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Lambrecht JM, Cady SR, Peterson EJ, Dunning JL, Dinsmoor DA, Pape F, Graczyk EL, Tyler DJ. A distributed, high-channel-count, implanted bidirectional system for restoration of somatosensation and myoelectric control. J Neural Eng 2024; 21:036049. [PMID: 38861967 DOI: 10.1088/1741-2552/ad56c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/11/2024] [Indexed: 06/13/2024]
Abstract
Objective. We intend to chronically restore somatosensation and provide high-fidelity myoelectric control for those with limb loss via a novel, distributed, high-channel-count, implanted system.Approach.We have developed the implanted Somatosensory Electrical Neurostimulation and Sensing (iSens®) system to support peripheral nerve stimulation through up to 64, 96, or 128 electrode contacts with myoelectric recording from 16, 8, or 0 bipolar sites, respectively. The rechargeable central device has Bluetooth® wireless telemetry to communicate to external devices and wired connections for up to four implanted satellite stimulation or recording devices. We characterized the stimulation, recording, battery runtime, and wireless performance and completed safety testing to support its use in human trials.Results.The stimulator operates as expected across a range of parameters and can schedule multiple asynchronous, interleaved pulse trains subject to total charge delivery limits. Recorded signals in saline show negligible stimulus artifact when 10 cm from a 1 mA stimulating source. The wireless telemetry range exceeds 1 m (direction and orientation dependent) in a saline torso phantom. The bandwidth supports 100 Hz bidirectional update rates of stimulation commands and data features or streaming select full bandwidth myoelectric signals. Preliminary first-in-human data validates the bench testing result.Significance.We developed, tested, and clinically implemented an advanced, modular, fully implanted peripheral stimulation and sensing system for somatosensory restoration and myoelectric control. The modularity in electrode type and number, including distributed sensing and stimulation, supports a wide variety of applications; iSens® is a flexible platform to bring peripheral neuromodulation applications to clinical reality. ClinicalTrials.gov ID NCT04430218.
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Affiliation(s)
- Joris M Lambrecht
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States of America
| | - Sedona R Cady
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States of America
| | | | - Jeremy L Dunning
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States of America
| | | | - Forrest Pape
- Medtronic plc, Minneapolis, MN, United States of America
| | - Emily L Graczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States of America
| | - Dustin J Tyler
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States of America
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Becerra-Fajardo L, Minguillon J, Krob MO, Rodrigues C, González-Sánchez M, Megía-García Á, Galán CR, Henares FG, Comerma A, Del-Ama AJ, Gil-Agudo A, Grandas F, Schneider-Ickert A, Barroso FO, Ivorra A. First-in-human demonstration of floating EMG sensors and stimulators wirelessly powered and operated by volume conduction. J Neuroeng Rehabil 2024; 21:4. [PMID: 38172975 PMCID: PMC10765656 DOI: 10.1186/s12984-023-01295-5] [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: 10/03/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Recently we reported the design and evaluation of floating semi-implantable devices that receive power from and bidirectionally communicate with an external system using coupling by volume conduction. The approach, of which the semi-implantable devices are proof-of-concept prototypes, may overcome some limitations presented by existing neuroprostheses, especially those related to implant size and deployment, as the implants avoid bulky components and can be developed as threadlike devices. Here, it is reported the first-in-human acute demonstration of these devices for electromyography (EMG) sensing and electrical stimulation. METHODS A proof-of-concept device, consisting of implantable thin-film electrodes and a nonimplantable miniature electronic circuit connected to them, was deployed in the upper or lower limb of six healthy participants. Two external electrodes were strapped around the limb and were connected to the external system which delivered high frequency current bursts. Within these bursts, 13 commands were modulated to communicate with the implant. RESULTS Four devices were deployed in the biceps brachii and the gastrocnemius medialis muscles, and the external system was able to power and communicate with them. Limitations regarding insertion and communication speed are reported. Sensing and stimulation parameters were configured from the external system. In one participant, electrical stimulation and EMG acquisition assays were performed, demonstrating the feasibility of the approach to power and communicate with the floating device. CONCLUSIONS This is the first-in-human demonstration of EMG sensors and electrical stimulators powered and operated by volume conduction. These proof-of-concept devices can be miniaturized using current microelectronic technologies, enabling fully implantable networked neuroprosthetics.
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Affiliation(s)
- Laura Becerra-Fajardo
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
| | - Jesus Minguillon
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
- Research Centre for Information and Communications Technologies, University of Granada, Granada, 18014, Spain
- Department of Signal Theory, Telematics and Communications, University of Granada, Granada, 18014, Spain
| | - Marc Oliver Krob
- Fraunhofer Institute for Biomedical Engineering IBMT, 66280, Sulzbach, Germany
| | - Camila Rodrigues
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, 28002, Spain
- Systems Engineering and Automation Department, Carlos III University of Madrid, Madrid, 28903, Spain
| | - Miguel González-Sánchez
- Movement Disorders Unit, Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | - Álvaro Megía-García
- Biomechanics and Assistive Technology Unit, National Hospital for Paraplegics. Unit of Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), Unit associated to the CSIC, Toledo, Spain
| | - Carolina Redondo Galán
- Biomechanics and Assistive Technology Unit, National Hospital for Paraplegics. Unit of Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), Unit associated to the CSIC, Toledo, Spain
| | - Francisco Gutiérrez Henares
- Biomechanics and Assistive Technology Unit, National Hospital for Paraplegics. Unit of Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), Unit associated to the CSIC, Toledo, Spain
| | - Albert Comerma
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
| | - Antonio J Del-Ama
- School of Science and Technology, Department of Applied Mathematics, Materials Science and Engineering and Electronic Technology, Rey Juan Carlos University, Móstoles, 28933, Spain
| | - Angel Gil-Agudo
- Biomechanics and Assistive Technology Unit, National Hospital for Paraplegics. Unit of Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), Unit associated to the CSIC, Toledo, Spain
- CSIC's Associated RDI Unit 'Unidad De Neurorehabilitación, Biomecánica Y Función Sensitivo-Motora', Madrid, Spain
| | - Francisco Grandas
- Movement Disorders Unit, Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | | | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, 28002, Spain
- CSIC's Associated RDI Unit 'Unidad De Neurorehabilitación, Biomecánica Y Función Sensitivo-Motora', Madrid, Spain
| | - Antoni Ivorra
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain.
- Serra Húnter Fellow Programme, Universitat Pompeu Fabra, Barcelona, 08018, Spain.
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3
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Becerra-Fajardo L, Krob MO, Minguillon J, Rodrigues C, Welsch C, Tudela-Pi M, Comerma A, Oliveira Barroso F, Schneider A, Ivorra A. Floating EMG sensors and stimulators wirelessly powered and operated by volume conduction for networked neuroprosthetics. J Neuroeng Rehabil 2022; 19:57. [PMID: 35672857 PMCID: PMC9171952 DOI: 10.1186/s12984-022-01033-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implantable neuroprostheses consisting of a central electronic unit wired to electrodes benefit thousands of patients worldwide. However, they present limitations that restrict their use. Those limitations, which are more adverse in motor neuroprostheses, mostly arise from their bulkiness and the need to perform complex surgical implantation procedures. Alternatively, it has been proposed the development of distributed networks of intramuscular wireless microsensors and microstimulators that communicate with external systems for analyzing neuromuscular activity and performing stimulation or controlling external devices. This paradigm requires the development of miniaturized implants that can be wirelessly powered and operated by an external system. To accomplish this, we propose a wireless power transfer (WPT) and communications approach based on volume conduction of innocuous high frequency (HF) current bursts. The currents are applied through external textile electrodes and are collected by the wireless devices through two electrodes for powering and bidirectional digital communications. As these devices do not require bulky components for obtaining power, they may have a flexible threadlike conformation, facilitating deep implantation by injection. METHODS We report the design and evaluation of advanced prototypes based on the above approach. The system consists of an external unit, floating semi-implantable devices for sensing and stimulation, and a bidirectional communications protocol. The devices are intended for their future use in acute human trials to demonstrate the distributed paradigm. The technology is assayed in vitro using an agar phantom, and in vivo in hindlimbs of anesthetized rabbits. RESULTS The semi-implantable devices were able to power and bidirectionally communicate with the external unit. Using 13 commands modulated in innocuous 3 MHz HF current bursts, the external unit configured the sensing and stimulation parameters, and controlled their execution. Raw EMG was successfully acquired by the wireless devices at 1 ksps. CONCLUSIONS The demonstrated approach overcomes key limitations of existing neuroprostheses, paving the way to the development of distributed flexible threadlike sensors and stimulators. To the best of our knowledge, these devices are the first based on WPT by volume conduction that can work as EMG sensors and as electrical stimulators in a network of wireless devices.
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Affiliation(s)
- Laura Becerra-Fajardo
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain.
| | - Marc Oliver Krob
- Fraunhofer Institute for Biomedical Engineering IBMT, 66280, Sulzbach, Germany
| | - Jesus Minguillon
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
- Research Centre for Information and Communications Technologies, University of Granada, 18014, Granada, Spain
- Department of Signal Theory, Telematics and Communications, University of Granada, 18014, Granada, Spain
| | - Camila Rodrigues
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), 28002, Madrid, Spain
- Electronics, Automation and Communications Department, ICAI School of Engineering, Comillas Pontifical University, 28015, Madrid, Spain
| | - Christine Welsch
- Fraunhofer Institute for Biomedical Engineering IBMT, 66280, Sulzbach, Germany
| | - Marc Tudela-Pi
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Albert Comerma
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), 28002, Madrid, Spain
| | - Andreas Schneider
- Fraunhofer Institute for Biomedical Engineering IBMT, 66280, Sulzbach, Germany
| | - Antoni Ivorra
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
- Serra Húnter Fellow Programme, Universitat Pompeu Fabra, 08018, Barcelona, Spain
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Wolf DN, Schearer EM. Trajectory Optimization and Model Predictive Control for Functional Electrical Stimulation-Controlled Reaching. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3145946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Segil JL, Lukyanenko P, Lambrecht J, Weir RFF, Tyler D. Comparison of Myoelectric Control Schemes for Simultaneous Hand and Wrist Movement using Chronically Implanted Electromyography: A Case Series . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6224-6230. [PMID: 34892537 PMCID: PMC10964936 DOI: 10.1109/embc46164.2021.9630845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE A current biomedical engineering challenge is the development of a system that allows fluid control of multi-functional prosthetic devices through a human-machine interface. Here we probe this challenge by studying two subjects with trans-radial limb loss as they control a virtual hand and wrist system using 6 or 8 chronically implanted intramuscular electromyographic (iEMG) signals. The subjects successfully controlled a 4, 5, and 6 Degrees of Freedom (DoF's) virtual hand and wrist systems to perform a target matching task. APPROACH Two control systems were evaluated where one tied EMG features directly to movement directions (Direct Control) and the other method determines user intent in the context of prior training data (Linear Interpolation). MAIN RESULTS Subjects successfully matched most targets with both controllers but differences were seen as the complexity of the virtual limb system increased. The Direct Control method encountered difficulty due to crosstalk at higher DoF's. The Linear Interpolation method reduced crosstalk effects and outperformed Direct Control at higher DoF's. This work also studied the use of the Postural Control Algorithm to control the hand postures simultaneously with wrist degrees of freedom. SIGNIFICANCE This work presents preliminary evidence that the PC algorithm can be used in conjunction with wrist control, that Direct Control with iEMG signals allows stable 4-DoF control, and that EMG pre-processing using the Linear Interpolation method can improve performance at 5 and 6-DoF's.
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Jiang D, Liu F, Lancashire HT, Perkins TA, Schormans M, Vanhoestenberghe A, Donaldson NDN, Demosthenous A. A Versatile Hermetically Sealed Microelectronic Implant for Peripheral Nerve Stimulation Applications. Front Neurosci 2021; 15:681021. [PMID: 34366773 PMCID: PMC8339274 DOI: 10.3389/fnins.2021.681021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022] Open
Abstract
This article presents a versatile neurostimulation platform featuring a fully implantable multi-channel neural stimulator for chronic experimental studies with freely moving large animal models involving peripheral nerves. The implant is hermetically sealed in a ceramic enclosure and encapsulated in medical grade silicone rubber, and then underwent active tests at accelerated aging conditions at 100°C for 15 consecutive days. The stimulator microelectronics are implemented in a 0.6-μm CMOS technology, with a crosstalk reduction scheme to minimize cross-channel interference, and high-speed power and data telemetry for battery-less operation. A wearable transmitter equipped with a Bluetooth Low Energy radio link, and a custom graphical user interface provide real-time, remotely controlled stimulation. Three parallel stimulators provide independent stimulation on three channels, where each stimulator supports six stimulating sites and two return sites through multiplexing, hence the implant can facilitate stimulation at up to 36 different electrode pairs. The design of the electronics, method of hermetic packaging and electrical performance as well as in vitro testing with electrodes in saline are presented.
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Affiliation(s)
- Dai Jiang
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
| | - Fangqi Liu
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
| | - Henry T Lancashire
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Timothy A Perkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Matthew Schormans
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
| | - Anne Vanhoestenberghe
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,Division of Surgery and Interventional Science, Aspire Centre for Rehabilitation Engineering and Assistive Technology, University College London, London, United Kingdom
| | - Nicholas De N Donaldson
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Andreas Demosthenous
- Department of Electronic and Electrical Engineering, University College London, London, United Kingdom
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Makowski N, Campean A, Lambrecht J, Buckett J, Coburn J, Hart R, Miller M, Montague F, Crish T, Fu M, Kilgore K, Peckham PH, Smith B. Design and Testing of Stimulation and Myoelectric Recording Modules in an Implanted Distributed Neuroprosthetic System. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:281-293. [PMID: 33729949 PMCID: PMC8344369 DOI: 10.1109/tbcas.2021.3066838] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Implantable motor neuroprostheses can restore functionality to individuals with neurological disabilities by electrically activating paralyzed muscles in coordinated patterns. The typical design of neuroprosthetic systems relies on a single multi-use device, but this limits the number of stimulus and sensor channels that can be practically implemented. To address this limitation, a modular neuroprosthesis, the "Networked Neuroprosthesis" (NNP), was developed. The NNP system is the first fully implanted modular neuroprosthesis that includes implantation of all power, signal processing, biopotential signal recording, and stimulating components. This paper describes the design of stimulation and recording modules, bench testing to verify stimulus outputs and appropriate filtering and recording, and validation that the components function properly while implemented in persons with spinal cord injury. The results of system testing demonstrated that the NNP was functional and capable of generating stimulus pulses and recording myoelectric, temperature, and accelerometer signals. Based on the successful design, manufacturing, and testing of the NNP System, multiple clinical applications are anticipated.
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Bazarek S, Brown JM. The evolution of nerve transfers for spinal cord injury. Exp Neurol 2020; 333:113426. [DOI: 10.1016/j.expneurol.2020.113426] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/10/2020] [Accepted: 07/25/2020] [Indexed: 12/15/2022]
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Delianides C, Tyler D, Pinault G, Ansari R, Triolo R. Implanted High Density Cuff Electrodes Functionally Activate Human Tibial and Peroneal Motor Units Without Chronic Detriment to Peripheral Nerve Health. Neuromodulation 2020; 23:754-762. [PMID: 32189421 DOI: 10.1111/ner.13110] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Peripheral nerve stimulation via multi-contact nerve cuff electrodes (NCEs) has proved effective in restoring function to individuals with lower-extremity paralysis. This study investigates clinical measures of nerve health over one year post-implantation of a composite flat-interface nerve electrode (C-FINE) on the tibial and peroneal nerves above the knee in a human volunteer. This represents the first deployment of a novel NCE on new neural targets in a uniquely challenging location prone to prolonged externally applied forces, making acute and chronic postoperative observation critical. MATERIALS AND METHODS A 27-year-old man with an incomplete spinal cord injury (AIS C) at the C3 to C4 level received eight-contact C-FINEs bilaterally on the tibial and peroneal nerves, proximal to the knee. Access to four contacts per cuff exhibiting the most desirable responses was externalized via temporary percutaneous leads. Percutaneous leads were later removed, with contacts generating the best dorsiflexion (two of four) and plantar flexion (one of four) reconnected to a permanently implanted pulse generator. For 13 months post-implantation, nerve health and cuff performance were assessed through motor nerve conduction velocity (MNCV) studies, clinical needle electromyography, compound motor action potential (CMAP), sensory nerve action potential (SNAP), stimulation-evoked tetanic moment collection, and lower-limb circumference measurements. RESULTS Tibial and peroneal MNCVs remained stable bilaterally above 40 m/sec, with CMAPs increased or stable after six months. SNAPs remained stable across all measurements. CMAP initial charge thresholds remained below 50 nC, with minimal changes to muscle recruitment order in three of four externalized contacts per cuff. Peak tetanic moments remained stable, with bilateral increases in thigh and calf circumferences of 5% and 14% over one year. CONCLUSIONS Above-knee tibial and peroneal NCEs can restore stimulated ankle-joint function without chronic nerve health detriments. Alongside previous femoral nerve data, this study demonstrates the ability of NCEs to enhance lower-extremity function with limited neuromuscular impact.
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Affiliation(s)
- Christopher Delianides
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Dustin Tyler
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Gilles Pinault
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Department of Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Rahila Ansari
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Ronald Triolo
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
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Schearer EM, Wolf DN. Predicting functional force production capabilities of upper extremity functional electrical stimulation neuroprostheses: a proof of concept study. J Neural Eng 2020; 17:016051. [PMID: 31910397 DOI: 10.1088/1741-2552/ab68b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study's goal was to demonstrate person-specific predictions of the force production capabilities of a paralyzed arm when actuated with a functional electrical stimulation (FES) neuroprosthesis. These predictions allow us to determine, for each hand position in a person's workspace, if FES activated muscles can produce enough force to hold the arm against gravity and other passive forces, the amount of force the arm can potentially exert on external objects, and in which directions FES can move the arm. APPROACH We computed force production predictions for a person with high tetraplegia and an FES neuroprosthesis used to activate muscles in her shoulder and arm. We developed Gaussian process regression models of the force produced at the end of the forearm when stimulating individual muscles at different wrist positions in the person's workspace. For any given wrist position, we predicted all possible forces a person can produce by any combination of individual muscles. Based on the force predictions, we determined if FES could produce force sufficient to overcome passive forces to hold a wrist position, the maximum force FES could produce in all directions, and the set of directions in which FES could move the arm. To estimate the error in our predictions, we then compared our force predictions based on single-muscle models to the actual forces produced when stimulating combinations of the person's muscles. MAIN RESULTS Our models classified the person's ability to hold static arm positions correctly for 83% (Session #1) and 69% (Session #2) for 39 wrist positions over two sessions. We predicted this person's ability to produce force at the end of her arm with an RMS error of 5.5 N and the percent of directions for which FES could achieve motion with RMS error of 10%. The accuracy of these predictions is similar to that found in the literature for FES systems with fewer degrees of freedom and fewer muscles. SIGNIFICANCE These person and device-specific predictions of functional capabilities of the arm allow neuroprosthesis developers to set achievable functional objectives for the systems they develop. These predictions can potentially serve as a screening tool for clinicians to use in planning neuroprosthetic interventions, greatly reducing the risk and uncertainty in such interventions.
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Affiliation(s)
- Eric M Schearer
- Center for Human-Machine Systems, Cleveland State University, Cleveland, United States of America. Cleveland Functional Electrical Stimulation Center, Cleveland, United States of America. MetroHealth Medical Center, Department of Physical Medicine and Rehabilitation, Cleveland, United States of America. Author to whom any correspondence should be addressed
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Bogie KM, Kobetic R, Shire DB. Utilization of lower compliance voltages for effective clinical neuromuscular electrical stimulation. J Rehabil Assist Technol Eng 2019; 6:2055668319847116. [PMID: 31285837 PMCID: PMC6600490 DOI: 10.1177/2055668319847116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- KM Bogie
- Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC), Cleveland, OH, USA
| | - R Kobetic
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC), Cleveland, OH, USA
| | - DB Shire
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCVAMC), Cleveland, OH, USA
- Department of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA
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Wolf DN, Schearer EM. Holding Static Arm Configurations With Functional Electrical Stimulation: A Case Study. IEEE Trans Neural Syst Rehabil Eng 2018; 26:2044-2052. [PMID: 30130233 DOI: 10.1109/tnsre.2018.2866226] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Functional electrical stimulation (FES) is a promising solution for restoring functional motion to individuals with paralysis, but the potential for achieving any desired full-arm reaching motion has not been realized. We present a combined feedforward-feedback controller capable of automatically calculating and applying the necessary muscle stimulations to hold the wrist of an individual with high tetraplegia in a desired static position. We used the controller to hold a complete arm configuration to maintain a series of static wrist positions. The average distance to the target wrist position, or accuracy, was 2.9 cm. The precision is defined as the radius of the 95% confidence ellipsoid for the final positions of a set of trials with the same muscle stimulations and starting position. The average precision was 3.7 cm. The control architecture used in this study to hold static positions has the potential to control arbitrary reaching motions.
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Abstract
Individuals with tetraplegia face many obstacles with activities of daily living. Although approximately 65% to 75% of individuals with tetraplegia would benefit from upper extremity surgery that could make many of their activities of daily living more spontaneous, only 14% of patients who are surgical candidates undergo tendon transfer procedures. A good surgical candidate has an injury at one of the cervical spine levels and an International Classification for Surgery of the Hand in Tetraplegia group of 1 or better, has functional goals, and is committed to the postoperative rehabilitation process. Surgery primarily consists of tendon transfers, tenodesis, and arthrodesis to restore elbow extension and hand pinch, grasp, and release. Nerve transfers and functional electrical stimulation are also options for treatment.
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Wolf DN, Schearer EM. Evaluating an open-loop functional electrical stimulation controller for holding the shoulder and elbow configuration of a paralyzed arm. IEEE Int Conf Rehabil Robot 2018; 2017:789-794. [PMID: 28813916 DOI: 10.1109/icorr.2017.8009344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Functional electrical stimulation (FES) is a promising solution for restoring functional motion to individuals with paralysis, but the potential for achieving full-arm reaching motions with FES for various desired tasks has not been realized. We present an open-loop controller capable of calculating and applying the necessary muscle stimulations to hold the wrist of an individual with high tetraplegia at any desired position. We used the controller to hold the wrist at a series of static positions. The controller was capable of discriminating between different wrist positions. The average distance to the target wrist position, or accuracy, was 7.7 cm. The average radius of the 95% confidence ellipsoid for a set of trials with the same muscle stimulations, or precision, was 6.7 cm. Adding feedback or online model updates will likely improve the accuracy for tasks requiring finer control. The controller is a good first step to controlling full-arm motions with FES.
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Kilgore KL, Bryden A, Keith MW, Hoyen HA, Hart RL, Nemunaitis GA, Peckham PH. Evolution of Neuroprosthetic Approaches to Restoration of Upper Extremity Function in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 24:252-264. [PMID: 29997428 PMCID: PMC6037324 DOI: 10.1310/sci2403-252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Spinal cord injury (SCI) occurring at the cervical levels can result in significantly impaired arm and hand function. People with cervical-level SCI desire improved use of their arms and hands, anticipating that regained function will result in improved independence and ultimately improved quality of life. Neuroprostheses provide the most promising method for significant gain in hand and arm function for persons with cervical-level SCI. Neuroprostheses utilize small electrical currents to activate peripheral motor nerves, resulting in controlled contraction of paralyzed muscles. Methods: A myoelectrically-controlled neuroprosthesis was evaluated in 15 arms in 13 individuals with cervical-level SCI. All individuals had motor level C5 or C6 tetraplegia. Results: This study demonstrates that an implanted neuroprosthesis utilizing myoelectric signal (MES)-controlled stimulation allows considerable flexibility in the control algorithms that can be utilized for a variety of arm and hand functions. Improved active range of motion, grip strength, and the ability to pick up and release objects were improved in all arms tested. Adverse events were few and were consistent with the experience with similar active implantable devices. Conclusion: For individuals with cervical SCI who are highly motivated, implanted neuroprostheses provide the opportunity to gain arm and hand function that cannot be gained through the use of orthotics or surgical intervention alone. Upper extremity neuroprostheses have been shown to provide increased function and independence for persons with cervical-level SCI.
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Affiliation(s)
- Kevin L. Kilgore
- MetroHealth Medical Center, Cleveland, Ohio
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Anne Bryden
- Case Western Reserve University, Cleveland, Ohio
| | - Michael W. Keith
- MetroHealth Medical Center, Cleveland, Ohio
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Harry A. Hoyen
- MetroHealth Medical Center, Cleveland, Ohio
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Ronald L. Hart
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Gregory A. Nemunaitis
- MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - P. Hunter Peckham
- MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
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Long-Term Performance and User Satisfaction With Implanted Neuroprostheses for Upright Mobility After Paraplegia: 2- to 14-Year Follow-Up. Arch Phys Med Rehabil 2017; 99:289-298. [PMID: 28899825 DOI: 10.1016/j.apmr.2017.08.470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/21/2017] [Accepted: 08/06/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To quantify the long-term (>2y) effects of lower extremity (LE) neuroprostheses (NPs) for standing, transfers, stepping, and seated stability after spinal cord injury. DESIGN Single-subject design case series with participants acting as their own concurrent controls, including retrospective data review. SETTING Hospital-based clinical biomechanics laboratory with experienced (>20y in the field) research biomedical engineers, a physical therapist, and medical monitoring review. PARTICIPANTS Long-term (6.2±2.7y) at-home users (N=22; 19 men, 3 women) of implanted NPs for trunk and LE function with chronic (14.4±7.1y) spinal cord injury resulting in full or partial paralysis. INTERVENTIONS Technical and clinical performance measurements, along with user satisfaction surveys. MAIN OUTCOME MEASURES Knee extension moment, maximum standing time, body weight supported by lower extremities, 3 functional standing tasks, 2 satisfaction surveys, NP usage, and stability of implanted components. RESULTS Stimulated knee extension strength and functional capabilities were maintained, with 94% of implant recipients reporting being very or moderately satisfied with their system. More than half (60%) of the participants were still using their implanted NPs for exercise and function for >10min/d on nearly half or more of the days monitored; however, maximum standing times and percentage body weight through LEs decreased slightly over the follow-up interval. Stimulus thresholds were uniformly stable. Six-year survival rates for the first-generation implanted pulse generator (IPG) and epimysial electrodes were close to 90%, whereas those for the second-generation IPG along with the intramuscular and nerve cuff electrodes were >98%. CONCLUSIONS Objective and subjective measures of the technical and clinical performances of implanted LE NPs generally remained consistent for 22 participants after an average of 6 years of unsupervised use at home. These findings suggest that implanted LE NPs can provide lasting benefits that recipients value.
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Willand MP, Catapano J. Serial estimation of motor unit numbers using an implantable system following nerve injury and repair in rats. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:323-326. [PMID: 28268342 DOI: 10.1109/embc.2016.7590705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Motor unit number estimation (MUNE) is an established technique to assess recovery following peripheral nerve injury. In rats, where the vast majority of peripheral nerve research is conducted, assessing motor units at various time points requires a terminal procedure due to the invasive nature of current techniques. Here, we present an implanted system that was used to serially assess MUNE after peripheral nerve injury and repair in rats. This system significantly increases the efficiency of peripheral nerve research by negating the need for terminal procedures, allowing for serial MUNE assessment over time in the same rat. Our system utilizes a commercial implantable stimulator, custom designed cuff electrode, and corresponding custom software with automatic M-wave classification to quickly assess functional reinnervation up to 8 weeks following nerve injury and repair. The concepts presented in this paper are applicable to any implanted device with a transcutaneous radio frequency or inductive link that can be used to trigger nerve stimulation. The methodology is also applicable to researchers without access to implantable devices.
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Schearer EM, Liao YW, Perreault EJ, Tresch MC, Memberg WD, Kirsch RF, Lynch KM. Semiparametric Identification of Human Arm Dynamics for Flexible Control of a Functional Electrical Stimulation Neuroprosthesis. IEEE Trans Neural Syst Rehabil Eng 2016; 24:1405-1415. [PMID: 26955041 PMCID: PMC5205577 DOI: 10.1109/tnsre.2016.2535348] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We present a method to identify the dynamics of a human arm controlled by an implanted functional electrical stimulation neuroprosthesis. The method uses Gaussian process regression to predict shoulder and elbow torques given the shoulder and elbow joint positions and velocities and the electrical stimulation inputs to muscles. We compare the accuracy of torque predictions of nonparametric, semiparametric, and parametric model types. The most accurate of the three model types is a semiparametric Gaussian process model that combines the flexibility of a black box function approximator with the generalization power of a parameterized model. The semiparametric model predicted torques during stimulation of multiple muscles with errors less than 20% of the total muscle torque and passive torque needed to drive the arm. The identified model allows us to define an arbitrary reaching trajectory and approximately determine the muscle stimulations required to drive the arm along that trajectory.
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Morel P, Ferrea E, Taghizadeh-Sarshouri B, Audí JMC, Ruff R, Hoffmann KP, Lewis S, Russold M, Dietl H, Abu-Saleh L, Schroeder D, Krautschneider W, Meiners T, Gail A. Long-term decoding of movement force and direction with a wireless myoelectric implant. J Neural Eng 2015; 13:016002. [DOI: 10.1088/1741-2560/13/1/016002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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20
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Irwin ZT, Thompson DE, Schroeder KE, Tat DM, Hassani A, Bullard AJ, Woo SL, Urbanchek MG, Sachs AJ, Cederna PS, Stacey WC, Patil PG, Chestek CA. Enabling Low-Power, Multi-Modal Neural Interfaces Through a Common, Low-Bandwidth Feature Space. IEEE Trans Neural Syst Rehabil Eng 2015; 24:521-31. [PMID: 26600160 DOI: 10.1109/tnsre.2015.2501752] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Brain-Machine Interfaces (BMIs) have shown great potential for generating prosthetic control signals. Translating BMIs into the clinic requires fully implantable, wireless systems; however, current solutions have high power requirements which limit their usability. Lowering this power consumption typically limits the system to a single neural modality, or signal type, and thus to a relatively small clinical market. Here, we address both of these issues by investigating the use of signal power in a single narrow frequency band as a decoding feature for extracting information from electrocorticographic (ECoG), electromyographic (EMG), and intracortical neural data. We have designed and tested the Multi-modal Implantable Neural Interface (MINI), a wireless recording system which extracts and transmits signal power in a single, configurable frequency band. In prerecorded datasets, we used the MINI to explore low frequency signal features and any resulting tradeoff between power savings and decoding performance losses. When processing intracortical data, the MINI achieved a power consumption 89.7% less than a more typical system designed to extract action potential waveforms. When processing ECoG and EMG data, the MINI achieved similar power reductions of 62.7% and 78.8%. At the same time, using the single signal feature extracted by the MINI, we were able to decode all three modalities with less than a 9% drop in accuracy relative to using high-bandwidth, modality-specific signal features. We believe this system architecture can be used to produce a viable, cost-effective, clinical BMI.
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21
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Ho CH, Triolo RJ, Elias AL, Kilgore KL, DiMarco AF, Bogie K, Vette AH, Audu ML, Kobetic R, Chang SR, Chan KM, Dukelow S, Bourbeau DJ, Brose SW, Gustafson KJ, Kiss ZHT, Mushahwar VK. Functional electrical stimulation and spinal cord injury. Phys Med Rehabil Clin N Am 2015; 25:631-54, ix. [PMID: 25064792 DOI: 10.1016/j.pmr.2014.05.001] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Spinal cord injuries (SCI) can disrupt communications between the brain and the body, resulting in loss of control over otherwise intact neuromuscular systems. Functional electrical stimulation (FES) of the central and peripheral nervous system can use these intact neuromuscular systems to provide therapeutic exercise options to allow functional restoration and to manage medical complications following SCI. The use of FES for the restoration of muscular and organ functions may significantly decrease the morbidity and mortality following SCI. Many FES devices are commercially available and should be considered as part of the lifelong rehabilitation care plan for all eligible persons with SCI.
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Affiliation(s)
- Chester H Ho
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Foothills Medical Centre, Room 1195, 1403-29th Street NW, Calgary, Alberta T2N 2T9, Canada.
| | - Ronald J Triolo
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Orthopaedics, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Anastasia L Elias
- Chemical and Materials Engineering, W7-002 ECERF, University of Alberta, Edmonton, Alberta T6G 2V4, Canada
| | - Kevin L Kilgore
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Anthony F DiMarco
- MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Kath Bogie
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Orthopaedics, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Albert H Vette
- Department of Mechanical Engineering, University of Alberta, 4-9 Mechanical Engineering Building, Edmonton, Alberta T6G 2G8, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 - 111 Avenue, Edmonton, Alberta T5G 0B7, Canada
| | - Musa L Audu
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Rudi Kobetic
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Sarah R Chang
- Louis Stokes Cleveland VA Medical Center, Advanced Platform Technology Center, 151 AW/APT, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - K Ming Chan
- Division of Physical Medicine and Rehabilitation, Centre for Neuroscience, University of Alberta, 5005 Katz Group Centre, 11361-87 Avenue, Edmonton, Alberta T6G 2E1, Canada
| | - Sean Dukelow
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Foothills Medical Centre, Room 1195, 1403-29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Dennis J Bourbeau
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Steven W Brose
- Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA; Ohio University Heritage College of Osteopathic Medicine, Grosvenor Hall, Athens, OH 45701, USA
| | - Kenneth J Gustafson
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Cleveland FES Center, 11000 Cedar Avenue, Suite 230, Cleveland, OH 44106-3056, USA
| | - Zelma H T Kiss
- Department of Clinical Neurosciences, Foothills Medical Centre, Room 1195, 1403-29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Vivian K Mushahwar
- Division of Physical Medicine and Rehabilitation, Centre for Neuroscience, University of Alberta, 5005 Katz Group Centre, 11361-87 Avenue, Edmonton, Alberta T6G 2E1, Canada
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Lombardo LM, Bailey SN, Foglyano KM, Miller ME, Pinault G, Triolo RJ. A preliminary comparison of myoelectric and cyclic control of an implanted neuroprosthesis to modulate gait speed in incomplete SCI. J Spinal Cord Med 2015; 38:115-22. [PMID: 25243532 PMCID: PMC4293526 DOI: 10.1179/2045772314y.0000000262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Explore whether electromyography (EMG) control of electrical stimulation for walking after incomplete spinal cord injury (SCI) can affect ability to modulate speed and alter gait spatial-temporal parameters compared to cyclic repetition of pre-programmed stimulation. DESIGN Single case study with subject acting as own concurrent control. Setting Hospital-based biomechanics laboratory. PARTICIPANTS Single subject with C6 AIS D SCI using an implanted neuroprosthesis for walking. Interventions Lower extremity muscle activation via an implanted system with two different control methods: (1) pre-programmed pattern of stimulation, and (2) EMG-controlled stimulation based on signals from the gastrocnemius and quadriceps. OUTCOME MEASURES Gait speed, distance, and subjective rating of difficulty during 2-minute walks. Range of walking speeds and associated cadences, stride lengths, stride times, and double support times during quantitative gait analysis. RESULTS EMG control resulted in statistically significant increases in both walking speed and distance (P < 0.001) over cyclic stimulation during 2-minute walks. Maximum walking speed with EMG control (0.48 m/second) was significantly (P < 0.001) faster than the fastest automatic pattern (0.39 m/second), with increased cadence and decreased stride and double support times (P < 0.000) but no change in stride length (z = -0.085; P = 0.932). The slowest walking with EMG control (0.25 m/second) was virtually indistinguishable from the slowest with automatic cycling (z = -0.239; P = 0.811). CONCLUSION EMG control can increase the ability to modulate comfortable walking speed over pre-programmed cyclic stimulation. While control methods did not differ at the lowest speed, EMG-triggered stimulation allowed significantly faster walking than cyclic stimulation. The expanded range of available walking speeds could permit users to better avoid obstacles and naturally adapt to various environments. Further research is required to definitively determine the robustness, generalizability, and functional implications of these results.
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Affiliation(s)
- Lisa M. Lombardo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Research Service, Cleveland, OH, USA
| | - Stephanie N. Bailey
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Research Service, Cleveland, OH, USA
| | - Kevin M. Foglyano
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Research Service, Cleveland, OH, USA
| | - Michael E. Miller
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Research Service, Cleveland, OH, USA
| | - Gilles Pinault
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Research Service, Cleveland, OH, USA
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Memberg WD, Stage TG, Kirsch RF. A fully implanted intramuscular bipolar myoelectric signal recording electrode. Neuromodulation 2014; 17:794-9; discussion 799. [PMID: 24612356 PMCID: PMC4160438 DOI: 10.1111/ner.12165] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this study is to develop a fully implanted, intramuscular, bipolar, myoelectric signal (IM-MES) recording electrode for functional electrical stimulation (FES), prosthetic myoelectric control, and other permanently implantable systems. MATERIALS AND METHODS An existing fully implanted intramuscular stimulating electrode was modified at each end to allow bipolar recording. The design change also required a modification of the implantation method. Mechanical and in vivo testing was performed on the novel components of the electrode. The first clinical application also is described. RESULTS The electrode design modifications did not create any areas of excess mechanical strain on the wires at the distal end where the leads were wound into electrode surfaces. In vivo testing showed that the IM-MES electrode recorded myoelectric signals that were equivalent to an existing epimysial MES electrode. The modified implantation method was simple to implement. The IM-MES electrode was used in an upper extremity FES system in an individual with a spinal cord injury and provided signals that were suitable for a command signal. CONCLUSIONS A fully implanted, bipolar intramuscular recording electrode (IM-MES) was developed. Implantation of the IM-MES is straightforward, and almost any muscle can be targeted. Testing has been performed to demonstrate the suitability of the IM-MES electrode for clinical use. Initial clinical applications were successful.
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Affiliation(s)
- William D Memberg
- Case Western Reserve University, Cleveland, OH, USA; Cleveland FES Center, Cleveland, OH, USA
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24
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Martin C, Dejardin T, Hart A, Riehle MO, Cumming DRS. Directed nerve regeneration enabled by wirelessly powered electrodes printed on a biodegradable polymer. Adv Healthc Mater 2014; 3:1001-6. [PMID: 24376117 DOI: 10.1002/adhm.201300481] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/16/2013] [Indexed: 01/09/2023]
Abstract
Wirelessly directed nerve regeneration: inductively powered electrical stimulation circuits on the biodegradable polymer polycaprolactone demonstrate directed regeneration of sensory neurons from a dorsal root ganglion. These circuits, produced using a unique transfer printing process, illustrate progress towards the use of electrical stimulation systems on biodegradable materials to improve peripheral nerve repair functional outcomes.
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Affiliation(s)
- Christopher Martin
- Electronics Design Centre, School of Engineering; University of Glasgow; G12 8LT UK
| | - Théophile Dejardin
- Centre for Cell Engineering; Joseph Black Building, University of Glasgow; G12 8QQ UK
| | - Andrew Hart
- Centre for Cell Engineering; Joseph Black Building, University of Glasgow; G12 8QQ UK
| | - Mathis O. Riehle
- Centre for Cell Engineering; Joseph Black Building, University of Glasgow; G12 8QQ UK
| | - David R. S. Cumming
- Electronics Design Centre, School of Engineering; University of Glasgow; G12 8LT UK
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25
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Memberg WD, Polasek KH, Hart RL, Bryden AM, Kilgore KL, Nemunaitis GA, Hoyen HA, Keith MW, Kirsch RF. Implanted neuroprosthesis for restoring arm and hand function in people with high level tetraplegia. Arch Phys Med Rehabil 2014; 95:1201-1211.e1. [PMID: 24561055 PMCID: PMC4470503 DOI: 10.1016/j.apmr.2014.01.028] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/28/2014] [Accepted: 01/29/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop and apply an implanted neuroprosthesis to restore arm and hand function to individuals with high level tetraplegia. DESIGN Case study. SETTING Clinical research laboratory. PARTICIPANTS Individuals with spinal cord injuries (N=2) at or above the C4 motor level. INTERVENTIONS The individuals were each implanted with 2 stimulators (24 stimulation channels and 4 myoelectric recording channels total). Stimulating electrodes were placed in the shoulder and arm, being, to our knowledge, the first long-term application of spiral nerve cuff electrodes to activate a human limb. Myoelectric recording electrodes were placed in the head and neck areas. MAIN OUTCOME MEASURES Successful installation and operation of the neuroprosthesis and electrode performance, range of motion, grasp strength, joint moments, and performance in activities of daily living. RESULTS The neuroprosthesis system was successfully implanted in both individuals. Spiral nerve cuff electrodes were placed around upper extremity nerves and activated the intended muscles. In both individuals, the neuroprosthesis has functioned properly for at least 2.5 years postimplant. Hand, wrist, forearm, elbow, and shoulder movements were achieved. A mobile arm support was needed to support the mass of the arm during functional activities. One individual was able to perform several activities of daily living with some limitations as a result of spasticity. The second individual was able to partially complete 2 activities of daily living. CONCLUSIONS Functional electrical stimulation is a feasible intervention for restoring arm and hand functions to individuals with high tetraplegia. Forces and movements were generated at the hand, wrist, elbow, and shoulder that allowed the performance of activities of daily living, with some limitations requiring the use of a mobile arm support to assist the stimulated shoulder forces.
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Affiliation(s)
| | | | - Ronald L Hart
- Louis Stokes Veterans Affairs Medical Center, Cleveland, OH
| | | | - Kevin L Kilgore
- Case Western Reserve University, Cleveland, OH; Louis Stokes Veterans Affairs Medical Center, Cleveland, OH; MetroHealth Medical Center, Cleveland, OH
| | | | | | | | - Robert F Kirsch
- Case Western Reserve University, Cleveland, OH; Louis Stokes Veterans Affairs Medical Center, Cleveland, OH; MetroHealth Medical Center, Cleveland, OH
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Corbett EA, Sachs NA, Körding KP, Perreault EJ. Multimodal decoding and congruent sensory information enhance reaching performance in subjects with cervical spinal cord injury. Front Neurosci 2014; 8:123. [PMID: 24904265 PMCID: PMC4033069 DOI: 10.3389/fnins.2014.00123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/06/2014] [Indexed: 11/30/2022] Open
Abstract
Cervical spinal cord injury (SCI) paralyzes muscles of the hand and arm, making it difficult to perform activities of daily living. Restoring the ability to reach can dramatically improve quality of life for people with cervical SCI. Any reaching system requires a user interface to decode parameters of an intended reach, such as trajectory and target. A challenge in developing such decoders is that often few physiological signals related to the intended reach remain under voluntary control, especially in patients with high cervical injuries. Furthermore, the decoding problem changes when the user is controlling the motion of their limb, as opposed to an external device. The purpose of this study was to investigate the benefits of combining disparate signal sources to control reach in people with a range of impairments, and to consider the effect of two feedback approaches. Subjects with cervical SCI performed robot-assisted reaching, controlling trajectories with either shoulder electromyograms (EMGs) or EMGs combined with gaze. We then evaluated how reaching performance was influenced by task-related sensory feedback, testing the EMG-only decoder in two conditions. The first involved moving the arm with the robot, providing congruent sensory feedback through their remaining sense of proprioception. In the second, the subjects moved the robot without the arm attached, as in applications that control external devices. We found that the multimodal-decoding algorithm worked well for all subjects, enabling them to perform straight, accurate reaches. The inclusion of gaze information, used to estimate target location, was especially important for the most impaired subjects. In the absence of gaze information, congruent sensory feedback improved performance. These results highlight the importance of proprioceptive feedback, and suggest that multi-modal decoders are likely to be most beneficial for highly impaired subjects and in tasks where such feedback is unavailable.
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Affiliation(s)
- Elaine A. Corbett
- Sensory Motor Performance Program, Rehabilitation Institute of ChicagoChicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern UniversityChicago, IL, USA
- Melbourne School of Psychological Sciences, University of MelbourneParkville, VIC, Australia
| | - Nicholas A. Sachs
- Department of Biomedical Engineering, Northwestern UniversityEvanston, IL, USA
| | - Konrad P. Körding
- Sensory Motor Performance Program, Rehabilitation Institute of ChicagoChicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern UniversityChicago, IL, USA
- Department of Physiology, Northwestern UniversityChicago, IL, USA
| | - Eric J. Perreault
- Sensory Motor Performance Program, Rehabilitation Institute of ChicagoChicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern UniversityChicago, IL, USA
- Department of Biomedical Engineering, Northwestern UniversityEvanston, IL, USA
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Schearer EM, Liao YW, Perreault EJ, Tresch MC, Memberg WD, Kirsch RF, Lynch KM. Multi-muscle FES force control of the human arm for arbitrary goals. IEEE Trans Neural Syst Rehabil Eng 2013; 22:654-63. [PMID: 24122573 DOI: 10.1109/tnsre.2013.2282903] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present a method for controlling a neuroprosthesis for a paralyzed human arm using functional electrical stimulation (FES) and characterize the errors of the controller. The subject has surgically implanted electrodes for stimulating muscles in her shoulder and arm. Using input/output data, a model mapping muscle stimulations to isometric endpoint forces measured at the subject's hand was identified. We inverted the model of this redundant and coupled multiple-input multiple-output system by minimizing muscle activations and used this inverse for feedforward control. The magnitude of the total root mean square error over a grid in the volume of achievable isometric endpoint force targets was 11% of the total range of achievable forces. Major sources of error were random error due to trial-to-trial variability and model bias due to nonstationary system properties. Because the muscles working collectively are the actuators of the skeletal system, the quantification of errors in force control guides designs of motion controllers for multi-joint, multi-muscle FES systems that can achieve arbitrary goals.
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28
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Knutson JS, Chae J, Hart RL, Keith MW, Hoyen HA, Harley MY, Hisel TZ, Bryden AM, Kilgore KL, Peckham H. Implanted neuroprosthesis for assisting arm and hand function after stroke: a case study. ACTA ACUST UNITED AC 2013; 49:1505-16. [PMID: 23516054 DOI: 10.1682/jrrd.2011.09.0171] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Loss of arm and hand function is common after stroke. An implantable, 12-channel, electromyogram (EMG)-controlled functional electrical stimulation neuroprosthesis (NP) may be a viable assistive device for upper-limb hemiplegia. In this study, a research participant 4.8 yr poststroke underwent presurgical screening, surgical installation of the NP, training, and assessment of upper-limb impairment, activity limitation, and satisfaction over a 2.3 yr period. The NP increased active range of finger extension from 3 to 96 degrees, increased lateral pinch force from 16 to 29 N, increased the number of objects from 1 to 4 out of 6 that the participant could grasp and place in a Grasp-Release Test, and increased the Arm Motor Abilities Test score by 0.3 points. The upper-limb Fugl-Meyer score increased from 27 at baseline to 36 by the end of the study. The participant reported using the NP at home 3-4 d/wk, up to 3 h/d for exercise and household tasks. The effectiveness of the NP to assist with activities of daily living was dependent on the degree of flexor tone, which varied with task and level of fatigue. The EMG-based control strategy was not successfully implemented; button presses were used instead. Further advancements in technology may improve ease of use and address limitations caused by muscle spasticity.
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Affiliation(s)
- Jayme S Knutson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
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Rieger R, Deng SL. Double-differential recording and AGC using microcontrolled variable gain ASIC. IEEE Trans Neural Syst Rehabil Eng 2012; 21:47-54. [PMID: 22929480 DOI: 10.1109/tnsre.2012.2213842] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Low-power wearable recording of biopotentials requires acquisition front-ends with high common-mode rejection for interference suppression and adjustable gain to provide an optimum signal range to a cascading analogue-to-digital stage. A microcontroller operated double-differential (DD) recording setup and automatic gain control circuit (AGC) are discussed which reject common-mode interference and provide tunable gain, thus compensating for imbalance and variation in electrode interface impedance. Custom-designed variable gain amplifiers (ASIC) are used as part of the recording setup. The circuit gain and balance is set by the timing of microcontroller generated clock signals. Measured results are presented which confirm that improved common-mode rejection is achieved compared to a single differential amplifier in the presence of input network imbalance. Practical measured examples further validate gain control suitable for biopotential recording and power-line rejection for wearable ECG and EMG recording. The prototype front-end consumes 318 μW including amplifiers and microcontroller.
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Affiliation(s)
- Robert Rieger
- Electrical Engineering Department, National Sun Yat-Sen University, Kaohsiung 804, Taiwan.
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30
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Wilcox JT, Cadotte D, Fehlings MG. Spinal cord clinical trials and the role for bioengineering. Neurosci Lett 2012; 519:93-102. [PMID: 22366402 DOI: 10.1016/j.neulet.2012.02.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 02/08/2012] [Indexed: 12/31/2022]
Abstract
There is considerable need for bringing effective therapies for spinal cord injury (SCI) to the clinic. Excellent medical and surgical management has mitigated poor prognoses after SCI; however, few advances have been made to return lost function. Bioengineering approaches have shown great promise in preclinical rodent models, yet there remains a large translational gap to carry these forward in human trials. Herein, we provide a framework of human clinical trials, an overview of past trials for SCI, as well as bioengineered approaches that include: directly applied pharmacologics, cellular transplantation, biomaterials and functional neurorehabilitation. Success of novel therapies will require the correct application of comprehensive preclinical studies with well-designed and expertly conducted human clinical trials. While biologics and bioengineered strategies are widely considered to represent the high potential benefits for those who have sustained a spinal injury, few such therapies have been thoroughly tested with appreciable efficacy for use in human SCI. With these considerations, we propose that bioengineered strategies are poised to enter clinical trials.
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Affiliation(s)
- Jared T Wilcox
- Institute of Medical Science, University of Toronto, Toronto, Canada M5S 1A8
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