1
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Huang HH, Hargrove LJ, Ortiz-Catalan M, Sensinger JW. Integrating Upper-Limb Prostheses with the Human Body: Technology Advances, Readiness, and Roles in Human-Prosthesis Interaction. Annu Rev Biomed Eng 2024; 26:503-528. [PMID: 38594922 DOI: 10.1146/annurev-bioeng-110222-095816] [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] [Indexed: 04/11/2024]
Abstract
Significant advances in bionic prosthetics have occurred in the past two decades. The field's rapid expansion has yielded many exciting technologies that can enhance the physical, functional, and cognitive integration of a prosthetic limb with a human. We review advances in the engineering of prosthetic devices and their interfaces with the human nervous system, as well as various surgical techniques for altering human neuromusculoskeletal systems for seamless human-prosthesis integration. We discuss significant advancements in research and clinical translation, focusing on upper limbprosthetics since they heavily rely on user intent for daily operation, although many discussed technologies have been extended to lower limb prostheses as well. In addition, our review emphasizes the roles of advanced prosthetics technologies in complex interactions with humans and the technology readiness levels (TRLs) of individual research advances. Finally, we discuss current gaps and controversies in the field and point out future research directions, guided by TRLs.
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Affiliation(s)
- He Helen Huang
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina, USA;
| | - Levi J Hargrove
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Max Ortiz-Catalan
- Medical Bionics Department, University of Melbourne, Melbourne, Australia
- Bionics Institute, Melbourne, Australia
| | - Jonathon W Sensinger
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, New Brunswick, Canada;
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2
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Couppey T, Regnacq L, Giraud R, Romain O, Bornat Y, Kolbl F. NRV: An open framework for in silico evaluation of peripheral nerve electrical stimulation strategies. PLoS Comput Biol 2024; 20:e1011826. [PMID: 38995970 PMCID: PMC11268605 DOI: 10.1371/journal.pcbi.1011826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/24/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Electrical stimulation of peripheral nerves has been used in various pathological contexts for rehabilitation purposes or to alleviate the symptoms of neuropathologies, thus improving the overall quality of life of patients. However, the development of novel therapeutic strategies is still a challenging issue requiring extensive in vivo experimental campaigns and technical development. To facilitate the design of new stimulation strategies, we provide a fully open source and self-contained software framework for the in silico evaluation of peripheral nerve electrical stimulation. Our modeling approach, developed in the popular and well-established Python language, uses an object-oriented paradigm to map the physiological and electrical context. The framework is designed to facilitate multi-scale analysis, from single fiber stimulation to whole multifascicular nerves. It also allows the simulation of complex strategies such as multiple electrode combinations and waveforms ranging from conventional biphasic pulses to more complex modulated kHz stimuli. In addition, we provide automated support for stimulation strategy optimization and handle the computational backend transparently to the user. Our framework has been extensively tested and validated with several existing results in the literature.
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Affiliation(s)
- Thomas Couppey
- Laboratoire ETIS, Cergy Paris Université, ENSEA, CNRS UMR 8051, Cergy, France
| | - Louis Regnacq
- Laboratoire ETIS, Cergy Paris Université, ENSEA, CNRS UMR 8051, Cergy, France
- Univ. Bordeaux, CNRS, Bordeaux INP, IMS, UMR 5218, Talence, France
| | - Roland Giraud
- Laboratoire ETIS, Cergy Paris Université, ENSEA, CNRS UMR 8051, Cergy, France
- Univ. Bordeaux, CNRS, Bordeaux INP, IMS, UMR 5218, Talence, France
| | - Olivier Romain
- Laboratoire ETIS, Cergy Paris Université, ENSEA, CNRS UMR 8051, Cergy, France
| | - Yannick Bornat
- Univ. Bordeaux, CNRS, Bordeaux INP, IMS, UMR 5218, Talence, France
| | - Florian Kolbl
- Laboratoire ETIS, Cergy Paris Université, ENSEA, CNRS UMR 8051, Cergy, France
- Univ. Bordeaux, CNRS, Bordeaux INP, IMS, UMR 5218, Talence, France
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3
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Festin C, Ortmayr J, Maierhofer U, Tereshenko V, Blumer R, Schmoll M, Carrero-Rojas G, Luft M, Laengle G, Farina D, Bergmeister KD, Aszmann OC. Creation of a biological sensorimotor interface for bionic reconstruction. Nat Commun 2024; 15:5337. [PMID: 38914540 PMCID: PMC11196281 DOI: 10.1038/s41467-024-49580-8] [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: 08/07/2023] [Accepted: 06/12/2024] [Indexed: 06/26/2024] Open
Abstract
Neuromuscular control of bionic arms has constantly improved over the past years, however, restoration of sensation remains elusive. Previous approaches to reestablish sensory feedback include tactile, electrical, and peripheral nerve stimulation, however, they cannot recreate natural, intuitive sensations. Here, we establish an experimental biological sensorimotor interface and demonstrate its potential use in neuroprosthetics. We transfer a mixed nerve to a skeletal muscle combined with glabrous dermal skin transplantation, thus forming a bi-directional communication unit in a rat model. Morphological analyses indicate reinnervation of the skin, mechanoreceptors, NMJs, and muscle spindles. Furthermore, sequential retrograde labeling reveals specific sensory reinnervation at the level of the dorsal root ganglia. Electrophysiological recordings show reproducible afferent signals upon tactile stimulation and tendon manipulation. The results demonstrate the possibility of surgically creating an interface for both decoding efferent motor control, as well as encoding afferent tactile and proprioceptive feedback, and may indicate the way forward regarding clinical translation of biological communication pathways for neuroprosthetic applications.
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Affiliation(s)
- Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Joachim Ortmayr
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Roland Blumer
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Martin Schmoll
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Génova Carrero-Rojas
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Matthias Luft
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - 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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4
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Valle G, Katic Secerovic N, Eggemann D, Gorskii O, Pavlova N, Petrini FM, Cvancara P, Stieglitz T, Musienko P, Bumbasirevic M, Raspopovic S. Biomimetic computer-to-brain communication enhancing naturalistic touch sensations via peripheral nerve stimulation. Nat Commun 2024; 15:1151. [PMID: 38378671 PMCID: PMC10879152 DOI: 10.1038/s41467-024-45190-6] [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: 07/20/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Artificial communication with the brain through peripheral nerve stimulation shows promising results in individuals with sensorimotor deficits. However, these efforts lack an intuitive and natural sensory experience. In this study, we design and test a biomimetic neurostimulation framework inspired by nature, capable of "writing" physiologically plausible information back into the peripheral nervous system. Starting from an in-silico model of mechanoreceptors, we develop biomimetic stimulation policies. We then experimentally assess them alongside mechanical touch and common linear neuromodulations. Neural responses resulting from biomimetic neuromodulation are consistently transmitted towards dorsal root ganglion and spinal cord of cats, and their spatio-temporal neural dynamics resemble those naturally induced. We implement these paradigms within the bionic device and test it with patients (ClinicalTrials.gov identifier NCT03350061). He we report that biomimetic neurostimulation improves mobility (primary outcome) and reduces mental effort (secondary outcome) compared to traditional approaches. The outcomes of this neuroscience-driven technology, inspired by the human body, may serve as a model for advancing assistive neurotechnologies.
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Affiliation(s)
- Giacomo Valle
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Natalija Katic Secerovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
- School of Electrical Engineering, University of Belgrade, 11000, Belgrade, Serbia
- The Mihajlo Pupin Institute, University of Belgrade, 11000, Belgrade, Serbia
| | - Dominic Eggemann
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Oleg Gorskii
- Laboratory for Neuroprosthetics, Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia
- Laboratory for Neuromodulation, Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Petersburg, 199034, Russia
- Center for Biomedical Engineering, National University of Science and Technology "MISIS", 119049, Moscow, Russia
| | - Natalia Pavlova
- Laboratory for Neuroprosthetics, Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia
| | | | - Paul Cvancara
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center, BrainLinks-BrainTools Center of Excellence, University of Freiburg, D-79110, Freiburg, Germany
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center, BrainLinks-BrainTools Center of Excellence, University of Freiburg, D-79110, Freiburg, Germany
| | - Pavel Musienko
- Laboratory for Neuroprosthetics, Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia
- Sirius University of Science and Technology, Neuroscience Program, Sirius, Russia
- Laboratory for Neurorehabilitation Technologies, Life Improvement by Future Technologies Center "LIFT", Moscow, Russia
| | - Marko Bumbasirevic
- Orthopaedic Surgery Department, School of Medicine, University of Belgrade, 11000, Belgrade, Serbia
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland.
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5
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Taghlabi KM, Cruz-Garza JG, Hassan T, Potnis O, Bhenderu LS, Guerrero JR, Whitehead RE, Wu Y, Luan L, Xie C, Robinson JT, Faraji AH. Clinical outcomes of peripheral nerve interfaces for rehabilitation in paralysis and amputation: a literature review. J Neural Eng 2024; 21:011001. [PMID: 38237175 DOI: 10.1088/1741-2552/ad200f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024]
Abstract
Peripheral nerve interfaces (PNIs) are electrical systems designed to integrate with peripheral nerves in patients, such as following central nervous system (CNS) injuries to augment or replace CNS control and restore function. We review the literature for clinical trials and studies containing clinical outcome measures to explore the utility of human applications of PNIs. We discuss the various types of electrodes currently used for PNI systems and their functionalities and limitations. We discuss important design characteristics of PNI systems, including biocompatibility, resolution and specificity, efficacy, and longevity, to highlight their importance in the current and future development of PNIs. The clinical outcomes of PNI systems are also discussed. Finally, we review relevant PNI clinical trials that were conducted, up to the present date, to restore the sensory and motor function of upper or lower limbs in amputees, spinal cord injury patients, or intact individuals and describe their significant findings. This review highlights the current progress in the field of PNIs and serves as a foundation for future development and application of PNI systems.
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Affiliation(s)
- Khaled M Taghlabi
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
| | - Jesus G Cruz-Garza
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
| | - Taimur Hassan
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- School of Medicine, Texas A&M University, Bryan, TX 77807, United States of America
| | - Ojas Potnis
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- School of Engineering Medicine, Texas A&M University, Houston, TX 77030, United States of America
| | - Lokeshwar S Bhenderu
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- School of Medicine, Texas A&M University, Bryan, TX 77807, United States of America
| | - Jaime R Guerrero
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
| | - Rachael E Whitehead
- Department of Academic Affairs, Houston Methodist Academic Institute, Houston, TX 77030, United States of America
| | - Yu Wu
- Rice Neuroengineering Initiative, Rice University, Houston, TX 77005, United States of America
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, United States of America
| | - Lan Luan
- Rice Neuroengineering Initiative, Rice University, Houston, TX 77005, United States of America
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, United States of America
| | - Chong Xie
- Rice Neuroengineering Initiative, Rice University, Houston, TX 77005, United States of America
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, United States of America
| | - Jacob T Robinson
- Rice Neuroengineering Initiative, Rice University, Houston, TX 77005, United States of America
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, United States of America
| | - Amir H Faraji
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, United States of America
- Center for Neural Systems Restoration, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, TX 77030, United States of America
- Rice Neuroengineering Initiative, Rice University, Houston, TX 77005, United States of America
- Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, United States of America
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6
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Couppey T, Regnacq L, Giraud R, Romain O, Bornat Y, Kölbl F. NRV: An open framework for in silico evaluation of peripheral nerve electrical stimulation strategies. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.15.575628. [PMID: 38293181 PMCID: PMC10827078 DOI: 10.1101/2024.01.15.575628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Electrical stimulation of peripheral nerves has been used in various pathological contexts for rehabilitation purposes or to alleviate the symptoms of neuropathologies, thus improving the overall quality of life of patients. However, the development of novel therapeutic strategies is still a challenging issue requiring extensive in vivo experimental campaigns and technical development. To facilitate the design of new stimulation strategies, we provide a fully open source and self-contained software framework for the in silico evaluation of peripheral nerve electrical stimulation. Our modeling approach, developed in the popular and well-established Python language, uses an object-oriented paradigm to map the physiological and electrical context. The framework is designed to facilitate multi-scale analysis, from single fiber stimulation to whole multifascicular nerves. It also allows the simulation of complex strategies such as multiple electrode combinations and waveforms ranging from conventional biphasic pulses to more complex modulated kHz stimuli. In addition, we provide automated support for stimulation strategy optimization and handle the computational backend transparently to the user. Our framework has been extensively tested and validated with several existing results in the literature.
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Affiliation(s)
| | - Louis Regnacq
- ETIS CNRS UMR 8051, CY Cergy Paris University, ENSEA
- Univ. Bordeaux, Bordeaux INP, IMS CNRS UMR 5218, Aquitaine, Talence, France
| | - Roland Giraud
- ETIS CNRS UMR 8051, CY Cergy Paris University, ENSEA
- Univ. Bordeaux, Bordeaux INP, IMS CNRS UMR 5218, Aquitaine, Talence, France
| | | | - Yannick Bornat
- Univ. Bordeaux, Bordeaux INP, IMS CNRS UMR 5218, Aquitaine, Talence, France
| | - Florian Kölbl
- ETIS CNRS UMR 8051, CY Cergy Paris University, ENSEA
- Univ. Bordeaux, Bordeaux INP, IMS CNRS UMR 5218, Aquitaine, Talence, France
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7
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Donati E, Valle G. Neuromorphic hardware for somatosensory neuroprostheses. Nat Commun 2024; 15:556. [PMID: 38228580 PMCID: PMC10791662 DOI: 10.1038/s41467-024-44723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
In individuals with sensory-motor impairments, missing limb functions can be restored using neuroprosthetic devices that directly interface with the nervous system. However, restoring the natural tactile experience through electrical neural stimulation requires complex encoding strategies. Indeed, they are presently limited in effectively conveying or restoring tactile sensations by bandwidth constraints. Neuromorphic technology, which mimics the natural behavior of neurons and synapses, holds promise for replicating the encoding of natural touch, potentially informing neurostimulation design. In this perspective, we propose that incorporating neuromorphic technologies into neuroprostheses could be an effective approach for developing more natural human-machine interfaces, potentially leading to advancements in device performance, acceptability, and embeddability. We also highlight ongoing challenges and the required actions to facilitate the future integration of these advanced technologies.
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Affiliation(s)
- Elisa Donati
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Zurich, Switzerland.
| | - Giacomo Valle
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA.
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8
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Ortiz-Catalan M. Thermally sentient bionic limbs. Nat Biomed Eng 2024:10.1038/s41551-023-01174-3. [PMID: 38216669 DOI: 10.1038/s41551-023-01174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Affiliation(s)
- Max Ortiz-Catalan
- The Bionics Institute, Melbourne, Victoria, Australia.
- Department of Bionic Medicine, University of Melbourne, Melbourne, Victoria, Australia.
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9
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Lang VA, Munoz-Novoa M, Ortiz-Catalan M. Highly integrated bionic prostheses resolve the thermal asymmetry between residual amputated and contralateral limbs. Sci Rep 2023; 13:6260. [PMID: 37069299 PMCID: PMC10110514 DOI: 10.1038/s41598-023-33210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/09/2023] [Indexed: 04/19/2023] Open
Abstract
Residual limbs after amputation present colder temperatures than unaffected contralateral limbs. This temperature asymmetry has been attributed to autonomic and cognitive factors, such as changes in body representation. An ideal limb replacement should restore the body representation and resolve the temperature asymmetry, but conventional prostheses, commonly characterized as disembodied, fail to do so. Neuromusculoskeletal prostheses are a new concept of artificial limbs that directly interface with the user's nerves, muscles, and skeleton, and are operated in daily life by bidirectionally transferring control and somatosensory information. Here, we show that the temperature asymmetry commonly found in people with amputations is resolved when using a neuromusculoskeletal prosthesis but reappears when it is removed. A potential explanation for this phenomenon might be the increased embodiment reported by users of neuromusculoskeletal prostheses, which in turn would suggest unconscious perceptual mechanisms mediating the temperature asymmetry commonly found between intact and residual limbs after amputation.
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Affiliation(s)
- Victoria Ashley Lang
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Munoz-Novoa
- Center for Bionics and Pain Research, Mölndal, Sweden
- Center for Advanced Reconstruction of Extremity, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
- Bionics Institute, Melbourne, Australia.
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10
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Roche AD, Bailey ZK, Gonzalez M, Vu PP, Chestek CA, Gates DH, Kemp SWP, Cederna PS, Ortiz-Catalan M, Aszmann OC. Upper limb prostheses: bridging the sensory gap. J Hand Surg Eur Vol 2023; 48:182-190. [PMID: 36649123 PMCID: PMC9996795 DOI: 10.1177/17531934221131756] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Replacing human hand function with prostheses goes far beyond only recreating muscle movement with feedforward motor control. Natural sensory feedback is pivotal for fine dexterous control and finding both engineering and surgical solutions to replace this complex biological function is imperative to achieve prosthetic hand function that matches the human hand. This review outlines the nature of the problems underlying sensory restitution, the engineering methods that attempt to address this deficit and the surgical techniques that have been developed to integrate advanced neural interfaces with biological systems. Currently, there is no single solution to restore sensory feedback. Rather, encouraging animal models and early human studies have demonstrated that some elements of sensation can be restored to improve prosthetic control. However, these techniques are limited to highly specialized institutions and much further work is required to reproduce the results achieved, with the goal of increasing availability of advanced closed loop prostheses that allow sensory feedback to inform more precise feedforward control movements and increase functionality.
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Affiliation(s)
- Aidan D Roche
- College of Medicine, The Queen's Medical Research Institute, Edinburgh, UK.,Department of Plastic Surgery, NHS Lothian, Livingston, UK
| | - Zachary K Bailey
- Department of Bioengineering, Imperial College London, South Kensington Campus, UK
| | | | - Philip P Vu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Cynthia A Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, USA.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA
| | - Deanna H Gates
- Robotics Institute, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen W P Kemp
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Paul S Cederna
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Sweden.,Operational Area 3, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Oskar C Aszmann
- Department of Plastic & Reconstructive Surgery, Medical University of Vienna, Austria.,Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Austria
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11
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Non-rectangular neurostimulation waveforms elicit varied sensation quality and perceptive fields on the hand. Sci Rep 2023; 13:1588. [PMID: 36709376 PMCID: PMC9884304 DOI: 10.1038/s41598-023-28594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/20/2023] [Indexed: 01/30/2023] Open
Abstract
Electrical stimulation of the nerves is known to elicit distinct sensations perceived in distal parts of the body. The stimulation is typically modulated in current with charge-balanced rectangular shapes that, although easily generated by stimulators available on the market, are not able to cover the entire range of somatosensory experiences from daily life. In this regard, we have investigated the effect of electrical neurostimulation with four non-rectangular waveforms in an experiment involving 11 healthy able-bodied subjects. Weiss curves were estimated and rheobase and chronaxie values were obtained showing increases in stimulation time required to elicit sensations for some waveforms. The localization of the sensations reported in the hand also appeared to differ between waveforms, although the total area did not vary significantly. Finally, the possibility of distinguishing different charge- and amplitude-matched stimuli was demonstrated through a two-alternative-forced-choice (2AFC) match-to-sample task, showing the ability of participants to successfully distinguish between waveforms with similar electrical characteristics but different shapes and charge transfer rates. This study provides evidence that, by using different waveforms to stimulate nerves, it is possible to affect not only the required charge to elicit sensations but also the sensation quality and its localization.
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12
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Valle G. Peripheral neurostimulation for encoding artificial somatosensations. Eur J Neurosci 2022; 56:5888-5901. [PMID: 36097134 PMCID: PMC9826263 DOI: 10.1111/ejn.15822] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/08/2022] [Accepted: 09/08/2022] [Indexed: 01/11/2023]
Abstract
The direct neural stimulation of peripheral or central nervous systems has been shown as an effective tool to treat neurological conditions. The electrical activation of the nervous sensory pathway can be adopted to restore the artificial sense of touch and proprioception in people suffering from sensory-motor disorders. The modulation of the neural stimulation parameters has a direct effect on the electrically induced sensations, both when targeting the somatosensory cortex and the peripheral somatic nerves. The properties of the artificial sensations perceived, as their location, quality and intensity are strongly dependent on the direct modulation of pulse width, amplitude and frequency of the neural stimulation. Different sensory encoding schemes have been tested in patients showing distinct effects and outcomes according to their impact on the neural activation. Here, I reported the most adopted neural stimulation strategies to artificially encode somatosensation into the peripheral nervous system. The real-time implementation of these strategies in bionic devices is crucial to exploit the artificial sensory feedback in prosthetics. Thus, neural stimulation becomes a tool to directly communicate with the human nervous system. Given the importance of adding artificial sensory information to neuroprosthetic devices to improve their control and functionality, the choice of an optimal neural stimulation paradigm could increase the impact of prosthetic devices on the quality of life of people with sensorimotor disabilities.
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Affiliation(s)
- Giacomo Valle
- Laboratory for Neuroengineering, Department of Health Sciences and TechnologyInstitute for Robotics and Intelligent Systems, ETH ZürichZürichSwitzerland
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13
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Gonzalez M, Bismuth A, Lee C, Chestek CA, Gates DH. Artificial referred sensation in upper and lower limb prosthesis users: a systematic review. J Neural Eng 2022; 19:10.1088/1741-2552/ac8c38. [PMID: 36001115 PMCID: PMC9514130 DOI: 10.1088/1741-2552/ac8c38] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/23/2022] [Indexed: 11/12/2022]
Abstract
Objective.Electrical stimulation can induce sensation in the phantom limb of individuals with amputation. It is difficult to generalize existing findings as there are many approaches to delivering stimulation and to assessing the characteristics and benefits of sensation. Therefore, the goal of this systematic review was to explore the stimulation parameters that effectively elicited referred sensation, the qualities of elicited sensation, and how the utility of referred sensation was assessed.Approach.We searched PubMed, Web of Science, and Engineering Village through January of 2022 to identify relevant papers. We included papers which electrically induced referred sensation in individuals with limb loss and excluded papers that did not contain stimulation parameters or outcome measures pertaining to stimulation. We extracted information on participant demographics, stimulation approaches, and participant outcomes.Main results.After applying exclusion criteria, 49 papers were included covering nine stimulation methods. Amplitude was the most commonly adjusted parameter (n= 25), followed by frequency (n= 22), and pulse width (n= 15). Of the 63 reports of sensation quality, most reported feelings of pressure (n= 52), paresthesia (n= 48), or vibration (n= 40) while less than half (n= 29) reported a sense of position or movement. Most papers evaluated the functional benefits of sensation (n= 33) using force matching or object identification tasks, while fewer papers quantified subjective measures (n= 16) such as pain or embodiment. Only 15 studies (36%) observed percept intensity, quality, or location over multiple sessions.Significance.Most studies that measured functional performance demonstrated some benefit to providing participants with sensory feedback. However, few studies could experimentally manipulate sensation location or quality. Direct comparisons between studies were limited by variability in methodologies and outcome measures. As such, we offer recommendations to aid in more standardized reporting for future research.
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Affiliation(s)
- Michael Gonzalez
- Department of Robotics, University of Michigan, Ann Arbor, MI, United States of America
| | - Alex Bismuth
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States of America
| | - Christina Lee
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
| | - Cynthia A Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
| | - Deanna H Gates
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States of America
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14
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Ortiz-Catalan M. Engineering and surgical advancements enable more cognitively integrated bionic arms. Sci Robot 2021; 6:eabk3123. [PMID: 34516750 DOI: 10.1126/scirobotics.abk3123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Operational Area 3, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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15
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Kubiak CA, Svientek SR, Dehdashtian A, Lawera NG, Nadarajan V, Bratley JV, Kung TA, Cederna PS, Kemp SWP. Physiologic signaling and viability of the muscle cuff regenerative peripheral nerve interface (MC-RPNI) for intact peripheral nerves. J Neural Eng 2021; 18. [PMID: 34359056 DOI: 10.1088/1741-2552/ac1b6b] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/06/2021] [Indexed: 11/11/2022]
Abstract
Background. Robotic exoskeleton devices have become a promising modality for restoration of extremity function in individuals with limb loss or functional weakness. However, there exists no consistent or reliable way to record efferent motor action potentials from intact peripheral nerves to control device movement. Peripheral nerve motor action potentials are similar in amplitude to that of background noise, producing an unfavorable signal-to-noise ratio (SNR) that makes these signals difficult to detect and interpret. To address this issue, we have developed the muscle cuff regenerative peripheral nerve interface (MC-RPNI), a construct consisting of a free skeletal muscle graft wrapped circumferentially around an intact peripheral nerve. Over time, the muscle graft regenerates, and the intact nerve undergoes collateral axonal sprouting to reinnervate the muscle. The MC-RPNI amplifies efferent motor action potentials by several magnitudes, thereby increasing the SNR, allowing for higher fidelity signaling and detection of motor intention. The goal of this study was to characterize the signaling capabilities and viability of the MC-RPNI over time.Methods. Thirty-seven rats were randomly assigned to one of five experimental groups (Groups A-E). For MC-RPNI animals, their contralateral extensor digitorum longus (EDL) muscle was harvested and trimmed to either 8 mm (Group A) or 13 mm (Group B) in length, wrapped circumferentially around the intact ipsilateral common peroneal (CP) nerve, secured, and allowed to heal for 3 months. Additionally, one 8 mm (Group C) and one 13 mm (Group D) length group had an epineurial window created in the CP nerve immediately preceding MC-RPNI creation. Group E consisted of sham surgery animals. At 3 months, electrophysiologic analyses were conducted to determine the signaling capabilities of the MC-RPNI. Additionally, electromyography and isometric force analyses were performed on the CP-innervated EDL to determine the effects of the MC-RPNI on end organ function. Following evaluation, the CP nerve, MC-RPNI, and ipsilateral EDL muscle were harvested for histomorphometric analysis.Results. Study endpoint analysis was performed at 3 months post-surgery. All rats displayed visible muscle contractions in both the MC-RPNI and EDL following proximal CP nerve stimulation. Compound muscle action potentials were recorded from the MC-RPNI following proximal CP nerve stimulation and ranged from 3.67 ± 0.58 mV to 6.04 ± 1.01 mV, providing efferent motor action potential amplification of 10-20 times that of a normal physiologic nerve action potential. Maximum tetanic isometric force (Fo) testing of the distally-innervated EDL muscle in MC-RPNI groups producedFo(2341 ± 114 mN-2832 ± 102 mN) similar to controls (2497 ± 122 mN), thus demonstrating that creation of MC-RPNIs did not adversely impact the function of the distally-innervated EDL muscle. Overall, comparison between all MC-RPNI sub-groups did not reveal any statistically significant differences in signaling capabilities or negative effects on distal-innervated muscle function as compared to the control group.Conclusions. MC-RPNIs have the capability to provide efferent motor action potential amplification from intact nerves without adversely impacting distal muscle function. Neither the size of the muscle graft nor the presence of an epineurial window in the nerve had any significant impact on the ability of the MC-RPNI to amplify efferent motor action potentials from intact nerves. These results support the potential for the MC-RPNI to serve as a biologic nerve interface to control advanced exoskeleton devices.
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Affiliation(s)
- Carrie A Kubiak
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, 1150 W Medical Center Drive, Medical Sciences Research Building II, Rm.A570A, Ann Arbor, MI 48109-5456, United States of America
| | - Shelby R Svientek
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, 1150 W Medical Center Drive, Medical Sciences Research Building II, Rm.A570A, Ann Arbor, MI 48109-5456, United States of America
| | - Amir Dehdashtian
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, 1150 W Medical Center Drive, Medical Sciences Research Building II, Rm.A570A, Ann Arbor, MI 48109-5456, United States of America
| | - Nathan G Lawera
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, 1150 W Medical Center Drive, Medical Sciences Research Building II, Rm.A570A, Ann Arbor, MI 48109-5456, United States of America
| | - Vidhya Nadarajan
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, 1150 W Medical Center Drive, Medical Sciences Research Building II, Rm.A570A, Ann Arbor, MI 48109-5456, United States of America
| | - Jarred V Bratley
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, 1150 W Medical Center Drive, Medical Sciences Research Building II, Rm.A570A, Ann Arbor, MI 48109-5456, United States of America
| | - Theodore A Kung
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, 1150 W Medical Center Drive, Medical Sciences Research Building II, Rm.A570A, Ann Arbor, MI 48109-5456, United States of America
| | - Paul S Cederna
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, 1150 W Medical Center Drive, Medical Sciences Research Building II, Rm.A570A, Ann Arbor, MI 48109-5456, United States of America.,Department of Biomedical Engineering, The University of Michigan, Ann Arbor, MI, United States of America
| | - Stephen W P Kemp
- Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, 1150 W Medical Center Drive, Medical Sciences Research Building II, Rm.A570A, Ann Arbor, MI 48109-5456, United States of America.,Department of Biomedical Engineering, The University of Michigan, Ann Arbor, MI, United States of America
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16
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Zangrandi A, D'Alonzo M, Cipriani C, Di Pino G. Neurophysiology of slip sensation and grip reaction: insights for hand prosthesis control of slippage. J Neurophysiol 2021; 126:477-492. [PMID: 34232750 PMCID: PMC7613203 DOI: 10.1152/jn.00087.2021] [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] [Indexed: 11/22/2022] Open
Abstract
Sensory feedback is pivotal for a proficient dexterity of the hand. By modulating the grip force in function of the quick and not completely predictable change of the load force, grabbed objects are prevented to slip from the hand. Slippage control is an enabling achievement to all manipulation abilities. However, in hand prosthetics, the performance of even the most innovative research solutions proposed so far to control slippage remain distant from the human physiology. Indeed, slippage control involves parallel and compensatory activation of multiple mechanoceptors, spinal and supraspinal reflexes, and higher-order voluntary behavioral adjustments. In this work, we reviewed the literature on physiological correlates of slippage to propose a three-phases model for the slip sensation and reaction. Furthermore, we discuss the main strategies employed so far in the research studies that tried to restore slippage control in amputees. In the light of the proposed three-phase slippage model and from the weaknesses of already implemented solutions, we proposed several physiology-inspired solutions for slippage control to be implemented in the future hand prostheses. Understanding the physiological basis of slip detection and perception and implementing them in novel hand feedback system would make prosthesis manipulation more efficient and would boost its perceived naturalness, fostering the sense of agency for the hand movements.
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Affiliation(s)
- Andrea Zangrandi
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marco D'Alonzo
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Università Campus Bio-Medico di Roma, Rome, Italy
| | - Christian Cipriani
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Excellence in Robotics & A.I., Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giovanni Di Pino
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Università Campus Bio-Medico di Roma, Rome, Italy
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17
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Zbinden J, Ortiz-Catalan M. The rubber hand illusion is a fallible method to study ownership of prosthetic limbs. Sci Rep 2021; 11:4423. [PMID: 33627714 PMCID: PMC7904923 DOI: 10.1038/s41598-021-83789-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
Enabling sensory feedback in limb prostheses can reverse a damaged body image caused by amputation. The rubber hand illusion (RHI) is a popular paradigm to study ownership of artificial limbs and potentially useful to assess sensory feedback strategies. We investigated the RHI as means to induce ownership of a prosthetic hand by providing congruent visual and tactile stimuli. We elicited tactile sensations via electric stimulation of severed afferent nerve fibres in four participants with transhumeral amputation. Contrary to our expectations, they failed to experience the RHI. The sensations we elicited via nerve stimulation resemble tapping as opposed to stroking, as in the original RHI. We therefore investigated the effect of tapping versus stroking in 30 able-bodied subjects. We found that either tactile modality equally induced ownership in two-thirds of the subjects. Failure to induce the RHI in the intact hand of our participants with amputation later confirmed that they form part of the RHI-immune population. Conversely, these participants use neuromusculoskeletal prostheses with neural sensory feedback in their daily lives and reported said prostheses as part of their body. Our findings suggest that people immune to the RHI can nevertheless experience ownership over prosthetic limbs when used in daily life and accentuates a significant limitation of the RHI paradigm.
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Affiliation(s)
- Jan Zbinden
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
- Operational Area 3, Sahlgrenska University Hospital, Mölndal, Sweden.
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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18
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Cappello L, Alghilan W, Gabardi M, Leonardis D, Barsotti M, Frisoli A, Cipriani C. Continuous supplementary tactile feedback can be applied (and then removed) to enhance precision manipulation. J Neuroeng Rehabil 2020; 17:120. [PMID: 32859222 PMCID: PMC7456017 DOI: 10.1186/s12984-020-00736-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background Human sensorimotor control of dexterous manipulation relies on afferent sensory signals. Explicit tactile feedback is generally not available to prosthetic hand users, who have to rely on incidental information sources to partly close the control loop, resulting in suboptimal performance and manipulation difficulty. Recent studies on non-invasive supplementary sensory feedback indicated that time-discrete vibrational feedback delivered upon relevant mechanical events outperforms continuous tactile feedback. However, we hypothesize that continuous tactile feedback can be more effective in non-routine manipulation tasks (i.e., tasks where the grip force is modified reactively in response to the sensory feedback due to the unpredictable behavior of the manipulated object, such as picking and holding a virtual fragile object) if delivered to highly sensitive areas. We further hypothesize that this continuous tactile feedback is not necessary during all the duration of the manipulation task, since adaptation occurs. Methods We investigated the effectiveness of continuous tactile feedback in precision manipulation, together with a new sensory feedback policy, where the continuous tactile feedback is gradually removed when the grasp reaches a steady state (namely, transient tactile feedback). We carried out an experiment in a virtual-reality setting with custom tactile feedback devices, which can apply continuous pressure and vibrations, attached to the thumb and index finger. We enrolled 24 healthy participants and instructed them to pick and hold a fragile virtual cube without breaking it. We compared their manipulation performance when using four different sensory feedback methods, i.e., no tactile feedback, discrete vibrations, continuous tactile feedback, and transient tactile feedback. The latter consisted of gradually removing the continuous feedback in the static phase of the grasp. Results Continuous tactile feedback leads to a significantly larger number of successful trials than discrete vibrational cues and no feedback conditions, yet the gradual removal of the continuous feedback yields to comparable outcomes. Moreover, the participants preferred the continuous stimuli over the vibrational cues and the removal in the static phase did not significantly impact their appreciation of the continuous tactile feedback. Conclusions These results advocate for the use of continuous supplementary tactile feedback for fine manipulation control and indicate that it can seamlessly be removed in the static phase of the grasp, possibly due to the mechanism of sensory adaptation. This encourages the development of energy-efficient supplementary feedback devices for prosthetic and telemanipulation applications, where encumbrance and power consumption are burdensome constraints.
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Affiliation(s)
- Leonardo Cappello
- Scuola Superiore Sant'Anna, The BioRobotics Institute, Pisa, Italy. .,Scuola Superiore Sant'Anna, Department of Excellence in Robotics & AI, Pisa, Italy.
| | - Waleed Alghilan
- Scuola Superiore Sant'Anna, The BioRobotics Institute, Pisa, Italy.,Scuola Superiore Sant'Anna, Department of Excellence in Robotics & AI, Pisa, Italy
| | - Massimiliano Gabardi
- Scuola Superiore Sant'Anna, Department of Excellence in Robotics & AI, Pisa, Italy.,Scuola Superiore Sant'Anna, TeCIP Institute, PERCRO Laboratory, Pisa, Italy
| | - Daniele Leonardis
- Scuola Superiore Sant'Anna, Department of Excellence in Robotics & AI, Pisa, Italy.,Scuola Superiore Sant'Anna, TeCIP Institute, PERCRO Laboratory, Pisa, Italy
| | - Michele Barsotti
- Scuola Superiore Sant'Anna, Department of Excellence in Robotics & AI, Pisa, Italy.,Scuola Superiore Sant'Anna, TeCIP Institute, PERCRO Laboratory, Pisa, Italy
| | - Antonio Frisoli
- Scuola Superiore Sant'Anna, Department of Excellence in Robotics & AI, Pisa, Italy.,Scuola Superiore Sant'Anna, TeCIP Institute, PERCRO Laboratory, Pisa, Italy
| | - Christian Cipriani
- Scuola Superiore Sant'Anna, The BioRobotics Institute, Pisa, Italy.,Scuola Superiore Sant'Anna, Department of Excellence in Robotics & AI, Pisa, Italy
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19
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Middleton A, Ortiz-Catalan M. Neuromusculoskeletal Arm Prostheses: Personal and Social Implications of Living With an Intimately Integrated Bionic Arm. Front Neurorobot 2020; 14:39. [PMID: 32792933 PMCID: PMC7393241 DOI: 10.3389/fnbot.2020.00039] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/25/2020] [Indexed: 11/28/2022] Open
Abstract
People with limb loss are for the first time living chronically and uninterruptedly with intimately integrated neuromusculoskeletal prostheses. This new generation of artificial limbs are fixated to the skeleton and operated by bidirectionally transferred neural information. This unprecedented level of human-machine integration is bound to have profound psychosocial effects on the individuals living with these prostheses. Here, we examined the psychosociological impact on people as they integrate neuromusculoskeletal prostheses into their bodies and lives. Three people with transhumeral amputations participated in this study, all of whom had been living with neuromusculoskeletal prostheses in their daily lives between 2 and 6 years at the time of the interview. Direct neural sensory feedback had been enabled for 6 months to 2 years. Participants were interviewed about their experiences living with the neuromusculoskeletal prostheses in their home and professional daily lives. We analyzed these interviews to elucidate themes using an interpretive phenomenological approach that regards participants' own experiences as forms of expertise and knowledge-making. Our participant-generated results indicate that people adapted and integrated the technology into functional and social arenas of daily living, with positive psychosocial effects on self-esteem, self-image, and social relations intimately linked to improved trust of the prostheses. Participants expressed enhanced prosthetic function, increased and more diverse prosthesis use in tasks of daily living, and improved relationships between their prosthesis and phantom limb. Our interviews with patients also generated critiques of the language commonly used to describe human-prosthetic relations, including terms such as "embodiment," and the need for specificity surrounding the term "natural" with regard to control versus sensory feedback. Experiences living with neuromusculoskeletal prostheses were complex and subject-dependent, and therefore future research should consider human-machine interaction as a relationship that is constantly enacted, negotiated, and deeply contextualized.
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Affiliation(s)
- Alexandra Middleton
- Department of Anthropology, Princeton University, Princeton, NJ, United States
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Operational Area 3, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Chandrasekaran S, Nanivadekar AC, McKernan G, Helm ER, Boninger ML, Collinger JL, Gaunt RA, Fisher LE. Sensory restoration by epidural stimulation of the lateral spinal cord in upper-limb amputees. eLife 2020; 9:54349. [PMID: 32691733 PMCID: PMC7373432 DOI: 10.7554/elife.54349] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/21/2020] [Indexed: 12/14/2022] Open
Abstract
Restoring somatosensory feedback to people with limb amputations is crucial to improve prosthetic control. Multiple studies have demonstrated that peripheral nerve stimulation and targeted reinnervation can provide somatotopically relevant sensory feedback. While effective, the surgical procedures required for these techniques remain a major barrier to translatability. Here, we demonstrate in four people with upper-limb amputation that epidural spinal cord stimulation (SCS), a common clinical technique to treat pain, evoked somatosensory percepts that were perceived as emanating from the missing arm and hand. Over up to 29 days, stimulation evoked sensory percepts in consistent locations in the missing hand regardless of time since amputation or level of amputation. Evoked sensations were occasionally described as naturalistic (e.g. touch or pressure), but were often paresthesias. Increasing stimulus amplitude increased the perceived intensity linearly, without increasing area of the sensations. These results demonstrate the potential of SCS as a tool to restore somatosensation after amputations. Even some of the most advanced prosthetic arms lack an important feature: the ability to relay information about touch or pressure to the wearer. In fact, many people prefer to use simpler prostheses whose cables and harnesses pass on information about tension. However, recent studies suggest that electrical stimulation might give prosthesis users more sensation and better control. After an amputation, the nerves that used to deliver sensory information from the hand still exist above the injury. Stimulating these nerves can help to recreate sensations in the missing limb and improve the control of the prosthesis. Still, this stimulation requires complicated surgical interventions to implant electrodes in or around the nerves. Spinal cord stimulation – a technique where a small electrical device is inserted near the spinal cord to stimulate nerves – may be an easier alternative. This approach only requires a simple outpatient procedure, and it is routinely used to treat chronic pain conditions. Now, Chandrasekaran, Nanivadekar et al. show that spinal cord stimulation can produce the feeling of sensations in a person’s missing hand or arm. In the experiments, four people who had an arm amputation underwent spinal cord stimulation over 29 days. During the stimulation, the participants reported feeling electrical buzzing, vibration, or pressure in their missing limb. Changing the strength of the electric signals delivered to the spinal cord altered the intensity of these sensations. The experiments are a step toward developing better prosthetics that restore some sensation. Further studies are now needed to determine whether spinal cord stimulation would allow people to perform sensory tasks with a prosthetic, for example handling an object that they cannot see.
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Affiliation(s)
- Santosh Chandrasekaran
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States.,Center for Neural Basis of Cognition, Pittsburgh, United States
| | - Ameya C Nanivadekar
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Center for Neural Basis of Cognition, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States
| | - Gina McKernan
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States.,Human Engineering Research Labs, VA Center of Excellence, Department of Veteran Affairs, Pittsburgh, United States
| | - Eric R Helm
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Human Engineering Research Labs, VA Center of Excellence, Department of Veteran Affairs, Pittsburgh, United States.,University of Pittsburgh Clinical Translational Science Institute, Pittsburgh, United States
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States.,Center for Neural Basis of Cognition, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Human Engineering Research Labs, VA Center of Excellence, Department of Veteran Affairs, Pittsburgh, United States
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States.,Center for Neural Basis of Cognition, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States.,Center for Neural Basis of Cognition, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States
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21
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Mastinu E, Engels LF, Clemente F, Dione M, Sassu P, Aszmann O, Brånemark R, Håkansson B, Controzzi M, Wessberg J, Cipriani C, Ortiz-Catalan M. Neural feedback strategies to improve grasping coordination in neuromusculoskeletal prostheses. Sci Rep 2020; 10:11793. [PMID: 32678121 PMCID: PMC7367346 DOI: 10.1038/s41598-020-67985-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/11/2020] [Indexed: 11/09/2022] Open
Abstract
Conventional prosthetic arms suffer from poor controllability and lack of sensory feedback. Owing to the absence of tactile sensory information, prosthetic users must rely on incidental visual and auditory cues. In this study, we investigated the effect of providing tactile perception on motor coordination during routine grasping and grasping under uncertainty. Three transhumeral amputees were implanted with an osseointegrated percutaneous implant system for direct skeletal attachment and bidirectional communication with implanted neuromuscular electrodes. This neuromusculoskeletal prosthesis is a novel concept of artificial limb replacement that allows to extract control signals from electrodes implanted on viable muscle tissue, and to stimulate severed afferent nerve fibers to provide somatosensory feedback. Subjects received tactile feedback using three biologically inspired stimulation paradigms while performing a pick and lift test. The grasped object was instrumented to record grasping and lifting forces and its weight was either constant or unexpectedly changed in between trials. The results were also compared to the no-feedback control condition. Our findings confirm, in line with the neuroscientific literature, that somatosensory feedback is necessary for motor coordination during grasping. Our results also indicate that feedback is more relevant under uncertainty, and its effectiveness can be influenced by the selected neuromodulation paradigm and arguably also the prior experience of the prosthesis user.
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Affiliation(s)
- Enzo Mastinu
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Leonard F Engels
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesco Clemente
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Prensilia SRL, Pontedera, Italy
| | - Mariama Dione
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Paolo Sassu
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Rickard Brånemark
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Bo Håkansson
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Marco Controzzi
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Johan Wessberg
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christian Cipriani
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Operational Area 3, Sahlgrenska University Hospital, Mölndal, Sweden.
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Pan L, Vargas L, Fleming A, Hu X, Zhu Y, Huang HH. Evoking haptic sensations in the foot through high-density transcutaneous electrical nerve stimulations. J Neural Eng 2020; 17:036020. [PMID: 32348977 DOI: 10.1088/1741-2552/ab8e8d] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Evoking haptic sensation on upper limb amputees via peripheral nerve stimulation has been investigated intensively in the past decade, but related studies involving lower limb amputees are limited. This study aimed to evaluate the feasibility of using non-invasive transcutaneous electrical nerve stimulation to evoke haptic sensation along the phantom limb of the amputated foot of transtibial amputees. APPROACH A high-density electrode grid (4 × 4) was placed over the skin surface above the distal branching of the sciatic, tibial, and common peroneal nerves. We hypothesized that electrical stimulation delivered to distinct electrode pairs created unique electric fields, which can activate selective sets of sensory axons innervating different skin regions of the foot. Five transtibial amputee subjects (three unilateral and two bilateral) and one able-bodied subject were tested by scanning all possible electrode pair combinations. MAIN RESULTS All subjects reported various haptic percepts at distinct regions along the foot with each corresponding to specific electrode pairs. These results demonstrated the capability of our non-invasive nerve stimulation method to evoke haptic sensations in the foot of transtibial amputees and the able-bodied subject. SIGNIFICANCE The outcomes contribute important knowledge and evidence regarding missing tactile sensation in the foot of lower limb amputees and might also facilitate future development of strategies to manage phantom pain and enhance embodiment of prosthetic legs in the future.
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Affiliation(s)
- Lizhi Pan
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, Tianjin, People's Republic of China
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Ortiz-Catalan M, Mastinu E, Sassu P, Aszmann O, Brånemark R. Self-Contained Neuromusculoskeletal Arm Prostheses. N Engl J Med 2020; 382:1732-1738. [PMID: 32348644 DOI: 10.1056/nejmoa1917537] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report the use of a bone-anchored, self-contained robotic arm with both sensory and motor components over 3 to 7 years in four patients after transhumeral amputation. The implant allowed for bidirectional communication between a prosthetic hand and electrodes implanted in the nerves and muscles of the upper arm and was anchored to the humerus through osseointegration, the process in which bone cells attach to an artificial surface without formation of fibrous tissue. Use of the device did not require formal training and depended on the intuitive intent of the user to activate movement and sensory feedback from the prosthesis. Daily use resulted in increasing sensory acuity and effectiveness in work and other activities of daily life. (Funded by the Promobilia Foundation and others.).
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Affiliation(s)
- Max Ortiz-Catalan
- From the Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology (M.O.-C., E.M.), the Department of Hand Surgery, Sahlgrenska University Hospital (P.S.), and the Department of Orthopedics, Gothenburg University (R.B.) - all in Gothenburg, Sweden; the Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna (O.A.); and the Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge (R.B.)
| | - Enzo Mastinu
- From the Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology (M.O.-C., E.M.), the Department of Hand Surgery, Sahlgrenska University Hospital (P.S.), and the Department of Orthopedics, Gothenburg University (R.B.) - all in Gothenburg, Sweden; the Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna (O.A.); and the Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge (R.B.)
| | - Paolo Sassu
- From the Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology (M.O.-C., E.M.), the Department of Hand Surgery, Sahlgrenska University Hospital (P.S.), and the Department of Orthopedics, Gothenburg University (R.B.) - all in Gothenburg, Sweden; the Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna (O.A.); and the Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge (R.B.)
| | - Oskar Aszmann
- From the Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology (M.O.-C., E.M.), the Department of Hand Surgery, Sahlgrenska University Hospital (P.S.), and the Department of Orthopedics, Gothenburg University (R.B.) - all in Gothenburg, Sweden; the Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna (O.A.); and the Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge (R.B.)
| | - Rickard Brånemark
- From the Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology (M.O.-C., E.M.), the Department of Hand Surgery, Sahlgrenska University Hospital (P.S.), and the Department of Orthopedics, Gothenburg University (R.B.) - all in Gothenburg, Sweden; the Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna (O.A.); and the Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge (R.B.)
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24
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Affiliation(s)
- Max Ortiz-Catalan
- Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
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