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Song H, Hsieh TH, Yeon SH, Shu T, Nawrot M, Landis CF, Friedman GN, Israel EA, Gutierrez-Arango S, Carty MJ, Freed LE, Herr HM. Continuous neural control of a bionic limb restores biomimetic gait after amputation. Nat Med 2024; 30:2010-2019. [PMID: 38951635 PMCID: PMC11271427 DOI: 10.1038/s41591-024-02994-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 04/11/2024] [Indexed: 07/03/2024]
Abstract
For centuries scientists and technologists have sought artificial leg replacements that fully capture the versatility of their intact biological counterparts. However, biological gait requires coordinated volitional and reflexive motor control by complex afferent and efferent neural interplay, making its neuroprosthetic emulation challenging after limb amputation. Here we hypothesize that continuous neural control of a bionic limb can restore biomimetic gait after below-knee amputation when residual muscle afferents are augmented. To test this hypothesis, we present a neuroprosthetic interface consisting of surgically connected, agonist-antagonist muscles including muscle-sensing electrodes. In a cohort of seven leg amputees, the interface is shown to augment residual muscle afferents by 18% of biologically intact values. Compared with a matched amputee cohort without the afferent augmentation, the maximum neuroprosthetic walking speed is increased by 41%, enabling equivalent peak speeds to persons without leg amputation. Further, this level of afferent augmentation enables biomimetic adaptation to various walking speeds and real-world environments, including slopes, stairs and obstructed pathways. Our results suggest that even a small augmentation of residual muscle afferents restores biomimetic gait under continuous neuromodulation in individuals with leg amputation.
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Affiliation(s)
- Hyungeun Song
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tsung-Han Hsieh
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Seong Ho Yeon
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tony Shu
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michael Nawrot
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christian F Landis
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Gabriel N Friedman
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erica A Israel
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Samantha Gutierrez-Arango
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Matthew J Carty
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Lisa E Freed
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Hugh M Herr
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.
- McGovern Institute, Massachusetts Institute of Technology, Cambridge, MA, USA.
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Kulkarni PG, Paudel N, Magar S, Santilli MF, Kashyap S, Baranwal AK, Zamboni P, Vasavada P, Katiyar A, Singh AV. Overcoming Challenges and Innovations in Orthopedic Prosthesis Design: An Interdisciplinary Perspective. BIOMEDICAL MATERIALS & DEVICES (NEW YORK, N.Y.) 2023:1-12. [PMID: 37363137 PMCID: PMC10180679 DOI: 10.1007/s44174-023-00087-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/29/2023] [Indexed: 06/28/2023]
Abstract
Recent advances in the orthopedic prostheses design have significantly improved the quality of life for individuals with orthopedic disabilities. However, there are still critical challenges that need to be addressed to further enhance the functionality of orthopedic prostheses improving biocompatibility to promote better integration with natural tissues, enhancing durability to withstand the demands of daily use, and improving sensory feedback for better control of movement are the most pressing issues. To address these challenges, promising emerging solutions such as smart prosthetics, 3D printing, regenerative medicine, and artificial intelligence have been developed. These innovative technologies hold the potential to significantly enhance the functionality of orthopedic prostheses. Realizing the full potential of these next-generation orthopedic prostheses requires addressing several critical factors. These include interdisciplinary collaboration between experts in orthopedics, materials science, biology, and engineering, increased investment in research and development, standardization of components to ensure quality and reliability, and improved access to prosthetics. A comprehensive review of these challenges and considerations for future orthopedic prosthesis design is s provided in this paper addressing the further advances to the field. By addressing these issues, we can continue to improve the lives of individuals with orthopedic disabilities and further enhance the field of orthopedic prosthetics.
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Affiliation(s)
| | - Namuna Paudel
- Department of Chemistry, Amrit Campus, Institute of Science and Technology, Tribhuvan University, Lainchaur, Kathmandu, 44600 Nepal
| | - Shilpa Magar
- Seeta Nursing Home, Shivaji Nagar, Nashik, Maharashtra 422002 India
| | | | | | | | - Paolo Zamboni
- Chair Vascular Diseases Center, University of Ferrara, 44124 Ferrara, Italy
| | - Priyank Vasavada
- M.S. Ramaiah Medical College and Hospital, Bengaluru, 560054 India
| | - Aman Katiyar
- Jain University, Bengaluru, Karnataka 560069 India
| | - Ajay Vikram Singh
- Department of Chemical and Product Safety, German Federal Institute of Risk Assessment (BfR), Maxdohrnstrasse 8-10, 10589 Berlin, Germany
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Mablekos-Alexiou A, Kontogiannopoulos S, Bertos GA, Papadopoulos E. A biomechatronics-based EPP topology for upper-limb prosthesis control: Modeling & benchtop prototype. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
Scientist and technologist have long sought to advance limb prostheses that connect directly to the peripheral nervous system, enabling a person with amputation to volitionally control synthetic actuators that move, stiffen and power the prosthesis, as well as to experience natural afferent sensations from the prosthesis. Recently, the agonist-antagonist myoneural interface (AMI) was developed, a mechanoneural transduction architecture and neural interface system designed to provide persons with amputation improved muscle-tendon proprioception and neuroprosthetic control. In this paper, we provide an overview of the AMI, including its conceptual framing and preclinical science, surgical techniques for its construction, and clinical efficacy related to pain mitigation, phantom limb range of motion, fascicle dynamics, central brain proprioceptive sensorimotor preservation, and prosthetic controllability. Following this broad overview, we end with a discussion of current limitations of the AMI and potential resolutions to such challenges.
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Neural interfacing architecture enables enhanced motor control and residual limb functionality postamputation. Proc Natl Acad Sci U S A 2021; 118:2019555118. [PMID: 33593940 PMCID: PMC7936324 DOI: 10.1073/pnas.2019555118] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Despite advancements in prosthetic technologies, persons with amputation today suffer great diminution in mobility and quality of life. This is largely due to an outdated amputation paradigm that precludes efficacious communication between the residual limb and prosthesis. An amputation method utilizing agonist–antagonist myoneural interfaces (AMIs) constructs neuromuscular substrates in the residual limb to avail enhanced sensorimotor signaling. In our study, subjects with AMI amputation demonstrate improved motor control, phantom sensations, range of motion, and decreased pain when compared to patients with traditional amputation. With the demonstrated increases in motor coordination and position differentiation, our results suggest that patients with AMI amputation will be able to more efficaciously control bionic prostheses. Despite advancements in prosthetic technologies, patients with amputation today suffer great diminution in mobility and quality of life. We have developed a modified below-knee amputation (BKA) procedure that incorporates agonist–antagonist myoneural interfaces (AMIs), which surgically preserve and couple agonist–antagonist muscle pairs for the subtalar and ankle joints. AMIs are designed to restore physiological neuromuscular dynamics, enable bidirectional neural signaling, and offer greater neuroprosthetic controllability compared to traditional amputation techniques. In this prospective, nonrandomized, unmasked study design, 15 subjects with AMI below-knee amputation (AB) were matched with 7 subjects who underwent a traditional below-knee amputation (TB). AB subjects demonstrated significantly greater control of their residual limb musculature, production of more differentiable efferent control signals, and greater precision of movement compared to TB subjects (P < 0.008). This may be due to the presence of greater proprioceptive inputs facilitated by the significantly higher fascicle strains resulting from coordinated muscle excursion in AB subjects (P < 0.05). AB subjects reported significantly greater phantom range of motion postamputation (AB: 12.47 ± 2.41, TB: 10.14 ± 1.45 degrees) when compared to TB subjects (P < 0.05). Furthermore, AB subjects also reported less pain (12.25 ± 5.37) than TB subjects (17.29 ± 10.22) and a significant reduction when compared to their preoperative baseline (P < 0.05). Compared with traditional amputation, the construction of AMIs during amputation confers the benefits of enhanced physiological neuromuscular dynamics, proprioception, and phantom limb perception. Subjects’ activation of the AMIs produces more differentiable electromyography (EMG) for myoelectric prosthesis control and demonstrates more positive clinical outcomes.
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Abstract
The agonist-antagonist myoneural interface is a novel surgical construct and neural interfacing approach designed to augment volitional control of adapted prostheses, preserve proprioception, and prevent limb atrophy in the setting of limb amputation.
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Affiliation(s)
- Matthew J Carty
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Hugh M Herr
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, 75 Amherst Street, Cambridge, MA 02139, USA
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Fleming A, Stafford N, Huang S, Hu X, Ferris DP, Huang H(H. Myoelectric control of robotic lower limb prostheses: a review of electromyography interfaces, control paradigms, challenges and future directions. J Neural Eng 2021; 18:10.1088/1741-2552/ac1176. [PMID: 34229307 PMCID: PMC8694273 DOI: 10.1088/1741-2552/ac1176] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
Objective.Advanced robotic lower limb prostheses are mainly controlled autonomously. Although the existing control can assist cyclic movements during locomotion of amputee users, the function of these modern devices is still limited due to the lack of neuromuscular control (i.e. control based on human efferent neural signals from the central nervous system to peripheral muscles for movement production). Neuromuscular control signals can be recorded from muscles, called electromyographic (EMG) or myoelectric signals. In fact, using EMG signals for robotic lower limb prostheses control has been an emerging research topic in the field for the past decade to address novel prosthesis functionality and adaptability to different environments and task contexts. The objective of this paper is to review robotic lower limb Prosthesis control via EMG signals recorded from residual muscles in individuals with lower limb amputations.Approach.We performed a literature review on surgical techniques for enhanced EMG interfaces, EMG sensors, decoding algorithms, and control paradigms for robotic lower limb prostheses.Main results.This review highlights the promise of EMG control for enabling new functionalities in robotic lower limb prostheses, as well as the existing challenges, knowledge gaps, and opportunities on this research topic from human motor control and clinical practice perspectives.Significance.This review may guide the future collaborations among researchers in neuromechanics, neural engineering, assistive technologies, and amputee clinics in order to build and translate true bionic lower limbs to individuals with lower limb amputations for improved motor function.
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Affiliation(s)
- Aaron Fleming
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27695, United States of America
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
- Equal contribution as the first author
| | - Nicole Stafford
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL 32611, United States of America
- Equal contribution as the first author
| | - Stephanie Huang
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27695, United States of America
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Xiaogang Hu
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27695, United States of America
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Daniel P Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, United States of America
| | - He (Helen) Huang
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC 27695, United States of America
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
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8
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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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9
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Srinivasan SS, Tuckute G, Zou J, Gutierrez-Arango S, Song H, Barry RL, Herr HM. Agonist-antagonist myoneural interface amputation preserves proprioceptive sensorimotor neurophysiology in lower limbs. Sci Transl Med 2021; 12:12/573/eabc5926. [PMID: 33298564 DOI: 10.1126/scitranslmed.abc5926] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/22/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022]
Abstract
The brain undergoes marked changes in function and functional connectivity after limb amputation. The agonist-antagonist myoneural interface (AMI) amputation is a procedure that restores physiological agonist-antagonist muscle relationships responsible for proprioceptive sensory feedback to enable greater motor control. We compared results from the functional neuroimaging of individuals (n = 29) with AMI amputation, traditional amputation, and no amputation. Individuals with traditional amputation demonstrated a significant decrease in proprioceptive activity, measured by activation of Brodmann area 3a, whereas functional activation in individuals with AMIs was not significantly different from controls with no amputation (P < 0.05). The degree of proprioceptive activity in the brain strongly correlated with fascicle activity in the peripheral muscles and performance on motor tasks (P < 0.05), supporting the mechanistic basis of the AMI procedure. These results suggest that surgical techniques designed to restore proprioceptive peripheral neuromuscular constructs result in desirable central sensorimotor plasticity.
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Affiliation(s)
- Shriya S Srinivasan
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Greta Tuckute
- MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jasmine Zou
- MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Samantha Gutierrez-Arango
- MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Hyungeun Song
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Robert L Barry
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA.,Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Hugh M Herr
- MIT Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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10
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Agonist-antagonist Myoneural Interfaces in Above-knee Amputation Preserve Distal Joint Function and Perception. Ann Surg 2021; 273:e115-e118. [PMID: 33378297 DOI: 10.1097/sla.0000000000004153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Abstract
BACKGROUND Recent progress in biomechatronics and vascularized composite allotransplantation have occurred in the absence of congruent advancements in the surgical approaches generally utilized for limb amputation. Consideration of these advances, as well as of both novel and time-honored reconstructive surgical techniques, argues for a fundamental reframing of the way in which amputation procedures should be performed. METHODS We review sentinel developments in external prosthetic limb technology and limb transplantation, in addition to standard and emerging reconstructive surgical techniques relevant to limb modification, and then propose a new paradigm for limb amputation. RESULTS An approach to limb amputation based on the availability of native tissues is proposed, with the intent of maximizing limb function, limiting neuropathic pain, restoring limb perception/proprioception and mitigating limb atrophy. CONCLUSIONS We propose a reinvention of the manner in which limb amputations are performed, framed in the context of time-tested reconstructive techniques, as well as novel, state-of-the-art surgical procedures. Implementation of the proposed techniques in the acute setting has the potential to elevate advanced limb replacement strategies to a clinical solution that perhaps exceeds what is possible through traditional surgical approaches to limb salvage. We therefore argue that amputation, performed with the intent of optimizing the residuum for interaction with either a bionic or a transplanted limb, should be viewed not as a surgical failure, but as an alternative form of limb reconstruction.
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12
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Restoration of bilateral motor coordination from preserved agonist-antagonist coupling in amputation musculature. J Neuroeng Rehabil 2021; 18:38. [PMID: 33596960 PMCID: PMC7891024 DOI: 10.1186/s12984-021-00829-z] [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: 11/10/2020] [Accepted: 01/26/2021] [Indexed: 11/26/2022] Open
Abstract
Background Neuroprosthetic devices controlled by persons with standard limb amputation often lack the dexterity of the physiological limb due to limitations of both the user’s ability to output accurate control signals and the control system’s ability to formulate dynamic trajectories from those signals. To restore full limb functionality to persons with amputation, it is necessary to first deduce and quantify the motor performance of the missing limbs, then meet these performance requirements through direct, volitional control of neuroprosthetic devices. Methods We develop a neuromuscular modeling and optimization paradigm for the agonist-antagonist myoneural interface, a novel tissue architecture and neural interface for the control of myoelectric prostheses, that enables it to generate virtual joint trajectories coordinated with an intact biological joint at full physiologically-relevant movement bandwidth. In this investigation, a baseline of performance is first established in a population of non-amputee control subjects (\documentclass[12pt]{minimal}
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\begin{document}$$n = 8$$\end{document}n=8). Then, a neuromuscular modeling and optimization technique is advanced that allows unilateral AMI amputation subjects (\documentclass[12pt]{minimal}
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\begin{document}$$n = 4$$\end{document}n=4) to generate virtual subtalar prosthetic joint kinematics using measured surface electromyography (sEMG) signals generated by musculature within the affected leg residuum. Results Using their optimized neuromuscular subtalar models under blindfolded conditions with only proprioceptive feedback, AMI amputation subjects demonstrate bilateral subtalar coordination accuracy not significantly different from that of the non-amputee control group (Kolmogorov-Smirnov test, \documentclass[12pt]{minimal}
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\begin{document}$$P \ge 0.052$$\end{document}P≥0.052) while standard amputation subjects demonstrate significantly poorer performance (Kolmogorov-Smirnov test, \documentclass[12pt]{minimal}
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\begin{document}$$P < 0.001$$\end{document}P<0.001). Conclusions These results suggest that the absence of an intact biological joint does not necessarily remove the ability to produce neurophysical signals with sufficient information to reconstruct physiological movements. Further, the seamless manner in which virtual and intact biological joints are shown to coordinate reinforces the theory that desired movement trajectories are mentally formulated in an abstract task space which does not depend on physical limb configurations. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00829-z.
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13
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Srinivasan SS, Carty MJ, Calvaresi PW, Clites TR, Maimon BE, Taylor CR, Zorzos AN, Herr H. On prosthetic control: A regenerative agonist-antagonist myoneural interface. Sci Robot 2021; 2:2/6/eaan2971. [PMID: 33157872 DOI: 10.1126/scirobotics.aan2971] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/10/2017] [Indexed: 01/25/2023]
Abstract
Prosthetic limb control is fundamentally constrained by the current amputation procedure. Since the U.S. Civil War, the external prosthesis has benefited from a pronounced level of innovation, but amputation technique has not significantly changed. During a standard amputation, nerves are transected without the reintroduction of proper neural targets, causing painful neuromas and rendering efferent recordings infeasible. Furthermore, the physiological agonist-antagonist muscle relationships are severed, precluding the generation of musculotendinous proprioception, an afferent feedback modality critical for joint stability, trajectory planning, and fine motor control. We establish an agonist-antagonist myoneural interface (AMI), a unique surgical paradigm for amputation. Regenerated free muscle grafts innervated with transected nerves are linked in agonist-antagonist relationships, emulating the dynamic interactions found within an intact limb. Using biomechanical, electrophysiological, and histological evaluations, we demonstrate a viable architecture for bidirectional signaling with transected motor nerves. Upon neural activation, the agonist muscle contracts, generating electromyographic signal. This contraction in the agonist creates a stretch in the mechanically linked antagonist muscle, producing afferent feedback, which is transmitted through its motor nerve. Histological results demonstrate regeneration and the presence of the spindle fibers responsible for afferent signal generation. These results suggest that the AMI will not only produce robust signals for the efferent control of an external prosthesis but also provide an amputee's central nervous system with critical musculotendinous proprioception, offering the potential for an enhanced prosthetic controllability and sensation.
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Affiliation(s)
- S S Srinivasan
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - M J Carty
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - P W Calvaresi
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - T R Clites
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - B E Maimon
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - C R Taylor
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - A N Zorzos
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - H Herr
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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14
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Sun CX, Liu X. A state observer for the computational network model of neural populations. CHAOS (WOODBURY, N.Y.) 2021; 31:013127. [PMID: 33754748 DOI: 10.1063/5.0020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/29/2020] [Indexed: 06/12/2023]
Abstract
A state observer plays a vital role in the design of state feedback neuromodulation schemes used to prevent and treat neurological or psychiatric disorders. This paper aims to design a state observer to reconstruct all unmeasured states of the computational network model of neural populations that replicates patterns seen on the electroencephalogram by using the model inputs and outputs, as the theoretical basis for designing state feedback neuromodulation clinical schemes. The feasibility problem of linear matrix inequality conditions, which is the most important one for observer design of the computational network model of neural populations, is solved by using the input-output stability theory and the Lurie system theory. The observer matrices of the designed observer are formed by the optimal solution of the linear matrix inequality conditions. An illustrative example shows that the observer can simultaneously reproduce internal state variables of normal and lesion populations of the computational network model of neural populations under the background of focal origin brain dysfunction, and the designed observer has certain robustness toward input uncertainty and measurement noise. To the best of our knowledge, no observers have previously been designed for the computational network model of neural populations. The design of state feedback neuromodulation schemes based on the computational network model of neural populations is a new direction in the field of computational neuroscience.
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Affiliation(s)
- Cheng-Xia Sun
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China
| | - Xian Liu
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China
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Safari R. Lower limb prosthetic interfaces: Clinical and technological advancement and potential future direction. Prosthet Orthot Int 2020; 44:384-401. [PMID: 33164655 DOI: 10.1177/0309364620969226] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The human-prosthesis interface is one of the most complicated challenges facing the field of prosthetics, despite substantive investments in research and development by researchers and clinicians around the world. The journal of the International Society for Prosthetics and Orthotics, Prosthetics and Orthotics International, has contributed substantively to the growing body of knowledge on this topic. In celebrating the 50th anniversary of the International Society for Prosthetics and Orthotics, this narrative review aims to explore how human-prosthesis interfaces have changed over the last five decades; how research has contributed to an understanding of interface mechanics; how clinical practice has been informed as a result; and what might be potential future directions. Studies reporting on comparison, design, manufacturing and evaluation of lower limb prosthetic sockets, and osseointegration were considered. This review demonstrates that, over the last 50 years, clinical research has improved our understanding of socket designs and their effects; however, high-quality research is still needed. In particular, there have been advances in the development of volume and thermal control mechanisms with a few designs having the potential for clinical application. Similarly, advances in sensing technology, soft tissue quantification techniques, computing technology, and additive manufacturing are moving towards enabling automated, data-driven manufacturing of sockets. In people who are unable to use a prosthetic socket, osseointegration provides a functional solution not available 50 years ago. Furthermore, osseointegration has the potential to facilitate neuromuscular integration. Despite these advances, further improvement in mechanical features of implants, and infection control and prevention are needed.
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Affiliation(s)
- Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, UK
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16
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Grushko S, Spurný T, Černý M. Control Methods for Transradial Prostheses Based on Remnant Muscle Activity and Its Relationship with Proprioceptive Feedback. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4883. [PMID: 32872291 PMCID: PMC7506660 DOI: 10.3390/s20174883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
The loss of a hand can significantly affect one's work and social life. For many patients, an artificial limb can improve their mobility and ability to manage everyday activities, as well as provide the means to remain independent. This paper provides an extensive review of available biosensing methods to implement the control system for transradial prostheses based on the measured activity in remnant muscles. Covered techniques include electromyography, magnetomyography, electrical impedance tomography, capacitance sensing, near-infrared spectroscopy, sonomyography, optical myography, force myography, phonomyography, myokinetic control, and modern approaches to cineplasty. The paper also covers combinations of these approaches, which, in many cases, achieve better accuracy while mitigating the weaknesses of individual methods. The work is focused on the practical applicability of the approaches, and analyses present challenges associated with each technique along with their relationship with proprioceptive feedback, which is an important factor for intuitive control over the prosthetic device, especially for high dexterity prosthetic hands.
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Affiliation(s)
- Stefan Grushko
- Department of Robotics, VSB-Technical University of Ostrava, 70800 Ostrava, Czech Republic; (T.S.); (M.Č.)
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17
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Caprine Models of the Agonist-Antagonist Myoneural Interface Implemented at the Above- and Below-Knee Amputation Levels. Plast Reconstr Surg 2019; 144:218e-229e. [PMID: 31348345 DOI: 10.1097/prs.0000000000005864] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traditional approaches to amputation are not capable of reproducing the dynamic muscle relationships that are essential for proprioceptive sensation and joint control. In this study, the authors present two caprine models of the agonist-antagonist myoneural interface (AMI), a surgical approach designed to improve bidirectional neural control of a bionic limb. The key advancement of the AMI is the surgical coaptation of natively innervated agonist-antagonist muscle pairs within the residual limb. METHODS One AMI was surgically created in the hindlimb of each of two African Pygmy goats at the time of primary transtibial amputation. Each animal was also implanted with muscle electrodes and sonomicrometer crystals to enable measurement of muscle activation and muscle state, respectively. Coupled agonist-antagonist excursion in the agonist-antagonist myoneural interface muscles was measured longitudinally for each animal. Fibrosis in the residual limb was evaluated grossly in each animal as part of a planned terminal procedure. RESULTS Electromyographic and muscle state measurements showed coupled agonist-antagonist motion within the AMI in the presence of both neural activation and artificial muscle stimulation. Gross observation of the residual limb during a planned terminal procedure revealed a thin fibrotic encapsulation of the AMI constructs, which was not sufficient to preclude coupled muscle excursion. CONCLUSIONS These findings highlight the AMI's potential to provide coupled motion of distal agonist-antagonist muscle pairs preserved during below- or above-knee amputation at nearly human scale. Guided by these findings, it is the authors' expectation that further development of the AMI architecture will improve neural control of advanced limb prostheses through incorporation of physiologically relevant muscle-tendon proprioception.
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Lancashire HT, Al Ajam Y, Dowling RP, Pendegrass CJ, Blunn GW. Hard-wired Epimysial Recordings from Normal and Reinnervated Muscle Using a Bone-anchored Device. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2391. [PMID: 31741811 PMCID: PMC6799399 DOI: 10.1097/gox.0000000000002391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/07/2019] [Indexed: 12/02/2022]
Abstract
A combined approach for prosthetic attachment and control using a transcutaneous bone-anchored device and implanted muscle electrodes can improve function for upper-limb amputees. The bone-anchor provides a transcutaneous feed-through for muscle signal recording. This approach can be combined with targeted muscle reinnervation (TMR) to further improve myoelectric control. METHODS A bone-anchored device was implanted trans-tibially in n = 8 sheep with a bipolar recording electrode secured epimysially to the peroneus tertius muscle. TMR was carried out in a single animal: the peroneus tertius was deinnervated and the distal portion of the transected nerve to the peroneus muscle was coapted to a transected nerve branch previously supplying the tibialis anterior muscle. For 12 weeks (TMR) or 19 weeks (standard procedure), epimysial muscle signals were recorded while animals walked at 2 km·h-1. RESULTS After 19 weeks implantation following standard procedure, epimysial recording signal-to-noise ratio (SNR) was 18.7 dB (± 6.4 dB, 95% CI) with typical recordings falling in the range 10-25 dB. Recoveries in gait and muscle signals were coincident 6 weeks post-TMR; initial muscle activity was identifiable 3 weeks post-TMR though with low signal amplitude and signal-to-noise ratio compared with normal muscle recordings. CONCLUSIONS Following recovery, muscle signals were recorded reliably over 19 weeks following implantation. In this study, targeted reinnervation was successful in parallel with bone-anchor implantation, with recovery identified 6 weeks after surgery.
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Affiliation(s)
- Henry T. Lancashire
- From the Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Yazan Al Ajam
- Research Department of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Royal Free Hospital, London, UK
| | - Robert P. Dowling
- Research Department of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Catherine J. Pendegrass
- Research Department of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Gordon W. Blunn
- Research Department of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Potter BK. From Bench to Bedside: We Can (Still) Do Better-Moving Towards More Thoughtful, "Constructive" Amputations. Clin Orthop Relat Res 2019; 477:1793-1795. [PMID: 31335599 PMCID: PMC7000012 DOI: 10.1097/corr.0000000000000872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/09/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Benjamin K Potter
- B. K. Potter, Directorate for Surgical Services, Walter Reed National Military Medical Center & the Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD USA
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20
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Prosthetic Rehabilitation and Vascularized Composite Allotransplantation following Upper Limb Loss. Plast Reconstr Surg 2019; 143:1688-1701. [PMID: 31136485 DOI: 10.1097/prs.0000000000005638] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Upper limb loss is a devastating condition with dramatic physical, psychological, financial, and social consequences. Improvements in the fields of prosthetics and vascularized composite allotransplantation have opened exciting new frontiers for treatment and rehabilitation following upper limb loss. Each modality offers a unique set of advantages and limitations with regard to the restoration of hand function following amputation. METHODS Presented in this article is a discussion outlining the complex considerations and decisions encountered when determining patient appropriateness for either prosthetic rehabilitation or vascularized composite allotransplantation following upper limb loss. In this review, the authors examine how psychosocial factors, nature of injury, rehabilitation course, functional outcomes, and risks and benefits may affect overall patient selection for either rehabilitative approach. RESULTS This review summarizes the current state of the literature. Advancements in both prosthetic and biological strategies demonstrate promise with regard to facilitating rehabilitation following upper limb loss. However, there remains a dearth of research directly comparing outcomes in prosthetic rehabilitation to that following upper extremity transplantation. CONCLUSIONS Few studies have performed a direct comparison between patients undergoing vascularized composite allotransplantation and those undergoing prosthetic rehabilitation. Upper extremity transplantation and prosthetic reconstruction should not be viewed as competing options, but rather as two treatment modalities with different risk-to-benefit profiles and indications.
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21
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Srinivasan S, Vyas K, McAvoy M, Calvaresi P, Khan OF, Langer R, Anderson DG, Herr H. Polyimide Electrode-Based Electrical Stimulation Impedes Early Stage Muscle Graft Regeneration. Front Neurol 2019; 10:252. [PMID: 30967830 PMCID: PMC6438882 DOI: 10.3389/fneur.2019.00252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/25/2019] [Indexed: 01/22/2023] Open
Abstract
Given the increasing use of regenerative free muscle flaps for various reconstructive procedures and neuroprosthetic applications, there is great interest and value in their enhanced regeneration, revascularization, and reinnervation for improved functional recovery. Here, we implant polyimide-based mircroelectrodes on free flap grafts and perform electrical stimulation for 6 weeks in a murine model. Using electrophysiological and histological assessments, we compare outcomes of stimulated grafts with unstimulated control grafts. We find delayed reinnervation and abnormal electromyographic (EMG) signals, with significantly more polyphasia, lower compound muscle action potentials and higher fatigability in stimulated animals. These metrics are suggestive of myopathy in the free flap grafts stimulated with the electrode. Additionally, active inflammatory processes and partial necrosis are observed in grafts stimulated with the implanted electrode. The results suggest that under this treatment protocol, implanted epimysial electrodes and electrical stimulation to deinnervated, and devascularized flaps during the early recovery phase may be detrimental to regeneration. Future work should determine the optimal implantation and stimulation window for accelerating free muscle graft regeneration.
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Affiliation(s)
- Shriya Srinivasan
- Harvard/MIT Health Sciences and Technology, Harvard Medical School, Boston, MA, United States
- Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Keval Vyas
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Malia McAvoy
- Harvard/MIT Health Sciences and Technology, Harvard Medical School, Boston, MA, United States
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Peter Calvaresi
- Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Omar F. Khan
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Robert Langer
- Harvard/MIT Health Sciences and Technology, Harvard Medical School, Boston, MA, United States
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Daniel G. Anderson
- Harvard/MIT Health Sciences and Technology, Harvard Medical School, Boston, MA, United States
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Hugh Herr
- Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, MA, United States
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22
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Srinivasan SS, Diaz M, Carty M, Herr HM. Towards functional restoration for persons with limb amputation: A dual-stage implementation of regenerative agonist-antagonist myoneural interfaces. Sci Rep 2019; 9:1981. [PMID: 30760764 PMCID: PMC6374452 DOI: 10.1038/s41598-018-38096-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/14/2018] [Indexed: 12/26/2022] Open
Abstract
While amputation has traditionally been viewed as a failure of therapy, recent developments in amputation surgery and neural interfacing demonstrate improved functionality and bidirectional communication with prosthetic devices. The agonist antagonist myoneural interface (AMI) is one such bi-directional neural communication model comprised of two muscles, an agonist and an antagonist, surgically connected in series within the amputated residuum such that contraction of one muscle stretches the other. By preserving agonist-antagonist muscle dynamics, the AMI allows proprioceptive signals from mechanoreceptors within both muscles to be communicated to the central nervous system. Preliminary human evidence suggests that AMIs have the capacity to provide high fidelity control of a prosthetic device, force feedback, and natural proprioception. However, AMIs have been implemented only in planned amputations and require healthy distal tissues, whereas the majority of amputations occur in patients who do not have healthy distal tissues. Through the use of a dual-stage surgical procedure which leverages existent tissues, this study proposes a revision model for implementation of the AMI in patients who are undergoing traumatic amputation or have already undergone a standard amputation. This paper validates the resulting AMI's physiology, revealing robust viability and mechanical and electrophysiological function. We demonstrate the presence of H-waves in regenerative grafts, indicating the incorporation of the AMI into physiological reflexive loops.
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Affiliation(s)
- Shriya S Srinivasan
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Maurizio Diaz
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Matthew Carty
- Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Hugh M Herr
- Center for Extreme Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
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Srinivasan SS, Maimon BE, Diaz M, Song H, Herr HM. Closed-loop functional optogenetic stimulation. Nat Commun 2018; 9:5303. [PMID: 30546051 PMCID: PMC6294002 DOI: 10.1038/s41467-018-07721-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/16/2018] [Indexed: 12/30/2022] Open
Abstract
Optogenetics has been used to orchestrate temporal- and tissue-specific control of neural tissues and offers a wealth of unique advantages for neuromuscular control. Here, we establish a closed-loop functional optogenetic stimulation (CL-FOS) system to control ankle joint position in murine models. Using the measurement of either joint angle or fascicle length as a feedback signal, we compare the controllability of CL-FOS to closed-loop functional electrical stimulation (CL-FES) and demonstrate significantly greater accuracy, lower rise times and lower overshoot percentages. We demonstrate orderly recruitment of motor units and reduced fatigue when performing cyclical movements with CL-FOS compared with CL-FES. We develop and investigate a 3-phase, photo-kinetic model to elucidate the underlying mechanisms for temporal variations in optogenetically activated neuromusculature during closed-loop control experiments. Methods and insights from this study lay the groundwork for the development of closed-loop optogenetic neuromuscular stimulation therapies and devices for peripheral limb control.
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Affiliation(s)
- Shriya S Srinivasan
- MIT Media Lab, Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, 02139, MA, USA.
- Harvard-MIT Division of Health Sciences and Technology (HST), Massachusetts Institute of Technology, Cambridge, 02139, MA, USA.
| | - Benjamin E Maimon
- MIT Media Lab, Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, 02139, MA, USA
- Harvard-MIT Division of Health Sciences and Technology (HST), Massachusetts Institute of Technology, Cambridge, 02139, MA, USA
| | - Maurizio Diaz
- MIT Media Lab, Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, 02139, MA, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, 02139, MA, USA
| | - Hyungeun Song
- MIT Media Lab, Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, 02139, MA, USA
- Harvard-MIT Division of Health Sciences and Technology (HST), Massachusetts Institute of Technology, Cambridge, 02139, MA, USA
| | - Hugh M Herr
- MIT Media Lab, Center for Extreme Bionics, Massachusetts Institute of Technology, Cambridge, 02139, MA, USA.
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Clites TR, Herr HM, Srinivasan SS, Zorzos AN, Carty MJ. The Ewing Amputation: The First Human Implementation of the Agonist-Antagonist Myoneural Interface. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1997. [PMID: 30881798 PMCID: PMC6414116 DOI: 10.1097/gox.0000000000001997] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/14/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The agonist-antagonist myoneural interface (AMI) comprises a surgical construct and neural control architecture designed to serve as a bidirectional interface, capable of reflecting proprioceptive sensation of prosthetic joint position, speed, and torque from and advanced limb prosthesis onto the central nervous system. The AMI surgical procedure has previously been vetted in animal models; we here present the surgical results of its translation to human subjects. METHODS Modified unilateral below knee amputations were performed in the elective setting in 3 human subjects between July 2016 and April 2017. AMIs were constructed in each subject to control and interpret proprioception from the bionic ankle and subtalar joints. Intraoperative, perioperative, and postoperative residual-limb outcome measures were recorded and analyzed, including electromyographic and radiographic imaging of AMI musculature. RESULTS Mean subject age was 38 ± 13 years, and mean body mass index was 29.5 ± 5.5 kg/m2. Mean operative time was 346 ± 87 minutes, including 120 minutes of tourniquet time per subject. Complications were minor and included transient cellulitis and one instance of delayed wound healing. All subjects demonstrated mild limb hypertrophy postoperatively, and intact construct excursion with volitional muscle activation. All patients reported a high degree of phantom limb position perception with no reports of phantom pain. CONCLUSIONS The AMI offers the possibility of improved prosthetic control and restoration of muscle-tendon proprioception. Initial results in this first cohort of human patients are promising and provide evidence as to the potential role of AMIs in the care of patients requiring below knee amputation.
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Affiliation(s)
- Tyler R. Clites
- From the Massachusetts Institute of Technology, Center for Extreme Bionics, Cambridge, Mass
| | - Hugh M. Herr
- From the Massachusetts Institute of Technology, Center for Extreme Bionics, Cambridge, Mass
| | - Shriya S. Srinivasan
- From the Massachusetts Institute of Technology, Center for Extreme Bionics, Cambridge, Mass
| | - Anthony N. Zorzos
- From the Massachusetts Institute of Technology, Center for Extreme Bionics, Cambridge, Mass
| | - Matthew J. Carty
- From the Massachusetts Institute of Technology, Center for Extreme Bionics, Cambridge, Mass
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Mass
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Charkhkar H, Shell CE, Marasco PD, Pinault GJ, Tyler DJ, Triolo RJ. High-density peripheral nerve cuffs restore natural sensation to
individuals with lower-limb amputations. J Neural Eng 2018; 15:056002. [DOI: 10.1088/1741-2552/aac964] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Clites TR, Carty MJ, Ullauri JB, Carney ME, Mooney LM, Duval JF, Srinivasan SS, Herr HM. Proprioception from a neurally controlled lower-extremity prosthesis. Sci Transl Med 2018; 10:10/443/eaap8373. [DOI: 10.1126/scitranslmed.aap8373] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/09/2017] [Accepted: 05/03/2018] [Indexed: 11/02/2022]
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