Development of a battery-free ultrasonically powered functional electrical stimulator for movement restoration after paralyzing spinal cord injury

Wireless Battery-free and Fully Implantable Organ Interfaces

Advances in soft materials, miniaturized electronics, sensors, stimulators, radios, and battery-free power supplies are resulting in a new generation of fully implantable organ interfaces that leverage volumetric reduction and soft mechanics by eliminating electrochemical power storage. This device class offers the ability to provide high-fidelity readouts of physiological processes, enables stimulation, and allows control over organs to realize new therapeutic and diagnostic paradigms. Driven by seamless integration with connected infrastructure, these devices enable personalized digital medicine. Key to advances are carefully designed material, electrophysical, electrochemical, and electromagnetic systems that form implantables with mechanical properties closely matched to the target organ to deliver functionality that supports high-fidelity sensors and stimulators. The elimination of electrochemical power supplies enables control over device operation, anywhere from acute, to lifetimes matching the target subject with physical dimensions that supports imperceptible operation. This review provides a comprehensive overview of the basic building blocks of battery-free organ interfaces and related topics such as implantation, delivery, sterilization, and user acceptance. State of the art examples categorized by organ system and an outlook of interconnection and advanced strategies for computation leveraging the consistent power influx to elevate functionality of this device class over current battery-powered strategies is highlighted.

State of the Art and Current Challenges on Electroactive Biomaterials and Strategies for Neural Tissue Regeneration

The loss or failure of an organ/tissue stands as one of the healthcare system's most prevalent, devastating, and costly challenges. Strategies for neural tissue repair and regeneration have received significant attention due to their particularly strong impact on patients' well-being. Many research efforts are dedicated not only to control the disease symptoms but also to find solutions to repair the damaged tissues. Neural tissue engineering (TE) plays a key role in addressing this problem and significant efforts are being carried out to develop strategies for neural repair treatment. In the last years, active materials allowing to tune cell-materials interaction are being increasingly used, representing a recent paradigm in TE applications. Among the most important stimuli influencing cell behavior are the electrical and mechanical ones. In this way, materials with the ability to provide this kind of stimuli to the neural cells seem to be appropriate to support neural TE. In this scope, this review summarizes the different biomaterials types used for neural TE, highlighting the relevance of using active biomaterials and electrical stimulation. Furthermore, this review provides not only a compilation of the most relevant studies and results but also strategies for novel and more biomimetic approaches for neural TE.

Fully implanted battery-free high power platform for chronic spinal and muscular functional electrical stimulation

Electrical stimulation of the neuromuscular system holds promise for both scientific and therapeutic biomedical applications. Supplying and maintaining the power necessary to drive stimulation chronically is a fundamental challenge in these applications, especially when high voltages or currents are required. Wireless systems, in which energy is supplied through near field power transfer, could eliminate complications caused by battery packs or external connections, but currently do not provide the harvested power and voltages required for applications such as muscle stimulation. Here, we introduce a passive resonator optimized power transfer design that overcomes these limitations, enabling voltage compliances of ± 20 V and power over 300 mW at device volumes of 0.2 cm2, thereby improving power transfer 500% over previous systems. We show that this improved performance enables multichannel, biphasic, current-controlled operation at clinically relevant voltage and current ranges with digital control and telemetry in freely behaving animals. Preliminary chronic results indicate that implanted devices remain operational over 6 weeks in both intact and spinal cord injured rats and are capable of producing fine control of spinal and muscle stimulation.

Microenvironment-responsive electrocution of tumor and bacteria by implants modified with degenerate semiconductor film

Implantable biomaterials are widely used in the curative resection and palliative treatment of various types of cancers. However, cancer residue around the implants usually leads to treatment failure with cancer reoccurrence. Postoperation chemotherapy and radiation therapy are widely applied to clear the residual cancer cells but induce serious side effects. It is urgent to develop advanced therapy to minimize systemic toxicity while maintaining efficient cancer-killing ability. Herein, we report a degenerate layered double hydroxide (LDH) film modified implant, which realizes microenvironment-responsive electrotherapy. The film can gradually transform into a nondegenerate state and release holes. When in contact with tumor cells or bacteria, the film quickly transforms into a nondegenerate state and releases holes at a high rate, rendering the "electrocution" of tumor cells and bacteria. However, when placed in normal tissue, the hole release rate of the film is much slower, thus, causing little harm to normal cells. Therefore, the constructed film can intelligently identify and meet the physiological requirements promptly. In addition, the transformation between degenerate and nondegenerate states of LDH films can be cycled by electrical charging, so their selective and dynamic physiological functions can be artificially adjusted according to demand.

Foot Drop Stimulation via Piezoelectric Energy Harvester

The design and implementation of a piezoelectric energy-harvesting system, aimed at stimulating the Tibialis anterior muscle to aid patients struggling with a foot drop disability, are investigated. A physical prototype designed to be installed inside a shoe sole, consisting of an energy-harvesting unit along with a power-management circuit and a functional electrical-stimulation circuit, is fabricated. The piezoelectric energy harvester (PEH) incorporated six layers of Polyvinylidene-Fluoride sheets to achieve a mean-charge generation of 65.25 μC/step and a peak power of 10.76 mW/step. A peak voltage of +80.0 V generation was achieved during a stomping motion. The electrical systems store, convert, and deploy 60 mA electric pulses at the desired frequencies to the target muscle. The finalized prototype is best-suited to prolong the duration of the charged batteries whilst in use. In a practical sense, it should be used alongside external-power sources to recharge the batteries installed in a foot drop stimulation device. The PEH in its current state is fully capable of solely powering blood pressure sensors, glucose meters, or activity trackers.

Trans-Spinal Electrical Stimulation Therapy for Functional Rehabilitation after Spinal Cord Injury: Review

Spinal cord injury (SCI) is one of the most debilitating injuries in the world. Complications after SCI, such as respiratory issues, bowel/bladder incontinency, pressure ulcers, autonomic dysreflexia, spasticity, pain, etc., lead to immense suffering, a remarkable reduction in life expectancy, and even premature death. Traditional rehabilitations for people with SCI are often insignificant or ineffective due to the severity and complexity of the injury. However, the recent development of noninvasive electrical neuromodulation treatments to the spinal cord have shed a ray of hope for these individuals to regain some of their lost functions, a reduction in secondary complications, and an improvement in their life quality. For this review, 250 articles were screened and about 150 were included to summarize the two most promising noninvasive spinal cord electrical stimulation methods of SCI rehabilitation treatment, namely, trans-spinal direct current stimulation (tsDCS) and trans-spinal pulsed current stimulation (tsPCS). Both treatments have demonstrated good success in not only improving the sensorimotor function, but also autonomic functions. Due to the noninvasive nature and lower costs of these treatments, in the coming years, we expect these treatments to be integrated into regular rehabilitation therapies worldwide.

Autocharging Techniques for Implantable Medical Applications

Implantable devices have successfully proven their reliability and efficiency in the medical field due to their immense support in a variety of aspects concerning the monitoring of patients and treatment in many ways. Moreover, they assist the medical field in disease diagnosis and prevention. However, the devices' power sources rely on batteries, and with this reliance, comes certain complications. For example, their depletion may lead to surgical interference or leakage into the human body. Implicit studies have found ways to reduce the battery size or in some cases to eliminate its use entirely; these studies suggest the use of biocompatible harvesters that can support the device consumption by generating power. Harvesting mechanisms can be executed using a variety of biocompatible materials, namely, piezoelectric and triboelectric nanogenerators, biofuel cells, and environmental sources. As with all methods for implementing biocompatible harvesters, some of them are low in terms of power consumption and some are dependent on the device and the place of implantation. In this review, we discuss the application of harvesters into implantable devices and evaluate the different materials and methods and examine how new and improved circuits will help in assisting the generators to sustain the function of medical devices.

Wireless Power Delivery Techniques for Miniature Implantable Bioelectronics

Progress in implanted bioelectronic technology offers the opportunity to develop more effective tools for personalized electronic medicine. While there are numerous clinical and pre-clinical applications for these devices, power delivery to these systems can be challenging. Wireless battery-free devices offer advantages such as a smaller and lighter device footprint and reduced failures and infections by eliminating lead wires. However, with the development of wireless technologies, there are fundamental tradeoffs between five essential factors: power, miniaturization, depth, alignment tolerance, and transmitter distance, while still allowing devices to work within safety limits. These tradeoffs mean that multiple forms of wireless power transfer are necessary for different devices to best meet the needs for a given biological target. Here six different types of wireless power transfer technologies used in bioelectronic implants-inductive coupling, radio frequency, mid-field, ultrasound, magnetoelectrics, and light-are reviewed in context of the five tradeoffs listed above. This core group of wireless power modalities is then used to suggest possible future bioelectronic technologies and their biological applications.

Biomedical Implants with Charge-Transfer Monitoring and Regulating Abilities

Transmembrane charge (ion/electron) transfer is essential for maintaining cellular homeostasis and is involved in many biological processes, from protein synthesis to embryonic development in organisms. Designing implant devices that can detect or regulate cellular transmembrane charge transfer is expected to sense and modulate the behaviors of host cells and tissues. Thus, charge transfer can be regarded as a bridge connecting living systems and human-made implantable devices. This review describes the mode and mechanism of charge transfer between organisms and nonliving materials, and summarizes the strategies to endow implants with charge-transfer regulating or monitoring abilities. Furthermore, three major charge-transfer controlling systems, including wired, self-activated, and stimuli-responsive biomedical implants, as well as the design principles and pivotal materials are systematically elaborated. The clinical challenges and the prospects for future development of these implant devices are also discussed.

ANOVA-Based Analysis of Early Blood Transfusions on Hemodynamics with Severely Injured Trauma Using Bedside Ultrasound Imaging

The focus of the study was to quantitatively analyze the influence of early massive blood transfusions (MBTs) on the hemodynamics and prognostic living quality of patients with severely injured trauma. 114 patients with severely injured trauma were enrolled into MBT group (67 cases) and nonmassive blood transfusions (NBT) group (47 cases) according to whether they accepted MBTs within 24 hours after the admission. All patients had bedside ultrasound technology scanning. Furthermore, the indexes were calculated for inferior vena cava (IVC), peripheral arteries, and heart. The prognostic deaths were recorded. It was found that, in the MBT group, the mortality was lower (7.55% vs. 24.23%) (P < 0.05), and these indexes were higher for the IVC expansion (IVCE), the respiration variation index (RVI) of IVC (ΔIVC2), the peak flow velocity RVI of brachial artery (ΔVpeakBA), femoral artery (ΔVpeakFA), left ventricular outflow tract (ΔVpeakL), and aorta (ΔVpeakAO), as well as peak flow velocity time integral RVI of aorta (ΔVTIAO) (P < 0.05). In conclusion, early MBTs can elevate survival rate and prognostic living quality and alleviate the atrophy degree of IVC, peripheral artery, and blood vessel of patients with severely injured trauma. Furthermore, bedside ultrasound scanning demonstrated superb capabilities in quantitatively displaying hemodynamics and outcomes of MBTs of patients with severely injured trauma.

Ultrasonic wireless power links for battery-free condition monitoring in metallic enclosures

This paper presented a novel ultrasonic wireless power link (UWPL) to provide power supply for embedded condition monitoring of enclosed metallic structures, where recharging or replacing batteries can be problematic. Two piezoelectric transducers are adopted to establish the wireless power links, within which one transducer is used to generate ultrasonic waves and the other is to receive the transferred ultrasonic energy and to energize the associated embedded condition monitoring units. A power management solution is established to regulate the receiver output into a constant voltage suitable for sensing application. A theoretical model was established to understand the UWPL dynamics and to analyze the energy budget balance between the UWPL and the sensing power demands. A finite element model was built to validate the proposed idea. The UWPL was then experimentally implemented using two piezoelectric transducers and tested in aluminium plates with different thickness. A power management sub-system was developed and tested for sensing applications. An output power of 1.73 mW was obtained on a 1.5 kΩ resister with the input voltage of 15 V at 42.6 kHz through a 6 mm-thick aluminium plate. Sufficient power can be transferred over a large distance via metallic structures, showing the capability in implementing battery-free condition monitoring of enclosed metallic structures, such as petroleum pipelines, engines, and aluminium airframe.

Ultrasound in Traumatic Spinal Cord Injury: A Wide-Open Field

Traumatic spinal cord injury (SCI) is a common and devastating condition. In the absence of effective validated therapies, there is an urgent need for novel methods to achieve injury stabilization, regeneration, and functional restoration in SCI patients. Ultrasound is a versatile platform technology that can provide a foundation for viable diagnostic and therapeutic interventions in SCI. In particular, real-time perfusion and inflammatory biomarker monitoring, focal pharmaceutical delivery, and neuromodulation are capabilities that can be harnessed to advance our knowledge of SCI pathophysiology and to develop novel management and treatment options. Our review suggests that studies that evaluate the benefits and risks of ultrasound in SCI are severely lacking and our understanding of the technology's potential impact remains poorly understood. Although the complex anatomy and physiology of the spine and the spinal cord remain significant challenges, continued technological advances will help the field overcome the current barriers and bring ultrasound to the forefront of SCI research and development.

Distributed sensor and actuator networks for closed-loop bioelectronic medicine

Designing implantable bioelectronic systems that continuously monitor physiological functions and simultaneously provide personalized therapeutic solutions for patients remains a persistent challenge across many applications ranging from neural systems to bioelectronic organs. Closed-loop systems typically consist of three functional blocks, namely, sensors, signal processors and actuators. An effective system, that can provide the necessary therapeutics, tailored to individual physiological factors requires a distributed network of sensors and actuators. While significant progress has been made, closed-loop systems still face many challenges before they can truly be considered as long-term solutions for many diseases. In this review, we consider three important criteria where materials play a critical role to enable implantable closed-loop systems: Specificity, Biocompatibility and Connectivity. We look at the progress made in each of these fields with respect to a specific application and outline the challenges in creating bioelectronic technologies for the future.

Redox Polymers for Tissue Engineering

This review will focus on the targeted design, synthesis and application of redox polymers for use in regenerative medicine and tissue engineering. We define redox polymers to encompass a variety of polymeric materials, from the multifunctional conjugated conducting polymers to graphene and its derivatives, and have been adopted for use in the engineering of several types of stimulus responsive tissues. We will review the fundamental properties of organic conducting polymers (OCPs) and graphene, and how their properties are being tailored to enhance material - biological interfacing. We will highlight the recent development of high-resolution 3D fabrication processes suitable for biomaterials, and how the fabrication of intricate scaffolds at biologically relevant scales is providing exciting opportunities for the application of redox polymers for both in-vitro and in-vivo tissue engineering. We will discuss the application of OCPs in the controlled delivery of bioactive compounds, and the electrical and mechanical stimulation of cells to drive behaviour and processes towards the generation of specific functional tissue. We will highlight the relatively recent advances in the use of graphene and the exploitation of its physicochemical and electrical properties in tissue engineering. Finally, we will look forward at the future of organic conductors in tissue engineering applications, and where the combination of materials development and fabrication processes will next unite to provide future breakthroughs.

MiniVStimA: A miniaturized easy to use implantable electrical stimulator for small laboratory animals

According to PubMed, roughly 10% of the annually added publications are describing findings from the small animal model (mice and rats), including investigations in the field of muscle physiology and training. A subset of this research requires neural stimulation with flexible adjustments of stimulation parameters, highlighting the need for reliable implantable electrical stimulators, small enough (~1 cm³), that even mice can tolerate them without impairing their movement. The MiniVStimA is a battery-powered implant for nerve stimulation with an outer diameter of 15 mm and an encapsulated volume of 1.2 cm³ in its smallest variation. It can be pre-programmed according to the experimental protocol and controlled after implantation with a magnet. It delivers constant current charge-balanced monophasic rectangular pulses up to 2 mA and 1 ms phase width (1 kΩ load). The circuitry is optimized for small volume and energy efficiency. Due to the variation of the internal oscillator (31 kHz ± 10%), calibration measures must be implemented during the manufacturing process, which can reduce the deviation of the frequency related parameters down to ± 1%. The expected lifetime of the smaller (larger) version is 100 (480) days for stimulation with 7 Hz all day and 10 (48) days for stimulation with 100 Hz. Devices with complex stimulation patterns for nerve stimulation have been successfully used in two in-vivo studies, lasting up to nine weeks. The implant worked fully self-contained while the animal stayed in its familiar environment. External components are not required during the entire time.

Ultrasound powered piezoelectric neurostimulation devices: a commentary

Conventional neurostimulation systems for preclinical research can be bulky and invasive due to the need for batteries or wired interfaces. Emerging as a new neural interface technique, ultrasound-powered piezoelectric neural stimulators work by converting ultrasound energy to electrical charge for neural stimulation. In addition to the benefits of wireless powering and miniaturization leading to less traumatic surgery, piezoelectric neural stimulators can also exhibit prolonged operational lifetimes for a long-term stable neural interface, and show promise for clinical translation. As one of first steps to demonstrate the value of ultrasound-powered piezoelectric neural interface, Li et al. developed a piezoelectric stimulator to activate spinal cord neural circuits for locomotion restoration in a rat model with spinal cord injury (SCI) and compared its efficacy with conventional electrical stimulation (ES). From the point of view of materials science, neural engineering and microelectronics, we provide our commentary on the article, highlighting its importance and discussing the issues that remain to be addressed in future studies in the emerging field of ultrasound powered piezoelectric neurostimulation devices.

Emerging Implantable Energy Harvesters and Self-Powered Implantable Medical Electronics

Implantable energy harvesters (IEHs) are the crucial component for self-powered devices. By harvesting energy from organisms such as heartbeat, respiration, and chemical energy from the redox reaction of glucose, IEHs are utilized as the power source of implantable medical electronics. In this review, we summarize the IEHs and self-powered implantable medical electronics (SIMEs). The typical IEHs are nanogenerators, biofuel cells, electromagnetic generators, and transcutaneous energy harvesting devices that are based on ultrasonic or optical energy. A benefit from these technologies of energy harvesting in vivo, SIMEs emerged, including cardiac pacemakers, nerve/muscle stimulators, and physiological sensors. We provide perspectives on the challenges and potential solutions associated with IEHs and SIMEs. Beyond the energy issue, we highlight the implanted devices that show the therapeutic function in vivo.

Ultrasound-driven piezoelectric current activates spinal cord neurocircuits and restores locomotion in rats with spinal cord injury

Background

Neuromodulation via electrical stimulation (ES) is a common technique to treat numerous brain and spinal cord related neurological conditions. In the present study, we examined the efficacy of piezoelectric stimulation (pES) by a custom miniature piezostimulator to activate the spinal cord neurocircuit in comparison with conventional epidural ES in rats.

Methods

Stimulation electrodes were implanted on L2 and S1 spinal cord and were connected to a head-plug for ES, and a piezostimulator for pES. EMG electrodes were implanted into hindlimb muscles. To generate piezoelectric current, an ultrasound beam was delivered by an external ultrasound probe. Motor evoked potentials (MEPs) were recorded during the piezoelectric stimulation and compared with the signals generated by the ES.

Results

Our results suggest that ultrasound intensity as low as 0.1 mW/cm² could induce MEPs in the hindlimbs. No significant difference was found either in MEPs or in muscle recruitments for ES and pES. Similar to ES, pES induced by 22.5 mW/cm² ultrasound restored locomotion in paralyzed rats with complete thoracic cord injury. Locomotion EMG signals indicated that pES works same as ES.

Conclusion

We propose piezoelectric stimulation as a new avenue of neuromodulation with features overtaking conventional electrical stimulation to serve future bioelectronic medicine.