehabilitation and regeneration after spinal cord injury. J Orthop Traumatol 2022; 23:2. [PMID: 34989884 PMCID: PMC8738840 DOI: 10.1186/s10195-021-00623-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/27/2021] [Indexed: 12/26/2022] Open
Abstract
Electrical stimulation is used to elicit muscle contraction and can be utilized for neurorehabilitation following spinal cord injury when paired with voluntary motor training. This technology is now an important therapeutic intervention that results in improvement in motor function in patients with spinal cord injuries. The purpose of this review is to summarize the various forms of electrical stimulation technology that exist and their applications. Furthermore, this paper addresses the potential future of the technology.
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Affiliation(s)
- Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Nicholas Siegel
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Blake Nourie
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | | | - Robert F Heary
- Department of Neurological Surgery, Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA
| | - James S Harrop
- Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
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13
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Ting JE, Del Vecchio A, Sarma D, Verma N, Colachis SC, Annetta NV, Collinger JL, Farina D, Weber DJ. Sensing and decoding the neural drive to paralyzed muscles during attempted movements of a person with tetraplegia using a sleeve array. J Neurophysiol 2021; 126:2104-2118. [PMID: 34788156 DOI: 10.1152/jn.00220.2021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Motor neurons convey information about motor intent that can be extracted and interpreted to control assistive devices. However, most methods for measuring the firing activity of single neurons rely on implanted microelectrodes. Although intracortical brain-computer interfaces (BCIs) have been shown to be safe and effective, the requirement for surgery poses a barrier to widespread use that can be mitigated by instead using noninvasive interfaces. The objective of this study was to evaluate the feasibility of deriving motor control signals from a wearable sensor that can detect residual motor unit activity in paralyzed muscles after chronic cervical spinal cord injury (SCI). Despite generating no observable hand movement, volitional recruitment of motor units below the level of injury was observed across attempted movements of individual fingers and overt wrist and elbow movements. Subgroups of motor units were coactive during flexion or extension phases of the task. Single digit movement intentions were classified offline from the EMG power (RMS) or motor unit firing rates with median classification accuracies >75% in both cases. Simulated online control of a virtual hand was performed with a binary classifier to test feasibility of real-time extraction and decoding of motor units. The online decomposition algorithm extracted motor units in 1.2 ms, and the firing rates predicted the correct digit motion 88 ± 24% of the time. This study provides the first demonstration of a wearable interface for recording and decoding firing rates of motor units below the level of injury in a person with motor complete SCI.
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Affiliation(s)
- Jordyn E Ting
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.,Center for the Neural Basis of Cognition, Pittsburgh, PA, United States
| | - Alessandro Del Vecchio
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander University, Erlangen-Nürnberg, Erlangen, Germany
| | - Devapratim Sarma
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, United States.,Center for the Neural Basis of Cognition, Pittsburgh, PA, United States.,Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander University, Erlangen-Nürnberg, Erlangen, Germany.,Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Nikhil Verma
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Samuel C Colachis
- Medical Devices and Neuromodulation Group, Battelle Memorial Institute, Columbus, OH, United States
| | - Nicholas V Annetta
- Medical Devices and Neuromodulation Group, Battelle Memorial Institute, Columbus, OH, United States
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.,Center for the Neural Basis of Cognition, Pittsburgh, PA, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States.,Human Engineering Research Laboratories, VA Center of Excellence, Department of Veterans Affairs, Pittsburgh, PA, United States.,Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States.,Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, United States
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14
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Nason SR, Mender MJ, Vaskov AK, Willsey MS, Ganesh Kumar N, Kung TA, Patil PG, Chestek CA. Real-time linear prediction of simultaneous and independent movements of two finger groups using an intracortical brain-machine interface. Neuron 2021; 109:3164-3177.e8. [PMID: 34499856 DOI: 10.1016/j.neuron.2021.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/07/2021] [Accepted: 08/10/2021] [Indexed: 11/27/2022]
Abstract
Modern brain-machine interfaces can return function to people with paralysis, but current upper extremity brain-machine interfaces are unable to reproduce control of individuated finger movements. Here, for the first time, we present a real-time, high-speed, linear brain-machine interface in nonhuman primates that utilizes intracortical neural signals to bridge this gap. We created a non-prehensile task that systematically individuates two finger groups, the index finger and the middle-ring-small fingers combined. During online brain control, the ReFIT Kalman filter could predict individuated finger group movements with high performance. Next, training ridge regression decoders with individual movements was sufficient to predict untrained combined movements and vice versa. Finally, we compared the postural and movement tuning of finger-related cortical activity to find that individual cortical units simultaneously encode multiple behavioral dimensions. Our results suggest that linear decoders may be sufficient for brain-machine interfaces to execute high-dimensional tasks with the performance levels required for naturalistic neural prostheses.
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Affiliation(s)
- Samuel R Nason
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Matthew J Mender
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alex K Vaskov
- Robotics Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
| | - Matthew S Willsey
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Nishant Ganesh Kumar
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Theodore A Kung
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Parag G Patil
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Department of Neurology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
| | - Cynthia A Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Robotics Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA; Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA; Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, USA.
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15
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Restoring upper extremity function with brain-machine interfaces. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 159:153-186. [PMID: 34446245 DOI: 10.1016/bs.irn.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
One of the most exciting advances to emerge in neural interface technologies has been the development of real-time brain-machine interface (BMI) neuroprosthetic devices to restore upper extremity function. BMI neuroprostheses, made possible by synergistic advances in neural recording technologies, high-speed computation and signal processing, and neuroscience, have permitted the restoration of volitional movement to patients suffering the loss of upper-extremity function. In this chapter, we review the scientific and technological advances underlying these remarkable devices. After presenting an introduction to the current state of the field, we provide an accessible technical discussion of the two fundamental requirements of a successful neuroprosthesis: signal extraction from the brain and signal decoding that results in robust prosthetic control. We close with a presentation of emerging technologies that are likely to substantially advance the field.
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16
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Karczewski AM, Dingle AM, Poore SO. The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements. Front Neurorobot 2021; 15:711028. [PMID: 34366820 PMCID: PMC8334559 DOI: 10.3389/fnbot.2021.711028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022] Open
Abstract
Over the last few decades there has been a push to enhance the use of advanced prosthetics within the fields of biomedical engineering, neuroscience, and surgery. Through the development of peripheral neural interfaces and invasive electrodes, an individual's own nervous system can be used to control a prosthesis. With novel improvements in neural recording and signal decoding, this intimate communication has paved the way for bidirectional and intuitive control of prostheses. While various collaborations between engineers and surgeons have led to considerable success with motor control and pain management, it has been significantly more challenging to restore sensation. Many of the existing peripheral neural interfaces have demonstrated success in one of these modalities; however, none are currently able to fully restore limb function. Though this is in part due to the complexity of the human somatosensory system and stability of bioelectronics, the fragmentary and as-yet uncoordinated nature of the neuroprosthetic industry further complicates this advancement. In this review, we provide a comprehensive overview of the current field of neuroprosthetics and explore potential strategies to address its unique challenges. These include exploration of electrodes, surgical techniques, control methods, and prosthetic technology. Additionally, we propose a new approach to optimizing prosthetic limb function and facilitating clinical application by capitalizing on available resources. It is incumbent upon academia and industry to encourage collaboration and utilization of different peripheral neural interfaces in combination with each other to create versatile limbs that not only improve function but quality of life. Despite the rapidly evolving technology, if the field continues to work in divided "silos," we will delay achieving the critical, valuable outcome: creating a prosthetic limb that is right for the patient and positively affects their life.
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Affiliation(s)
| | - Aaron M. Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin–Madison, Madison, WI, United States
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17
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Makowski N, Campean A, Lambrecht J, Buckett J, Coburn J, Hart R, Miller M, Montague F, Crish T, Fu M, Kilgore K, Peckham PH, Smith B. Design and Testing of Stimulation and Myoelectric Recording Modules in an Implanted Distributed Neuroprosthetic System. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:281-293. [PMID: 33729949 PMCID: PMC8344369 DOI: 10.1109/tbcas.2021.3066838] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Implantable motor neuroprostheses can restore functionality to individuals with neurological disabilities by electrically activating paralyzed muscles in coordinated patterns. The typical design of neuroprosthetic systems relies on a single multi-use device, but this limits the number of stimulus and sensor channels that can be practically implemented. To address this limitation, a modular neuroprosthesis, the "Networked Neuroprosthesis" (NNP), was developed. The NNP system is the first fully implanted modular neuroprosthesis that includes implantation of all power, signal processing, biopotential signal recording, and stimulating components. This paper describes the design of stimulation and recording modules, bench testing to verify stimulus outputs and appropriate filtering and recording, and validation that the components function properly while implemented in persons with spinal cord injury. The results of system testing demonstrated that the NNP was functional and capable of generating stimulus pulses and recording myoelectric, temperature, and accelerometer signals. Based on the successful design, manufacturing, and testing of the NNP System, multiple clinical applications are anticipated.
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18
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Makowski NS, Lombardo LM, Foglyano KM, Kobetic R, Pinault G, Selkirk SM, Triolo RJ. Walking after incomplete spinal cord injury with an implanted neuromuscular electrical stimulation system and a hinged knee replacement: a single-subject study. Spinal Cord Ser Cases 2020; 6:86. [PMID: 32934207 DOI: 10.1038/s41394-020-00336-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Single-subject repeated measures study. OBJECTIVES Neuromuscular electrical stimulation (NMES) can enhance walking for people with partial paralysis from incomplete spinal cord injury (iSCI). This single-subject study documents an individual's experience who both received an experimental implanted NMES system and underwent clinical bilateral hinged total knee arthroplasty (TKA). She walked in the community with knee pain prior to either intervention. Walking performance improved with an implanted NMES system. Knee pain and instability continued to worsen over time and eventually required TKA. This study evaluates the effects of these interventions. SETTING Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland OH, USA. METHODS The differential and combined effects of NMES and hinged knee replacement were assessed in terms of walking speed, toe clearance, knee angle, and participant perceptions with and without stimulation assistance both before and after TKA. RESULTS The combined approach both reduced pain and restored walking ability to levels achieved prior to developing significant knee pain that prevented walking without NMES. There was an interaction effect between NMES and TKA on walking speed. Toe clearance consistently improved with stimulation assistance and TKA prevented significant knee hyperextension. The greatest impact was on endurance. Knee replacement re-enabled long distance walking with the addition of stimulation again more than doubling her maximum walking distance from 214 to 513 m. CONCLUSIONS These data support further research of combined implantable interventions that may benefit people with iSCI. Furthermore, joint laxity and pain may not necessarily be contraindications to NMES if addressed with conventional clinical treatments.
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Affiliation(s)
- Nathaniel S Makowski
- MetroHealth Medical Center, Cleveland, OH, USA. .,Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA. .,Case Western Reserve University, Cleveland, OH, USA.
| | - Lisa M Lombardo
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Kevin M Foglyano
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Rudi Kobetic
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Gilles Pinault
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Stephen M Selkirk
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Ronald J Triolo
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
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19
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Bhagat N, King K, Ramdeo R, Stein A, Bouton C. Determining grasp selection from arm trajectories via deep learning to enable functional hand movement in tetraplegia. Bioelectron Med 2020; 6:17. [PMID: 32864392 PMCID: PMC7449026 DOI: 10.1186/s42234-020-00053-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cervical spinal cord injury severely affects grasping ability of its survivors. Fortunately, many individuals with tetraplegia retain residual arm movements that allow them to reach for objects. We propose a wearable technology that utilizes arm movement trajectory information and deep learning methods to determine grasp selection. Furthermore, we combined this approach with neuromuscular stimulation to determine if self-driven functional hand movement could be enabled in spinal cord injury participants. Methods Two cervical SCI participants performed arbitrary and natural reaching movements toward target objects in three-dimensional space, which were recorded using an inertial sensor worn on their wrist. Time series classifiers were trained to recognize the trajectories using either a Dynamic Time Warping (DTW) algorithm or a Long Short-Term Memory (LSTM) recurrent neural network. As an initial proof-of-concept, we demonstrate real-time classification of the arbitrary movements using DTW only (due to its implementation simplicity), which when used in combination with a high density neuromuscular stimulation sleeve with textile electrodes, enabled participants to perform functional grasping. Results Participants were able to consistently perform arbitrary two-dimensional and three-dimensional arm movements which could be classified with high accuracy. Furthermore, it was found that natural reaching trajectories for two different target objects (requiring two different grasp types) were distinct and also discriminable with high accuracy. In offline comparisons, LSTM (mean accuracies 99%) performed significantly better than DTW (mean accuracies 86 and 83%) for both arbitrary and natural reaching movements, respectively. Type I and II errors occurred more frequently for DTW (up to 60 and 15%, respectively), whereas it stayed under 5% for LSTM. Also, DTW achieved online accuracy of 79%. Conclusions We demonstrate the feasibility of utilizing arm trajectory information to determine grasp selection using a wearable inertial sensor along with DTW and deep learning methods. Importantly, this technology can be successfully used to control neuromuscular stimulation and restore functional independence to individuals living with paralysis. Trial registration NCT, NCT03385005. Registered September 26, 2017.
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Affiliation(s)
- Nikunj Bhagat
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY USA.,Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Kevin King
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY USA.,Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Richard Ramdeo
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY USA.,Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Adam Stein
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Chad Bouton
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY USA.,Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY USA.,Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
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20
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Abstract
Comprehensive programs for children who sustain traumatic spinal cord injury should incorporate optimizing hand and upper extremity function along with the other traditional pillars of rehabilitation. Children's smaller anatomy, open growth plates, and future skeletal growth, combined with the age-related psychosocial impact of these injuries, require protocols suited to these age-related issues. There is a role for surgical reconstruction, as is the case for adults with traumatic tetraplegia, and surgical outcomes are equally beneficial and long lasting. Strict adherence to surgical indications, and surgical strategies and protocols that incorporate their age-related challenges, are the keys to successful management.
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Affiliation(s)
- Allan Peljovich
- The Hand & Upper Extremity Center of Georgia, Suite 1020, 980 Johnsons Ferry Road, Atlanta, GA 30342, USA; Hand & Upper Extremity Program, Children's Healthcare of Atlanta, Atlanta, GA, USA; Orthopaedic Surgery Residency Program, Atlanta Medical Center, Atlanta, GA, USA; Hand & Upper Extremity Program, Shepherd Center.
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21
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Kilgore KL, Smith B, Campean A, Hart RL, Lambrecht JM, Buckett JR, Peckham PH. Powering strategies for implanted multi-function neuroprostheses for spinal cord injury. Healthc Technol Lett 2020; 7:81-86. [PMID: 32754342 PMCID: PMC7353817 DOI: 10.1049/htl.2019.0113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/22/2022] Open
Abstract
Implantable motor neuroprosthetic systems can restore function to individuals with significant disabilities, such as spinal cord injury, stroke, cerebral palsy, and multiple sclerosis. Neuroprostheses provide restored functionality by electrically activating paralysed muscles in coordinated patterns that replicate (enable) controlled movement that was lost through injury or disease. It is important to consider the general topology of the implanted system itself. The authors demonstrate that the wired multipoint implant technology is practical and feasible as a basis for the development of implanted multi-function neuroprosthetic systems. The advantages of a centralised power supply are significant. Heating due to recharge can be mitigated by using an actively cooled external recharge coil. Using this approach, the time required to perform a full recharge was significantly reduced. This approach has been demonstrated as a practical option for regular clinical use of implanted neuroprostheses.
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Affiliation(s)
- Kevin L Kilgore
- Department of Orthopaedics and Department of Physical Medicine and Rehabilitation, MetroHealth System, Cleveland, OH, 44109, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA.,Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH, 44106, USA
| | - Brian Smith
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Alex Campean
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Ronald L Hart
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH, 44106, USA
| | - Joris M Lambrecht
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - James R Buckett
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Paul Hunter Peckham
- Department of Orthopaedics and Department of Physical Medicine and Rehabilitation, MetroHealth System, Cleveland, OH, 44109, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
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22
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Lee SW, Qiu D, Fischer HC, Conrad MO, Kamper DG. Modulation of finger muscle activation patterns across postures is coordinated across all muscle groups. J Neurophysiol 2020; 124:330-341. [PMID: 32579416 DOI: 10.1152/jn.00088.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Successful grasp requires that grip forces be properly directed between the fingertips and the held object. Changes in digit posture significantly affect the mapping between muscle force and fingertip force. Joint torques must subsequently be altered to maintain the desired force direction at the fingertips. Our current understanding of the roles of hand muscles in force production remains incomplete, as past studies focused on a limited set of postures or force directions. To thoroughly examine how hand muscles adapt to changing external (force direction) and internal (posture) conditions, activation patterns of six index finger muscles were examined with intramuscular electrodes in 10 healthy subjects. Participants produced submaximal isometric forces in each of six orthogonal directions at nine different finger postures. Across force directions, participants significantly altered activation patterns to accommodate postural changes in the interphalangeal joint angles but not changes in the metacarpophalangeal joint angles. Modulation of activation levels of the extrinsic hand muscles, particularly the extensors, were as great as those of intrinsic muscles, suggesting that both extrinsic and intrinsic muscles were involved in creating the desired forces. Despite considerable between-subject variation in the absolute activation patterns, principal component analysis revealed that participants used similar strategies to accommodate the postural changes. The changes in muscle coordination also helped increase joint impedance in order to stabilize the end-point force direction. This effect counteracts the increased signal-dependent motor noise that arises with greater magnitude of muscle activation as interphalangeal joint flexion is increased. These results highlight the role of the extrinsic muscles in controlling fingertip force direction across finger postures.NEW & NOTEWORTHY We examined how hand muscles adapt to changing external (force direction) and internal (posture) conditions. Muscle activations, particularly of the extrinsic extensors, were significantly affected by postural changes of the interphalangeal, but not metacarpophalangeal, joints. Joint impedance was modulated so that the effects of the signal-dependent motor noise on the force output were reduced. Comparisons with theoretical solutions showed that the chosen activation patterns occupied a small portion of the possible solution space, minimizing the maximum activation of any one muscle.
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Affiliation(s)
- Sang Wook Lee
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia.,Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia.,Department of Mechanical Engineering, Korean Advanced Institute of Science and Technology, Daejeon, Korea.,Sensory Motor Performance Program, Rehabilitation Institute of Chicago (currently Shirley Ryan AbilityLab), Chicago, Illinois
| | - Dan Qiu
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Heidi C Fischer
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago (currently Shirley Ryan AbilityLab), Chicago, Illinois.,Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois
| | - Megan O Conrad
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago (currently Shirley Ryan AbilityLab), Chicago, Illinois.,Department of Mechanical Engineering, University of Detroit Mercy, Detroit, Michigan
| | - Derek G Kamper
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago (currently Shirley Ryan AbilityLab), Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois.,Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, North Carolina.,Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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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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24
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A review of methods for achieving upper limb movement following spinal cord injury through hybrid muscle stimulation and robotic assistance. Exp Neurol 2020; 328:113274. [DOI: 10.1016/j.expneurol.2020.113274] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 11/20/2022]
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25
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Tigra W, Dali M, William L, Fattal C, Gélis A, Divoux JL, Coulet B, Teissier J, Guiraud D, Azevedo Coste C. Selective neural electrical stimulation restores hand and forearm movements in individuals with complete tetraplegia. J Neuroeng Rehabil 2020; 17:66. [PMID: 32429963 PMCID: PMC7236876 DOI: 10.1186/s12984-020-00676-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/01/2020] [Indexed: 11/15/2022] Open
Abstract
Background We hypothesized that a selective neural electrical stimulation of radial and median nerves enables the activation of functional movements in the paralyzed hand of individuals with tetraplegia. Compared to previous approaches for which up to 12 muscles were targeted through individual muscular stimulations, we focused on minimizing the number of implanted electrodes however providing almost all the needed and useful hand movements for subjects with complete tetraplegia. Methods We performed acute experiments during scheduled surgeries of the upper limb with eligible subjects. We scanned a set of multicontact neural stimulation cuff electrode configurations, pre-computed through modeling simulations. We reported the obtained isolated and functional movements that were considered useful for the subject (different grasping movements). Results In eight subjects, we demonstrated that selective stimulation based on multicontact cuff electrodes and optimized current spreading over the active contacts provided isolated, compound, functional and strong movements; most importantly 3 out of 4 had isolated fingers or thumb flexion, one patient performed a Key Grip, another one the Power and Hook Grips, and the 2 last all the 3 Grips. Several configurations were needed to target different areas within the nerve to obtain all the envisioned movements. We further confirmed that the upper limb nerves have muscle specific fascicles, which makes it possible to activate isolated movements. Conclusions The future goal is to provide patients with functional restoration of object grasping and releasing with a minimally invasive solution: only two cuff electrodes above the elbow. Ethics Committee / ANSM clearance prior to the beginning of the study (inclusion period 2016–2018): CPP Sud Méditerranée, #ID-RCB:2014-A01752–45, first acceptance 10th of February 2015, amended 12th of January 2016. Trial registration (www.clinicaltrials.gov): #NCT03721861, Retrospectively registered on 26th of October 2018.
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Affiliation(s)
- Wafa Tigra
- INRIA, University of Montpellier, CNRS, Montpellier, France.,MXM group, Sophia-Antipolis, France
| | - Mélissa Dali
- INRIA, University of Montpellier, CNRS, Montpellier, France
| | - Lucie William
- INRIA, University of Montpellier, CNRS, Montpellier, France
| | - Charles Fattal
- La Châtaigneraie Rehabilitation Center, Menucourt, France
| | | | | | | | | | - David Guiraud
- INRIA, University of Montpellier, CNRS, Montpellier, France. .,NEURINNOV SAS, Montpellier, France.
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26
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Yildiz KA, Shin AY, Kaufman KR. Interfaces with the peripheral nervous system for the control of a neuroprosthetic limb: a review. J Neuroeng Rehabil 2020; 17:43. [PMID: 32151268 PMCID: PMC7063740 DOI: 10.1186/s12984-020-00667-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/17/2020] [Indexed: 12/22/2022] Open
Abstract
The field of prosthetics has been evolving and advancing over the past decade, as patients with missing extremities are expecting to control their prostheses in as normal a way as possible. Scientists have attempted to satisfy this expectation by designing a connection between the nervous system of the patient and the prosthetic limb, creating the field of neuroprosthetics. In this paper, we broadly review the techniques used to bridge the patient's peripheral nervous system to a prosthetic limb. First, we describe the electrical methods including myoelectric systems, surgical innovations and the role of nerve electrodes. We then describe non-electrical methods used alone or in combination with electrical methods. Design concerns from an engineering point of view are explored, and novel improvements to obtain a more stable interface are described. Finally, a critique of the methods with respect to their long-term impacts is provided. In this review, nerve electrodes are found to be one of the most promising interfaces in the future for intuitive user control. Clinical trials with larger patient populations, and for longer periods of time for certain interfaces, will help to evaluate the clinical application of nerve electrodes.
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Affiliation(s)
- Kadir A Yildiz
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kenton R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
- Motion Analysis Laboratory, W. Hall Wendel, Jr., Musculoskeletal Research, 200 First Street SW, Rochester, MN, 55905, USA.
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27
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A Review of Functional Electrical Stimulation Treatment in Spinal Cord Injury. Neuromolecular Med 2020; 22:447-463. [DOI: 10.1007/s12017-019-08589-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/28/2019] [Indexed: 12/11/2022]
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Venugopalan L, Taylor PN, Cobb JE, Swain ID. TetraGrip - a four channel upper limb FES device for people with C5/C6 tetraplegia: device design and clinical outcome. J Med Eng Technol 2020; 44:38-44. [PMID: 31997672 DOI: 10.1080/03091902.2020.1713239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The TetraGrip is an inertial measurement unit-controlled surface upper limb FES device developed for improving hand functions of people with tetraplegia. The reliability of the control system and the repeatability and reproducibility of the device were assessed by analysing the results obtained when 14 able-bodied volunteers used the device. These volunteers were able to generate the control signals effectively once they had sufficient training. The two tetraplegic volunteers participated in a 12-week long clinical study (exercise, 4 weeks; functional tasks, 8 weeks), where they used the device to perform functional tasks. Outcome measures used were the grasp release test, the grip strength test, and the box and block test. Both tetraplegic volunteers showed improvement in performing the tasks specified in all outcome measures. The TetraGrip performed as intended when the able-bodied volunteers used it, and it improved the hand functions of both volunteers with tetraplegia. However, a larger clinical study is necessary to assess the performance of the device with a wider range of people with tetraplegia such as those with C5 complete/incomplete.
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Affiliation(s)
- L Venugopalan
- Department of Biomedical Engineering, Vel Tech Multi Tech Dr. Rangarajan and Dr. Sakunthala Engineering College, Chennai, India
| | - P N Taylor
- The National Clinical FES Centre, Salisbury District Hospital, Salisbury, UK
| | - J E Cobb
- The Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - I D Swain
- The Faculty of Science and Technology, Bournemouth University, Poole, UK
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29
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Davidson IU, Quinones DJ, Haines CM, Kilgore KL, Keith MW, Moore TA. A Rare Case of Cervical Charcot After Spinal Cord Injury: A Case Report. JBJS Case Connect 2019; 9:e0362. [PMID: 31789666 DOI: 10.2106/jbjs.cc.18.00362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE We present a rare case of cervical Charcot disease that was diagnosed in a paraplegic patient by loss of function caudal to the original level of spinal cord injury. Clinical imaging, diagnosis, differentials, and operative management are discussed. CONCLUSIONS Charcot disease of the cervical spine is rare and very difficult to diagnose in the paraplegic patient population. High clinical suspicion should be maintained in these patients who demonstrate any form of neurologic deterioration, mechanical instability, or change in spinal alignment. It is often necessary to rule out infection. Spinal decompression and surgical stabilization is the treatment of choice.
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Affiliation(s)
| | | | | | - Kevin L Kilgore
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
- Research Service, Louis Stokes VAMC, Cleveland, Ohio
| | - Michael W Keith
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Timothy A Moore
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
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30
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Cole NM, Ajiboye AB. Muscle synergies for predicting non-isometric complex hand function for commanding FES neuroprosthetic hand systems. J Neural Eng 2019; 16:056018. [PMID: 31247614 PMCID: PMC8059247 DOI: 10.1088/1741-2552/ab2d47] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Myoelectric controlled neuroprostheses can restore hand function to mid-cervical level (C5/C6) paralyzed individuals through voluntary control. However restored functionality is limited due to the small number of available voluntary electromyographic (EMG) signals after paralysis. The purpose of this study was to determine whether dynamic hand function could be reduced to as few as three degrees of freedom using the time-invariant muscle synergy model thereby showing the feasibility of synergy-based neuroprosthetic control. APPROACH Task cross-validated, time-invariant synergies were derived from static hand postures and from dynamic functional task data collected from five able-bodied participants. The time-invariant synergies were extracted from EMG data in task cross-validation using non-negative matrix factorization. MAIN RESULTS Three functional synergies yielded significantly higher performance than chance (p < 0.01) with 66.0% ± 4.9% variance accounted for (VAF) compared to 42.5% ± 4.4% VAF. SIGNIFICANCE The results of this study, along with other studies showing continuous 3D EMG control, show the feasibility of a possible synergy-based controller for hand neuroprostheses.
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Affiliation(s)
- Natalie M Cole
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America. Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, United States of America
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31
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Heald E, Kilgore K, Hart R, Moss C, Peckham PH. Myoelectric signal from below the level of spinal cord injury as a command source for an implanted upper extremity neuroprosthesis - a case report. J Neuroeng Rehabil 2019; 16:100. [PMID: 31375143 PMCID: PMC6679451 DOI: 10.1186/s12984-019-0571-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 07/29/2019] [Indexed: 12/04/2022] Open
Abstract
Implanted motor neuroprostheses offer significant restoration of function for individuals with spinal cord injury. Providing adequate user control for these devices is a challenge but is crucial for successful performance. Electromyographic (EMG) signals can serve as effective control sources, but the number of above-injury muscles suitable to provide EMG-based control signals is very limited. Previous work has shown the presence of below-injury volitional myoelectric signals even in subjects diagnosed with motor complete spinal cord injury. In this case report, we present a demonstration of a hand grasp neuroprosthesis being controlled by a user with a C6 level, motor complete injury through EMG signals from their toe flexor. These signals were successfully translated into a functional grasp output, which performed similarly to the participant’s usual shoulder position control in a grasp-release functional test. This proof-of-concept demonstrates the potential for below-injury myoelectric activity to serve as a novel form of neuroprosthesis control.
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Affiliation(s)
- Elizabeth Heald
- Dept. of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Wickenden Building, Cleveland, OH, 44106, USA
| | - Kevin Kilgore
- Dept. of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Wickenden Building, Cleveland, OH, 44106, USA.,Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, USA.,MetroHealth Medical Center, Cleveland, OH, USA
| | - Ronald Hart
- Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Christa Moss
- Dept. of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Wickenden Building, Cleveland, OH, 44106, USA
| | - P Hunter Peckham
- Dept. of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Wickenden Building, Cleveland, OH, 44106, USA. .,MetroHealth Medical Center, Cleveland, OH, USA.
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32
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Williams JJ, Watson AM, Vazquez AL, Schwartz AB. Viral-Mediated Optogenetic Stimulation of Peripheral Motor Nerves in Non-human Primates. Front Neurosci 2019; 13:759. [PMID: 31417342 PMCID: PMC6684788 DOI: 10.3389/fnins.2019.00759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: Reanimation of muscles paralyzed by disease states such as spinal cord injury remains a highly sought therapeutic goal of neuroprosthetic research. Optogenetic stimulation of peripheral motor nerves expressing light-sensitive opsins is a promising approach to muscle reanimation that may overcome several drawbacks of traditional methods such as functional electrical stimulation (FES). However, the utility of these methods has only been demonstrated in rodents to date, while translation to clinical practice will likely first require demonstration and refinement of these gene therapy techniques in non-human primates. Approach: Three rhesus macaques were injected intramuscularly with either one or both of two optogenetic constructs (AAV6-hSyn-ChR2-eYFP and/or AAV6-hSyn-Chronos-eYFP) to transduce opsin expression in the corresponding nerves. Neuromuscular junctions were targeted for virus delivery using an electrical stimulating injection technique. Functional opsin expression was periodically evaluated up to 13 weeks post-injection by optically stimulating targeted nerves with a 472 nm fiber-coupled laser while recording electromyographic (EMG) responses. Main Results: One monkey demonstrated functional expression of ChR2 at 8 weeks post-injection in each of two injected muscles, while the second monkey briefly exhibited contractions coupled to optical stimulation in a muscle injected with the Chronos construct at 10 weeks. A third monkey injected only in one muscle with the ChR2 construct showed strong optically coupled contractions at 5 ½ weeks which then disappeared by 9 weeks. EMG responses to optical stimulation of ChR2-transduced nerves demonstrated graded recruitment relative to both stimulus pulse-width and light intensity, and followed stimulus trains up to 16 Hz. In addition, the EMG response to prolonged stimulation showed delayed fatigue over several minutes. Significance: These results demonstrate the feasibility of viral transduction of peripheral motor nerves for functional optical stimulation of motor activity in non-human primates, a variable timeline of opsin expression in a animal model closer to humans, and fundamental EMG response characteristics to optical nerve stimulation. Together, they represent an important step in translating these optogenetic techniques as a clinically viable gene therapy.
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Affiliation(s)
- Jordan J. Williams
- Department of Neurobiology, Systems Neuroscience Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alan M. Watson
- Center for Biologic Imaging, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alberto L. Vazquez
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew B. Schwartz
- Department of Neurobiology, Systems Neuroscience Institute, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
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33
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Anderson KD, Bryden AM, Moynahan M. Risk-benefit value of upper extremity function by an implanted electrical stimulation device targeting chronic cervical spinal cord injury. Spinal Cord Ser Cases 2019; 5:68. [PMID: 31632726 PMCID: PMC6786403 DOI: 10.1038/s41394-019-0213-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/20/2022] Open
Abstract
Study design A cross-sectional stated-preference survey using direct-assessment questions. Objective To determine the relative value placed on different outcomes to be used in a pivotal trial for the upper extremity configuration of the Networked Neuroprosthesis (NNP) as well as the tolerance of the expected adverse event profile. Setting Academic medical center in the United States. Methods Distribution of an online survey to adults living with tetraplegia; extent of agreement with each question/statement was obtaining using a 1-7 Likert scale. Results There were 8 statements about potential benefits in arm/hand function; for all statements, more than 70% of participants rated the functions as "1-very important" to regain. There were variable degrees of concern related to risks that could occur during the 30-day post-surgical period and increasing degrees of concern related to risks that could occur in the first 5 years, potentially due to the device, based on the increasing degree of invasiveness of the intervention required to address the event. When analysing the results based on all degrees of interest, more than 64% of responders were interested in getting the NNP with a success rate threshold as low as 50% regardless of time post-injury. Chi-squared analyses revealed some associations between responses and sex, injury level, and injury duration; however, none of these were statistically significant upon post-hoc analysis. Conclusion Data here indicate that people with tetraplegia are highly interested in a range of arm/hand functions and are tolerant of expected risks that may be associated with implanted neuroprosthetics. Sponsorship The Institute for Functional Restoration funded this project through a sub-contract to K.D. Anderson from a larger Special Projects Award (grant number FP0020773) from the Craig H. Neilsen Foundation.
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Affiliation(s)
- Kim D. Anderson
- Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL USA
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
| | - Anne M. Bryden
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
- Department of Orthopaedics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH USA
| | - Megan Moynahan
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
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34
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Yozbatiran N, Francisco GE. Robot-assisted Therapy for the Upper Limb after Cervical Spinal Cord Injury. Phys Med Rehabil Clin N Am 2019; 30:367-384. [DOI: 10.1016/j.pmr.2018.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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35
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Wilson RD, Bryden AM, Kilgore KL, Makowski N, Bourbeau D, Kowalski KE, DiMarco AF, Knutson JS. Neuromodulation for Functional Electrical Stimulation. Phys Med Rehabil Clin N Am 2019; 30:301-318. [DOI: 10.1016/j.pmr.2018.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Toward the Bionic Face: A Novel Neuroprosthetic Device Paradigm for Facial Reanimation Consisting of Neural Blockade and Functional Electrical Stimulation. Plast Reconstr Surg 2019; 143:62e-76e. [PMID: 30589784 DOI: 10.1097/prs.0000000000005164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facial palsy is a devastating condition potentially amenable to rehabilitation by functional electrical stimulation. Herein, a novel paradigm for unilateral facial reanimation using an implantable neuroprosthetic device is proposed and its feasibility demonstrated in a live rodent model. The paradigm comprises use of healthy-side electromyographic activity as control inputs to a system whose outputs are neural stimuli to effect symmetric facial displacements. The vexing issue of suppressing undesirable activity resulting from aberrant neural regeneration (synkinesis) or nerve transfer procedures is addressed using proximal neural blockade. METHODS Epimysial and nerve cuff electrode arrays were implanted in the faces of Wistar rats. Stimuli were delivered to evoke blinks and whisks of various durations and amplitudes. The dynamic relation between electromyographic signals and facial displacements was modeled, and model predictions were compared against measured displacements. Optimal parameters to achieve facial nerve blockade by means of high-frequency alternating current were determined, and the safety of continuous delivery was assessed. RESULTS Electrode implantation was well tolerated. Blinks and whisks of tunable amplitudes and durations were evoked by controlled variation of neural stimuli parameters. Facial displacements predicted from electromyographic input modelling matched those observed with a variance-accounted-for exceeding 96 percent. Effective and reversible facial nerve blockade in awake behaving animals was achieved, without detrimental effect noted from long-term continual use. CONCLUSIONS Proof-of-principle of rehabilitation of hemifacial palsy by means of a neuroprosthetic device has been demonstrated. The use of proximal neural blockade coupled with distal functional electrical stimulation may have relevance to rehabilitation of other peripheral motor nerve deficits.
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37
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Anderson HE, Weir RFF. On the development of optical peripheral nerve interfaces. Neural Regen Res 2019; 14:425-436. [PMID: 30539808 PMCID: PMC6334609 DOI: 10.4103/1673-5374.245461] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/19/2018] [Indexed: 11/04/2022] Open
Abstract
Limb loss and spinal cord injury are two debilitating conditions that continue to grow in prevalence. Prosthetic limbs and limb reanimation present two ways of providing affected individuals with means to interact in the world. These techniques are both dependent on a robust interface with the peripheral nerve. Current methods for interfacing with the peripheral nerve tend to suffer from low specificity, high latency and insufficient robustness for a chronic implant. An optical peripheral nerve interface may solve some of these problems by decreasing invasiveness and providing single axon specificity. In order to implement such an interface three elements are required: (1) a transducer capable of translating light into a neural stimulus or translating neural activity into changes in fluorescence, (2) a means for delivering said transducer and (3) a microscope for providing the stimulus light and detecting the fluorescence change. There are continued improvements in both genetically encoded calcium and voltage indicators as well as new optogenetic actuators for stimulation. Similarly, improvements in specificity of viral vectors continue to improve expression in the axons of the peripheral nerve. Our work has recently shown that it is possible to virally transduce axons of the peripheral nerve for recording from small fibers. The improvements of these components make an optical peripheral nerve interface a rapidly approaching alternative to current methods.
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Affiliation(s)
- Hans E. Anderson
- Department of Bioengineering, University of Colorado Denver | Anschutz Medical Campus, Aurora, CO, USA
| | - Richard F. ff. Weir
- Department of Bioengineering, University of Colorado Denver | Anschutz Medical Campus, Aurora, CO, USA
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38
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Bullard AJ, Nason SR, Irwin ZT, Nu CS, Smith B, Campean A, Peckham PH, Kilgore KL, Willsey MS, Patil PG, Chestek CA. Design and testing of a 96-channel neural interface module for the Networked Neuroprosthesis system. Bioelectron Med 2019; 5:3. [PMID: 32232094 PMCID: PMC7098219 DOI: 10.1186/s42234-019-0019-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/25/2019] [Indexed: 11/20/2022] Open
Abstract
Background The loss of motor functions resulting from spinal cord injury can have devastating implications on the quality of one’s life. Functional electrical stimulation has been used to help restore mobility, however, current functional electrical stimulation (FES) systems require residual movements to control stimulation patterns, which may be unintuitive and not useful for individuals with higher level cervical injuries. Brain machine interfaces (BMI) offer a promising approach for controlling such systems; however, they currently still require transcutaneous leads connecting indwelling electrodes to external recording devices. While several wireless BMI systems have been designed, high signal bandwidth requirements limit clinical translation. Case Western Reserve University has developed an implantable, modular FES system, the Networked Neuroprosthesis (NNP), to perform combinations of myoelectric recording and neural stimulation for controlling motor functions. However, currently the existing module capabilities are not sufficient for intracortical recordings. Methods Here we designed and tested a 1 × 4 cm, 96-channel neural recording module prototype to fit within the specifications to mate with the NNP. The neural recording module extracts power between 0.3–1 kHz, instead of transmitting the raw, high bandwidth neural data to decrease power requirements. Results The module consumed 33.6 mW while sampling 96 channels at approximately 2 kSps. We also investigated the relationship between average spiking band power and neural spike rate, which produced a maximum correlation of R = 0.8656 (Monkey N) and R = 0.8023 (Monkey W). Conclusion Our experimental results show that we can record and transmit 96 channels at 2ksps within the power restrictions of the NNP system and successfully communicate over the NNP network. We believe this device can be used as an extension to the NNP to produce a clinically viable, fully implantable, intracortically-controlled FES system and advance the field of bioelectronic medicine.
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Affiliation(s)
- Autumn J Bullard
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
| | - Samuel R Nason
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
| | - Zachary T Irwin
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
| | - Chrono S Nu
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
| | - Brian Smith
- 2Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA
| | - Alex Campean
- 2Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA
| | - P Hunter Peckham
- 2Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA.,3Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH USA
| | - Kevin L Kilgore
- 2Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA.,3Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH USA.,4Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH USA
| | - Matthew S Willsey
- 5Department of Neurosurgery, University of Michigan, Ann Arbor, MI USA
| | - Parag G Patil
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA.,5Department of Neurosurgery, University of Michigan, Ann Arbor, MI USA.,6Department of Neurology, University of Michigan, Ann Arbor, MI USA.,7Department of Anesthesiology, University of Michigan, Ann Arbor, MI USA
| | - Cynthia A Chestek
- 1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA.,8Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI USA
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Peng X, Hickman JL, Bowles SG, Donegan DC, Welle CG. Innovations in electrical stimulation harness neural plasticity to restore motor function. BIOELECTRONICS IN MEDICINE 2018; 1:251-263. [PMID: 33859830 PMCID: PMC8046169 DOI: 10.2217/bem-2019-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/21/2019] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Xiaoyu Peng
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
| | - Jordan L. Hickman
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
| | - Spencer G. Bowles
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
| | - Dane C. Donegan
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
- ETH Zurich, Department Health Science and Technology, Institute for Neuroscience. Schorenstrasse 16, 8603 Schwerzenbach, Switzerland
| | - Cristin G. Welle
- Dept. of Neurosurgery, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO 80045
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Vaskov AK, Irwin ZT, Nason SR, Vu PP, Nu CS, Bullard AJ, Hill M, North N, Patil PG, Chestek CA. Cortical Decoding of Individual Finger Group Motions Using ReFIT Kalman Filter. Front Neurosci 2018; 12:751. [PMID: 30455621 PMCID: PMC6231049 DOI: 10.3389/fnins.2018.00751] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 09/28/2018] [Indexed: 01/01/2023] Open
Abstract
Objective: To date, many brain-machine interface (BMI) studies have developed decoding algorithms for neuroprostheses that provide users with precise control of upper arm reaches with some limited grasping capabilities. However, comparatively few have focused on quantifying the performance of precise finger control. Here we expand upon this work by investigating online control of individual finger groups. Approach: We have developed a novel training manipulandum for non-human primate (NHP) studies to isolate the movements of two specific finger groups: index and middle-ring-pinkie (MRP) fingers. We use this device in combination with the ReFIT (Recalibrated Feedback Intention-Trained) Kalman filter to decode the position of each finger group during a single degree of freedom task in two rhesus macaques with Utah arrays in motor cortex. The ReFIT Kalman filter uses a two-stage training approach that improves online control of upper arm tasks with substantial reductions in orbiting time, thus making it a logical first choice for precise finger control. Results: Both animals were able to reliably acquire fingertip targets with both index and MRP fingers, which they did in blocks of finger group specific trials. Decoding from motor signals online, the ReFIT Kalman filter reliably outperformed the standard Kalman filter, measured by bit rate, across all tested finger groups and movements by 31.0 and 35.2%. These decoders were robust when the manipulandum was removed during online control. While index finger movements and middle-ring-pinkie finger movements could be differentiated from each other with 81.7% accuracy across both subjects, the linear Kalman filter was not sufficient for decoding both finger groups together due to significant unwanted movement in the stationary finger, potentially due to co-contraction. Significance: To our knowledge, this is the first systematic and biomimetic separation of digits for continuous online decoding in a NHP as well as the first demonstration of the ReFIT Kalman filter improving the performance of precise finger decoding. These results suggest that novel nonlinear approaches, apparently not necessary for center out reaches or gross hand motions, may be necessary to achieve independent and precise control of individual fingers.
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Affiliation(s)
- Alex K Vaskov
- Robotics Graduate Program, University of Michigan, Ann Arbor, MI, United States
| | - Zachary T Irwin
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.,Department of Neurology, University of Alabama, Birmingham, AL, United States
| | - Samuel R Nason
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Philip P Vu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Chrono S Nu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Autumn J Bullard
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Mackenna Hill
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.,Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Naia North
- Mechanical Engineering Department, University of Michigan, Ann Arbor, MI, United States
| | - Parag G Patil
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.,Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States.,Department of Neurology, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
| | - Cynthia A Chestek
- Robotics Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, United States
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Neuroprosthetic Surgical Strategies for Neuromuscular Stimulation. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kilgore KL, Bryden A, Keith MW, Hoyen HA, Hart RL, Nemunaitis GA, Peckham PH. Evolution of Neuroprosthetic Approaches to Restoration of Upper Extremity Function in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 24:252-264. [PMID: 29997428 PMCID: PMC6037324 DOI: 10.1310/sci2403-252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Spinal cord injury (SCI) occurring at the cervical levels can result in significantly impaired arm and hand function. People with cervical-level SCI desire improved use of their arms and hands, anticipating that regained function will result in improved independence and ultimately improved quality of life. Neuroprostheses provide the most promising method for significant gain in hand and arm function for persons with cervical-level SCI. Neuroprostheses utilize small electrical currents to activate peripheral motor nerves, resulting in controlled contraction of paralyzed muscles. Methods: A myoelectrically-controlled neuroprosthesis was evaluated in 15 arms in 13 individuals with cervical-level SCI. All individuals had motor level C5 or C6 tetraplegia. Results: This study demonstrates that an implanted neuroprosthesis utilizing myoelectric signal (MES)-controlled stimulation allows considerable flexibility in the control algorithms that can be utilized for a variety of arm and hand functions. Improved active range of motion, grip strength, and the ability to pick up and release objects were improved in all arms tested. Adverse events were few and were consistent with the experience with similar active implantable devices. Conclusion: For individuals with cervical SCI who are highly motivated, implanted neuroprostheses provide the opportunity to gain arm and hand function that cannot be gained through the use of orthotics or surgical intervention alone. Upper extremity neuroprostheses have been shown to provide increased function and independence for persons with cervical-level SCI.
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Affiliation(s)
- Kevin L. Kilgore
- MetroHealth Medical Center, Cleveland, Ohio
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Anne Bryden
- Case Western Reserve University, Cleveland, Ohio
| | - Michael W. Keith
- MetroHealth Medical Center, Cleveland, Ohio
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Harry A. Hoyen
- MetroHealth Medical Center, Cleveland, Ohio
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Ronald L. Hart
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Gregory A. Nemunaitis
- MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - P. Hunter Peckham
- MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
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Kilgore KL, Peckham PH. Stimulation for Return of Upper-Extremity Function. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00096-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Robot-Assisted Training of Arm and Hand Movement Shows Functional Improvements for Incomplete Cervical Spinal Cord Injury. Am J Phys Med Rehabil 2017; 96:S171-S177. [DOI: 10.1097/phm.0000000000000815] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guvanasen GS, Guo L, Aguilar RJ, Cheek AL, Shafor CS, Rajaraman S, Nichols TR, DeWeerth SP. A Stretchable Microneedle Electrode Array for Stimulating and Measuring Intramuscular Electromyographic Activity. IEEE Trans Neural Syst Rehabil Eng 2017; 25:1440-1452. [DOI: 10.1109/tnsre.2016.2629461] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Heald E, Hart R, Kilgore K, Peckham PH. Characterization of Volitional Electromyographic Signals in the Lower Extremity After Motor Complete Spinal Cord Injury. Neurorehabil Neural Repair 2017; 31:583-591. [PMID: 28443786 PMCID: PMC5560032 DOI: 10.1177/1545968317704904] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have demonstrated the presence of intact axons across a spinal cord lesion, even in those clinically diagnosed with complete spinal cord injury (SCI). These axons may allow volitional motor signals to be transmitted through the injury, even in the absence of visible muscle contraction. OBJECTIVE To demonstrate the presence of volitional electromyographic (EMG) activity below the lesion in motor complete SCI and to characterize this activity to determine its value for potential use as a neuroprosthetic command source. METHODS Twenty-four subjects with complete (AIS A or B), chronic, cervical SCI were tested for the presence of volitional below-injury EMG activity. Surface electrodes recorded from 8 to 12 locations of each lower limb, while participants were asked to attempt specific movements of the lower extremity in response to visual and audio cues. EMG trials were ranked through visual inspection, and were scored using an amplitude threshold algorithm to identify channels of interest with volitional motor unit activity. RESULTS Significant below-injury muscle activity was identified through visual inspection in 16 of 24 participants, and visual inspection rankings were well correlated to the algorithm scoring. CONCLUSIONS The surface EMG protocol utilized here is relatively simple and noninvasive, ideal for a clinical screening tool. The majority of subjects tested were able to produce a volitional EMG signal below their injury level, and the algorithm developed allows automatic identification of signals of interest. The presence of this volitional activity in the lower extremity could provide an innovative new command signal source for implanted neuroprostheses or other assistive technology.
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Affiliation(s)
- Elizabeth Heald
- Dept. of Biomedical Engineering, Case Western Reserve University, Cleveland OH
| | - Ronald Hart
- Louis Stokes Veterans Affairs Medical Center, Cleveland OH
| | - Kevin Kilgore
- Dept. of Biomedical Engineering, Case Western Reserve University, Cleveland OH
- Louis Stokes Veterans Affairs Medical Center, Cleveland OH
- MetroHealth Medical Center, Cleveland OH
| | - P. Hunter Peckham
- Dept. of Biomedical Engineering, Case Western Reserve University, Cleveland OH
- MetroHealth Medical Center, Cleveland OH
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Ajiboye AB, Willett FR, Young DR, Memberg WD, Murphy BA, Miller JP, Walter BL, Sweet JA, Hoyen HA, Keith MW, Peckham PH, Simeral JD, Donoghue JP, Hochberg LR, Kirsch RF. Restoration of reaching and grasping movements through brain-controlled muscle stimulation in a person with tetraplegia: a proof-of-concept demonstration. Lancet 2017; 389:1821-1830. [PMID: 28363483 PMCID: PMC5516547 DOI: 10.1016/s0140-6736(17)30601-3] [Citation(s) in RCA: 450] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 01/02/2017] [Accepted: 01/06/2017] [Indexed: 11/01/2022]
Abstract
BACKGROUND People with chronic tetraplegia, due to high-cervical spinal cord injury, can regain limb movements through coordinated electrical stimulation of peripheral muscles and nerves, known as functional electrical stimulation (FES). Users typically command FES systems through other preserved, but unrelated and limited in number, volitional movements (eg, facial muscle activity, head movements, shoulder shrugs). We report the findings of an individual with traumatic high-cervical spinal cord injury who coordinated reaching and grasping movements using his own paralysed arm and hand, reanimated through implanted FES, and commanded using his own cortical signals through an intracortical brain-computer interface (iBCI). METHODS We recruited a participant into the BrainGate2 clinical trial, an ongoing study that obtains safety information regarding an intracortical neural interface device, and investigates the feasibility of people with tetraplegia controlling assistive devices using their cortical signals. Surgical procedures were performed at University Hospitals Cleveland Medical Center (Cleveland, OH, USA). Study procedures and data analyses were performed at Case Western Reserve University (Cleveland, OH, USA) and the US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center (Cleveland, OH, USA). The study participant was a 53-year-old man with a spinal cord injury (cervical level 4, American Spinal Injury Association Impairment Scale category A). He received two intracortical microelectrode arrays in the hand area of his motor cortex, and 4 months and 9 months later received a total of 36 implanted percutaneous electrodes in his right upper and lower arm to electrically stimulate his hand, elbow, and shoulder muscles. The participant used a motorised mobile arm support for gravitational assistance and to provide humeral abduction and adduction under cortical control. We assessed the participant's ability to cortically command his paralysed arm to perform simple single-joint arm and hand movements and functionally meaningful multi-joint movements. We compared iBCI control of his paralysed arm with that of a virtual three-dimensional arm. This study is registered with ClinicalTrials.gov, number NCT00912041. FINDINGS The intracortical implant occurred on Dec 1, 2014, and we are continuing to study the participant. The last session included in this report was Nov 7, 2016. The point-to-point target acquisition sessions began on Oct 8, 2015 (311 days after implant). The participant successfully cortically commanded single-joint and coordinated multi-joint arm movements for point-to-point target acquisitions (80-100% accuracy), using first a virtual arm and second his own arm animated by FES. Using his paralysed arm, the participant volitionally performed self-paced reaches to drink a mug of coffee (successfully completing 11 of 12 attempts within a single session 463 days after implant) and feed himself (717 days after implant). INTERPRETATION To our knowledge, this is the first report of a combined implanted FES+iBCI neuroprosthesis for restoring both reaching and grasping movements to people with chronic tetraplegia due to spinal cord injury, and represents a major advance, with a clear translational path, for clinically viable neuroprostheses for restoration of reaching and grasping after paralysis. FUNDING National Institutes of Health, Department of Veterans Affairs.
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Affiliation(s)
- A Bolu Ajiboye
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA.
| | - Francis R Willett
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA
| | - Daniel R Young
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA
| | - William D Memberg
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA
| | - Brian A Murphy
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin L Walter
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jennifer A Sweet
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Harry A Hoyen
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH, USA
| | - Michael W Keith
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH, USA
| | - P Hunter Peckham
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA
| | - John D Simeral
- School of Engineering, Brown University, Providence, RI, USA; Brown Institute for Brain Science, Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - John P Donoghue
- Brown Institute for Brain Science, Brown University, Providence, RI, USA; Department of Neuroscience, Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA; Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Leigh R Hochberg
- School of Engineering, Brown University, Providence, RI, USA; Brown Institute for Brain Science, Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs Medical Center, Providence, RI, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Robert F Kirsch
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA; School of Medicine, Case Western Reserve University, Cleveland, OH, USA; US Department of Veterans Affairs, Louis Stokes Cleveland Veterans Affairs Medical Center, Functional Electrical Stimulation Center of Excellence, Rehabilitation R&D Service, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Barelli RG, Aquino Junior PT, Ferrari de Castro MC. Mobile interface for neuroprosthesis control aiming tetraplegic users. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2618-2621. [PMID: 28268859 DOI: 10.1109/embc.2016.7591267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article proposes the development of a mobile interface for controlling a Neuroprosthesis, designed to restore grasp patterns, aiming tetraplegics users at C5 and C6 levels. Human Computer Interface paradigms and usability concepts guide its planning and development to garantee the quality of user's interaction with the system and thus, the sucess and controlability of the neuroprostheses. The number of screens and menus were optimized, thus the user may feel the interface as more intuitive, leading to fast learning and increasing the trust on it.
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