1
|
Chateaux M, Rossel O, Vérité F, Nicol C, Touillet A, Paysant J, Jarrassé N, De Graaf JB. New insights into muscle activity associated with phantom hand movements in transhumeral amputees. Front Hum Neurosci 2024; 18:1443833. [PMID: 39281369 PMCID: PMC11392834 DOI: 10.3389/fnhum.2024.1443833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/19/2024] [Indexed: 09/18/2024] Open
Abstract
Introduction Muscle activity patterns in the residual arm are systematically present during phantom hand movements (PHM) in transhumeral amputees. However, their characteristics have not been directly investigated yet, leaving their neurophysiological origin poorly understood. This study pioneers a neurophysiological perspective in examining PHM-related muscle activity patterns by characterizing and comparing them with those in the arm, forearm, and hand muscles of control participants executing intact hand movements (IHM) of similar types. Methods To enable rigorous comparison, we developed meta-variables independent of electrode placement, quantifying the phasic profile of recorded surface EMG signals and the specificity of their patterns across electrode sites and movement types. Results Similar to the forearm and hand muscles during IHM, each signal recorded from the residual upper arm during PHM displays a phasic profile, synchronized with the onset and offset of each movement repetition. Furthermore, the PHM-related patterns of phasic muscle activity are specific not only to the type of movement but also to the electrode site, even within the same upper arm muscle, while these muscles exhibit homogeneous activities in intact arms. Discussion Our results suggest the existence of peripheral reorganization, eventually leading to the emergence of independently controlled muscular sub-volumes. This reorganization potentially occurs through the sprouting of severed axons and the recapture of muscle fibers in the residual limb. Further research is imperative to comprehend this mechanism and its relationship with PHM, holding significant implications for the rehabilitation process and myoelectric prosthesis control.
Collapse
Affiliation(s)
| | | | - Fabien Vérité
- ISM, Aix Marseille University, CNRS, Marseille, France
| | | | | | | | - Nathanaël Jarrassé
- U1150 Agathe-ISIR, CNRS, UMR 7222, ISIR/INSERM, Sorbonne University, Paris, France
| | | |
Collapse
|
2
|
Festin C, Ortmayr J, Maierhofer U, Tereshenko V, Blumer R, Schmoll M, Carrero-Rojas G, Luft M, Laengle G, Farina D, Bergmeister KD, Aszmann OC. Creation of a biological sensorimotor interface for bionic reconstruction. Nat Commun 2024; 15:5337. [PMID: 38914540 PMCID: PMC11196281 DOI: 10.1038/s41467-024-49580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 06/12/2024] [Indexed: 06/26/2024] Open
Abstract
Neuromuscular control of bionic arms has constantly improved over the past years, however, restoration of sensation remains elusive. Previous approaches to reestablish sensory feedback include tactile, electrical, and peripheral nerve stimulation, however, they cannot recreate natural, intuitive sensations. Here, we establish an experimental biological sensorimotor interface and demonstrate its potential use in neuroprosthetics. We transfer a mixed nerve to a skeletal muscle combined with glabrous dermal skin transplantation, thus forming a bi-directional communication unit in a rat model. Morphological analyses indicate reinnervation of the skin, mechanoreceptors, NMJs, and muscle spindles. Furthermore, sequential retrograde labeling reveals specific sensory reinnervation at the level of the dorsal root ganglia. Electrophysiological recordings show reproducible afferent signals upon tactile stimulation and tendon manipulation. The results demonstrate the possibility of surgically creating an interface for both decoding efferent motor control, as well as encoding afferent tactile and proprioceptive feedback, and may indicate the way forward regarding clinical translation of biological communication pathways for neuroprosthetic applications.
Collapse
Affiliation(s)
- Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Joachim Ortmayr
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Roland Blumer
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Martin Schmoll
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Génova Carrero-Rojas
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Matthias Luft
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
3
|
Gstoettner C, Laengle G, Harnoncourt L, Sassu P, Aszmann OC. Targeted muscle reinnervation in bionic upper limb reconstruction: current status and future directions. J Hand Surg Eur Vol 2024; 49:783-791. [PMID: 38366374 DOI: 10.1177/17531934241227795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Selective nerve transfers are used in the setting of upper limb amputation to improve myoelectric prosthesis control. This surgical concept is referred to as targeted muscle reinnervation (TMR) and describes the rerouting of the major nerves of the arm onto the motor branches of the residual limb musculature. Aside from providing additional myosignals for prosthetic control, TMR can treat and prevent neuroma pain and possibly also phantom limb pain. This article reviews the history and current applications of TMR in upper limb amputation, with a focus on practical considerations. It further explores and identifies technological innovations to improve the man-machine interface in amputation care, particularly regarding implantable interfaces, such as muscle electrodes and osseointegration. Finally, future clinical directions and possible scientific avenues in this field are presented and critically discussed.
Collapse
Affiliation(s)
- Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Vienna, Vienna, Austria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Vienna, Vienna, Austria
| | - Leopold Harnoncourt
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Vienna, Vienna, Austria
| | - Paolo Sassu
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Orthoplastic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Vienna, Vienna, Austria
| |
Collapse
|
4
|
Tanzarella S, Di Domenico D, Forsiuk I, Boccardo N, Chiappalone M, Bartolozzi C, Semprini M. Arm muscle synergies enhance hand posture prediction in combination with forearm muscle synergies. J Neural Eng 2024; 21:026043. [PMID: 38547534 DOI: 10.1088/1741-2552/ad38dd] [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: 09/06/2023] [Accepted: 03/28/2024] [Indexed: 04/16/2024]
Abstract
Objective.We analyze and interpret arm and forearm muscle activity in relation with the kinematics of hand pre-shaping during reaching and grasping from the perspective of human synergistic motor control.Approach.Ten subjects performed six tasks involving reaching, grasping and object manipulation. We recorded electromyographic (EMG) signals from arm and forearm muscles with a mix of bipolar electrodes and high-density grids of electrodes. Motion capture was concurrently recorded to estimate hand kinematics. Muscle synergies were extracted separately for arm and forearm muscles, and postural synergies were extracted from hand joint angles. We assessed whether activation coefficients of postural synergies positively correlate with and can be regressed from activation coefficients of muscle synergies. Each type of synergies was clustered across subjects.Main results.We found consistency of the identified synergies across subjects, and we functionally evaluated synergy clusters computed across subjects to identify synergies representative of all subjects. We found a positive correlation between pairs of activation coefficients of muscle and postural synergies with important functional implications. We demonstrated a significant positive contribution in the combination between arm and forearm muscle synergies in estimating hand postural synergies with respect to estimation based on muscle synergies of only one body segment, either arm or forearm (p< 0.01). We found that dimensionality reduction of multi-muscle EMG root mean square (RMS) signals did not significantly affect hand posture estimation, as demonstrated by comparable results with regression of hand angles from EMG RMS signals.Significance.We demonstrated that hand posture prediction improves by combining activity of arm and forearm muscles and we evaluate, for the first time, correlation and regression between activation coefficients of arm muscle and hand postural synergies. Our findings can be beneficial for myoelectric control of hand prosthesis and upper-limb exoskeletons, and for biomarker evaluation during neurorehabilitation.
Collapse
Affiliation(s)
- Simone Tanzarella
- Event-Driven Perception, Italian Institute of Technology, Via San Quirico, 19, 16163 Genova, GE, Italy
| | - Dario Di Domenico
- Rehab Technologies Lab, Italian Institute of Technology, Via Morego, 30, 16163 Genova, GE, Italy
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin 10124, Italy
| | - Inna Forsiuk
- Rehab Technologies Lab, Italian Institute of Technology, Via Morego, 30, 16163 Genova, GE, Italy
| | - Nicolò Boccardo
- Rehab Technologies Lab, Italian Institute of Technology, Via Morego, 30, 16163 Genova, GE, Italy
- Open University Affiliated Research Centre at Istituto Italiano di Tecnologia (ARC@IIT), Genova, Italy
| | - Michela Chiappalone
- Rehab Technologies Lab, Italian Institute of Technology, Via Morego, 30, 16163 Genova, GE, Italy
- Bioengineering Lab, University of Genova, DIBRIS, Genova, Italy
| | - Chiara Bartolozzi
- Event-Driven Perception, Italian Institute of Technology, Via San Quirico, 19, 16163 Genova, GE, Italy
| | - Marianna Semprini
- Rehab Technologies Lab, Italian Institute of Technology, Via Morego, 30, 16163 Genova, GE, Italy
| |
Collapse
|
5
|
Sun H, He C, Vujaklija I. Design trends in actuated lower-limb prosthetic systems: a narrative review. Expert Rev Med Devices 2023; 20:1157-1172. [PMID: 37925668 DOI: 10.1080/17434440.2023.2279999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Actuated lower limb prostheses, including powered (active) and semi-active (quasi-passive) joints, are endowed with controllable power and/or impedance, which can be advantageous to limb impairment individuals by improving locomotion mechanics and reducing the overall metabolic cost of ambulation. However, an increasing number of commercial and research-focused options have made navigating this field a daunting task for users, researchers, clinicians, and professionals. AREAS COVERED The present paper provides an overview of the latest trends and developments in the field of actuated lower-limb prostheses and corresponding technologies. Following a gentle summary of essential gait features, we introduce and compare various actuated prosthetic solutions in academia and the market designed to provide assistance at different levels of impairments. Correspondingly, we offer insights into the latest developments of sockets and suspension systems, before finally discussing the established and emerging trends in surgical approaches aimed at improving prosthetic experience through enhanced physical and neural interfaces. EXPERT OPINION The ongoing challenges and future research opportunities in the field are summarized for exploring potential avenues for development of next generation of actuated lower limb prostheses. In our opinions, a closer multidisciplinary integration can be found in the field of actuated lower-limb prostheses in the future.
Collapse
Affiliation(s)
- Haoran Sun
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, P.R. China
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Chaoming He
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, P.R. China
| | - Ivan Vujaklija
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| |
Collapse
|
6
|
Farina D, Vujaklija I, Brånemark R, Bull AMJ, Dietl H, Graimann B, Hargrove LJ, Hoffmann KP, Huang HH, Ingvarsson T, Janusson HB, Kristjánsson K, Kuiken T, Micera S, Stieglitz T, Sturma A, Tyler D, Weir RFF, Aszmann OC. Toward higher-performance bionic limbs for wider clinical use. Nat Biomed Eng 2023; 7:473-485. [PMID: 34059810 DOI: 10.1038/s41551-021-00732-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/01/2021] [Indexed: 12/19/2022]
Abstract
Most prosthetic limbs can autonomously move with dexterity, yet they are not perceived by the user as belonging to their own body. Robotic limbs can convey information about the environment with higher precision than biological limbs, but their actual performance is substantially limited by current technologies for the interfacing of the robotic devices with the body and for transferring motor and sensory information bidirectionally between the prosthesis and the user. In this Perspective, we argue that direct skeletal attachment of bionic devices via osseointegration, the amplification of neural signals by targeted muscle innervation, improved prosthesis control via implanted muscle sensors and advanced algorithms, and the provision of sensory feedback by means of electrodes implanted in peripheral nerves, should all be leveraged towards the creation of a new generation of high-performance bionic limbs. These technologies have been clinically tested in humans, and alongside mechanical redesigns and adequate rehabilitation training should facilitate the wider clinical use of bionic limbs.
Collapse
Affiliation(s)
- Dario Farina
- Department of Bioengineering, Imperial College London, London, UK.
| | - Ivan Vujaklija
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Rickard Brånemark
- Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
| | - Hans Dietl
- Ottobock Products SE & Co. KGaA, Vienna, Austria
| | | | - Levi J Hargrove
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Klaus-Peter Hoffmann
- Department of Medical Engineering & Neuroprosthetics, Fraunhofer-Institut für Biomedizinische Technik, Sulzbach, Germany
| | - He Helen Huang
- NCSU/UNC Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thorvaldur Ingvarsson
- Department of Research and Development, Össur Iceland, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hilmar Bragi Janusson
- School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland
| | | | - Todd Kuiken
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pontedera, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pontedera, Italy
- Bertarelli Foundation Chair in Translational NeuroEngineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, BrainLinks-BrainTools Center and Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Agnes Sturma
- Department of Bioengineering, Imperial College London, London, UK
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Dustin Tyler
- Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Veterans Affairs Medical Centre, Cleveland, OH, USA
| | - Richard F Ff Weir
- Biomechatronics Development Laboratory, Bioengineering Department, University of Colorado Denver and VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
7
|
Wang H, Zuo S, Cerezo-Sánchez M, Arekhloo NG, Nazarpour K, Heidari H. Wearable super-resolution muscle-machine interfacing. Front Neurosci 2022; 16:1020546. [PMID: 36466163 PMCID: PMC9714306 DOI: 10.3389/fnins.2022.1020546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/21/2022] [Indexed: 09/19/2023] Open
Abstract
Muscles are the actuators of all human actions, from daily work and life to communication and expression of emotions. Myography records the signals from muscle activities as an interface between machine hardware and human wetware, granting direct and natural control of our electronic peripherals. Regardless of the significant progression as of late, the conventional myographic sensors are still incapable of achieving the desired high-resolution and non-invasive recording. This paper presents a critical review of state-of-the-art wearable sensing technologies that measure deeper muscle activity with high spatial resolution, so-called super-resolution. This paper classifies these myographic sensors according to the different signal types (i.e., biomechanical, biochemical, and bioelectrical) they record during measuring muscle activity. By describing the characteristics and current developments with advantages and limitations of each myographic sensor, their capabilities are investigated as a super-resolution myography technique, including: (i) non-invasive and high-density designs of the sensing units and their vulnerability to interferences, (ii) limit-of-detection to register the activity of deep muscles. Finally, this paper concludes with new opportunities in this fast-growing super-resolution myography field and proposes promising future research directions. These advances will enable next-generation muscle-machine interfaces to meet the practical design needs in real-life for healthcare technologies, assistive/rehabilitation robotics, and human augmentation with extended reality.
Collapse
Affiliation(s)
- Huxi Wang
- Microelectronics Lab, James Watt School of Engineering, The University of Glasgow, Glasgow, United Kingdom
- Neuranics Ltd., Glasgow, United Kingdom
| | - Siming Zuo
- Microelectronics Lab, James Watt School of Engineering, The University of Glasgow, Glasgow, United Kingdom
- Neuranics Ltd., Glasgow, United Kingdom
| | - María Cerezo-Sánchez
- Microelectronics Lab, James Watt School of Engineering, The University of Glasgow, Glasgow, United Kingdom
- Neuranics Ltd., Glasgow, United Kingdom
| | - Negin Ghahremani Arekhloo
- Microelectronics Lab, James Watt School of Engineering, The University of Glasgow, Glasgow, United Kingdom
- Neuranics Ltd., Glasgow, United Kingdom
| | - Kianoush Nazarpour
- Neuranics Ltd., Glasgow, United Kingdom
- School of Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Hadi Heidari
- Microelectronics Lab, James Watt School of Engineering, The University of Glasgow, Glasgow, United Kingdom
- Neuranics Ltd., Glasgow, United Kingdom
| |
Collapse
|
8
|
An Algorithm for Elective Amputation Combined with Targeted Muscle Reinnervation in Complex Regional Pain Syndrome—A Perspective. J Pers Med 2022; 12:jpm12071169. [PMID: 35887666 PMCID: PMC9319192 DOI: 10.3390/jpm12071169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 11/30/2022] Open
Abstract
Complex regional pain syndrome (CRPS) can result in a devastating condition. For a small number of patients, there is a non-response to any existing multimodal therapies and they ultimately request amputation. Such a drastic and final decision is not easy to take for both the patient and the surgeon and requires careful and interdisciplinary assessments and considerations. Furthermore, new surgical procedures, such as targeted muscle reinnervation (TMR) and hybrid prosthetic fitting, and multidisciplinary board advice should be included when considering amputation. In order to help other therapeutic teams in decision making for such rare but more than demanding cases, we aimed to propose an advanced algorithm for amputation indications in CRPS patients combining all these new factors. This algorithm consists of extensive pre-operative psychiatric assessment, diagnostic hybrid prosthetic fitting including fMRI analyses, multidisciplinary board advice as well as targeted muscle reinnervation and amputation procedures with final prosthetic fitting and rehabilitation. By involving multiple disciplines, this algorithm should provide optimized and individualized patient treatment on the one hand and a reliable base for decision making for therapists on the other.
Collapse
|
9
|
Gstoettner C, Festin C, Prahm C, Bergmeister KD, Salminger S, Sturma A, Hofer C, Russold MF, Howard CL, McDonnall D, Farina D, Aszmann OC. Feasibility of a Wireless Implantable Multi-electrode System for High-bandwidth Prosthetic Interfacing: Animal and Cadaver Study. Clin Orthop Relat Res 2022; 480:1191-1204. [PMID: 35202032 PMCID: PMC9263498 DOI: 10.1097/corr.0000000000002135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Currently used prosthetic solutions in upper extremity amputation have limited functionality, owing to low information transfer rates of neuromuscular interfacing. Although surgical innovations have expanded the functional potential of the residual limb, available interfaces are inefficacious in translating this potential into improved prosthetic control. There is currently no implantable solution for functional interfacing in extremity amputation which offers long-term stability, high information transfer rates, and is applicable for all levels of limb loss. In this study, we presented a novel neuromuscular implant, the the Myoelectric Implantable Recording Array (MIRA). To our knowledge, it is the first fully implantable system for prosthetic interfacing with a large channel count, comprising 32 intramuscular electrodes. QUESTIONS/PURPOSES The purpose of this study was to evaluate the MIRA in terms of biocompatibility, functionality, and feasibility of implantation to lay the foundations for clinical application. This was achieved through small- and large-animal studies as well as test surgeries in a human cadaver. METHODS We evaluated the biocompatibility of the system's intramuscular electromyography (EMG) leads in a rabbit model. Ten leads as well as 10 pieces of a biologically inert control material were implanted into the paravertebral muscles of four animals. After a 3-month implantation, tissue samples were taken and histopathological assessment performed. The probes were scored according to a protocol for the assessment of the foreign body response, with primary endpoints being inflammation score, tissue response score, and capsule thickness in µm. In a second study, chronic functionality of the full system was evaluated in large animals. The MIRA was implanted into the shoulder region of six dogs and three sheep, with intramuscular leads distributed across agonist and antagonist muscles of shoulder flexion. During the observation period, regular EMG measurements were performed. The implants were removed after 5 to 6 months except for one animal, which retained the implant for prolonged observation. Primary endpoints of the large-animal study were mechanical stability, telemetric capability, and EMG signal quality. A final study involved the development of test surgeries in a fresh human cadaver, with the goal to determine feasibility to implant relevant target muscles for prosthetic control at all levels of major upper limb amputation. RESULTS Evaluation of the foreign body reaction revealed favorable biocompatibility and a low-grade tissue response in the rabbit study. No differences regarding inflammation score (EMG 4.60 ± 0.97 [95% CI 4.00 to 5.20] versus control 4.20 ± 1.48 [95% CI 3.29 to 5.11]; p = 0.51), tissue response score (EMG 4.00 ± 0.82 [95% CI 3.49 to 4.51] versus control 4.00 ± 0.94 [95% CI 3.42 to 4.58]; p > 0.99), or thickness of capsule (EMG 19.00 ± 8.76 µm [95% CI 13.57 to 24.43] versus control 29.00 ± 23.31 µm [95% CI 14.55 to 43.45]; p = 0.29) were found compared with the inert control article (high-density polyethylene) after 3 months of intramuscular implantation. Throughout long-term implantation of the MIRA in large animals, telemetric communication remained unrestricted in all specimens. Further, the implants retained the ability to record and transmit intramuscular EMG data in all animals except for two sheep where the implants became dislocated shortly after implantation. Electrode impedances remained stable and below 5 kΩ. Regarding EMG signal quality, there was little crosstalk between muscles and overall average signal-to-noise ratio was 22.2 ± 6.2 dB. During the test surgeries, we found that it was possible to implant the MIRA at all major amputation levels of the upper limb in a human cadaver (the transradial, transhumeral, and glenohumeral levels). For each level, it was possible to place the central unit in a biomechanically stable environment to provide unhindered telemetry, while reaching the relevant target muscles for prosthetic control. At only the glenohumeral level, it was not possible to reach the teres major and latissimus dorsi muscles, which would require longer lead lengths. CONCLUSION As assessed in a combination of animal model and cadaver research, the MIRA shows promise for clinical research in patients with limb amputation, where it may be employed for all levels of major upper limb amputation to provide long-term stable intramuscular EMG transmission. CLINICAL RELEVANCE In our study, the MIRA provided high-bandwidth prosthetic interfacing through intramuscular electrode sites. Its high number of individual EMG channels may be combined with signal decoding algorithms for accessing spinal motor neuron activity after targeted muscle reinnervation, thus providing numerous degrees of freedom. Together with recent innovations in amputation surgery, the MIRA might enable improved control approaches for upper limb amputees, particularly for patients with above-elbow amputation where the mismatch between available control signals and necessary degrees of freedom for prosthetic control is highest.
Collapse
Affiliation(s)
- Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Cosima Prahm
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- BG Trauma Clinic, Eberhard Karls University, Department for Plastic and Reconstructive Surgery, Tübingen, Germany
| | - Konstantin D. Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Bioengineering, Imperial College London, London, UK
| | - Christian Hofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Otto Bock Healthcare Products GmbH, Vienna, Austria
| | | | | | | | - Dario Farina
- Department of Bioengineering, Imperial College London, London, UK
| | - Oskar C. Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
10
|
Pasluosta C, Kiele P, Čvančara P, Micera S, Aszmann OC, Stieglitz T. Bidirectional bionic limbs: a perspective bridging technology and physiology. J Neural Eng 2022; 19. [PMID: 35132954 DOI: 10.1088/1741-2552/ac4bff] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/17/2022] [Indexed: 11/11/2022]
Abstract
Precise control of bionic limbs relies on robust decoding of motor commands from nerves or muscles signals and sensory feedback from artificial limbs to the nervous system by interfacing the afferent nerve pathways. Implantable devices for bidirectional communication with bionic limbs have been developed in parallel with research on physiological alterations caused by an amputation. In this perspective article, we question whether increasing our effort on bridging these technologies with a deeper understanding of amputation pathophysiology and human motor control may help to overcome pressing stalls in the next generation of bionic limbs.
Collapse
Affiliation(s)
- C Pasluosta
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - P Kiele
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - P Čvančara
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany.,BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany
| | - S Micera
- School of Engineering, École Polytechnique Fédérale de Lausanne, Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, Lausanne, Switzerland.,The BioRobotics Institute and Department of Excellence in Robotics and Artificial Intelligence, Scuola Superiore Sant'Anna, Pisa, Italy
| | - O C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna; Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - T Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany.,Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany.,BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany
| |
Collapse
|
11
|
Liu X, Li J, Mao W, Chen Z, Chen Z, Wan P, Yu H. A Charge Balanced Neural Stimulator Silicon Chip for Human-Machine Interface. FRONTIERS IN ELECTRONICS 2021. [DOI: 10.3389/felec.2021.773812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This paper proposes a neural stimulator silicon chip design with an improved charge balancing technology. The proposed neural stimulation integrated circuit (IC) uses two charge balancing modules including synchronous charge detection module and short-time pulse insertion module. The synchronous charge detection module is designed based on a current splitter with ultra-small output current and an integrator circuit for neural stimulation pulse width control, which greatly reduces the residual charge remained on the electrode-tissue interface. The short-time pulse insertion module is designed based on the electrode voltage detection and compensation current control, which further reduces the accumulated residual charge and keeps the electrode voltage within a safety range of ±25 mV during multiple stimulation cycles. Finally, this neural stimulator is implemented in TSMC 0.18-μm CMOS process technology, and the chip function is tested and verified in both experiments with the electrode-tissue RC model and the PBS saline solution environment. The measurement result shows the neural stimulator chip achieves improved charge balancing with the residual charge smaller than 0.95 nC, which is the lowest compared to the traditional neural stimulator chips.
Collapse
|
12
|
Luft M, Klepetko J, Muceli S, Ibáñez J, Tereshenko V, Festin C, Laengle G, Politikou O, Maierhofer U, Farina D, Aszmann OC, Bergmeister KD. Proof of concept for multiple nerve transfers to a single target muscle. eLife 2021; 10:e71312. [PMID: 34596042 PMCID: PMC8530510 DOI: 10.7554/elife.71312] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Surgical nerve transfers are used to efficiently treat peripheral nerve injuries, neuromas, phantom limb pain, or improve bionic prosthetic control. Commonly, one donor nerve is transferred to one target muscle. However, the transfer of multiple nerves onto a single target muscle may increase the number of muscle signals for myoelectric prosthetic control and facilitate the treatment of multiple neuromas. Currently, no experimental models are available. This study describes a novel experimental model to investigate the neurophysiological effects of peripheral double nerve transfers to a common target muscle. In 62 male Sprague-Dawley rats, the ulnar nerve of the antebrachium alone (n=30) or together with the anterior interosseus nerve (n=32) was transferred to reinnervate the long head of the biceps brachii. Before neurotization, the motor branch to the biceps' long head was transected at the motor entry point. Twelve weeks after surgery, muscle response to neurotomy, behavioral testing, retrograde labeling, and structural analyses were performed to assess reinnervation. These analyses indicated that all nerves successfully reinnervated the target muscle. No aberrant reinnervation was observed by the originally innervating nerve. Our observations suggest a minimal burden for the animal with no signs of functional deficit in daily activities or auto-mutilation in both procedures. Furthermore, standard neurophysiological analyses for nerve and muscle regeneration were applicable. This newly developed nerve transfer model allows for the reliable and standardized investigation of neural and functional changes following the transfer of multiple donor nerves to one target muscle.
Collapse
Affiliation(s)
- Matthias Luft
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of ViennaViennaAustria
- Center for Biomedical Research, Medical University of ViennaViennaAustria
| | - Johanna Klepetko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of ViennaViennaAustria
- Center for Biomedical Research, Medical University of ViennaViennaAustria
| | - Silvia Muceli
- Department of Electrical Engineering, Chalmers University of TechnologyGothenburgSweden
| | - Jaime Ibáñez
- Department of Bioengineering, Imperial College LondonLondonUnited Kingdom
- Department of Clinical and Movement Neuroscience, University College London, LondonLondonUnited Kingdom
- BSICoS Group, IIS Aragón, Universidad de ZaragozaZaragozaSpain
| | - Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of ViennaViennaAustria
- Center for Biomedical Research, Medical University of ViennaViennaAustria
| | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of ViennaViennaAustria
- Center for Biomedical Research, Medical University of ViennaViennaAustria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of ViennaViennaAustria
- Center for Biomedical Research, Medical University of ViennaViennaAustria
| | - Olga Politikou
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of ViennaViennaAustria
- Center for Biomedical Research, Medical University of ViennaViennaAustria
| | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of ViennaViennaAustria
- Center for Biomedical Research, Medical University of ViennaViennaAustria
| | - Dario Farina
- Department of Bioengineering, Imperial College LondonLondonUnited Kingdom
- Department of Clinical and Movement Neuroscience, University College London, LondonLondonUnited Kingdom
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of ViennaViennaAustria
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of ViennaViennaAustria
| | - Konstantin Davide Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of ViennaViennaAustria
- Center for Biomedical Research, Medical University of ViennaViennaAustria
- Karl Landsteiner University of Health Sciences, Department of Plastic, Aesthetic and ReconstructiveSurgery, University Hospital St. PoeltenSt. PoeltenAustria
| |
Collapse
|
13
|
Yu T, Akhmadeev K, Carpentier EL, Aoustin Y, Farina D. Highly accurate real-time decomposition of single channel intramuscular EMG. IEEE Trans Biomed Eng 2021; 69:746-757. [PMID: 34388089 DOI: 10.1109/tbme.2021.3104621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Real-time intramuscular electromyography (iEMG) decomposition, as an identification procedure of individual motor neuron (MN) discharge timings from a streaming iEMG recording, has the potential to be used in human-machine interfacing. However, for these applications, the decomposition accuracy and speed of current approaches need to be improved. METHODS In our previous work, a real-time decomposition algorithm based on a Hidden Markov Model of EMG, using GPU-implemented Bayesian filter to estimate the spike trains of motor units (MU) and their action potentials (MUAPs), was proposed. In this paper, a substantially extended version of this algorithm that boosts the accuracy while maintaining real-time implementation, is introduced. Specifically, multiple heuristics that aim at resolving the problems leading to performance degradation, are applied to the original model. In addition, the recursive maximum likelihood (RML) estimator previously used to estimate the statistical parameters of the spike trains, is replaced by a linear regression (LR) estimator, which is computationally more efficient, in order to ensure real-time decomposition with the new heuristics. RESULTS The algorithm was validated using twenty-one experimental iEMG signals acquired from the tibialis anterior muscle of five subjects by fine wire electrodes. All signals were decomposed in real time. The decomposition accuracy depended on the level of muscle activation and was >90% when less than 10 MUs were identified, substantially exceeding previous real-time results. CONCLUSION Single channel iEMG signals can be very accurately decomposed in real time with the proposed algorithm. SIGNIFICANCE The proposed highly accurate algorithm for single-channel iEMG decomposition has the potential of providing neural information on motor tasks for human interfacing.
Collapse
|
14
|
Abstract
Targeted muscle reinnervation (TMR) is a surgical procedure, whereby nerves without muscle targets after extremity amputation are transferred to residual stump muscles. Thereby, the control of prosthesis is improved by increasing the number of independent muscle signals. The authors describe indications for TMR to improve prosthetic control and present standard nerve transfer matrices suitable for transhumeral and glenohumeral amputees. In addition, the perioperative procedure is described, including preoperative testing, surgical approach, and postoperative rehabilitation. Based on recent neurophysiological insights and technological advances, they present an outlook into the future of prosthetic control combining TMR and implantable electromyographic technology.
Collapse
Affiliation(s)
- Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
15
|
Hochgeschurz S, Bergmeister KD, Brånemark R, Aman M, Rocchi A, Restitutti F, Gumpenberger M, Sporer ME, Gstoettner C, Kramer AM, Lang S, Podesser BK, Aszmann OC. Avian extremity reconstruction via osseointegrated leg-prosthesis for intuitive embodiment. Sci Rep 2021; 11:12360. [PMID: 34117270 PMCID: PMC8195993 DOI: 10.1038/s41598-021-90048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 04/13/2021] [Indexed: 11/09/2022] Open
Abstract
For large avians such as vultures, limb loss leads to loss of ambulation and eventually death from malnutrition. Prosthetic devices may replace the limb, however, conventional prosthetic sockets are not feasible in feathered limbs and the extreme stress and strain of unreflected daily use in animals. Osseointegration is a novel technique, where external prosthetic parts are connected directly to a bone anchor to provide a solid skeletal-attachment. This concept provides a high degree of embodiment since osseoperception will provide direct intuitive feedback allowing natural use of the limb in gait and feeding. Here we demonstrate for the first time an osseointegrated bionic reconstruction of a limb in a vulture after a tarsometatarsal amputation with a longterm follow-up.
Collapse
Affiliation(s)
- Sarah Hochgeschurz
- Service for Birds and Reptiles, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria.
| | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Rickard Brånemark
- Department of Orthopaedics, Gothenburg University, Gothenburg, Sweden.,Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Martin Aman
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Attillio Rocchi
- Department of Anaesthesiology and Perioperative Intensive-Care Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Flavia Restitutti
- Department of Anaesthesiology and Perioperative Intensive-Care Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Michaela Gumpenberger
- Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Matthias E Sporer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | | | - Susanna Lang
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Bruno K Podesser
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
16
|
Tanzarella S, Muceli S, Del Vecchio A, Casolo A, Farina D. Non-invasive analysis of motor neurons controlling the intrinsic and extrinsic muscles of the hand. J Neural Eng 2020; 17:046033. [PMID: 32674079 DOI: 10.1088/1741-2552/aba6db] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We present a non-invasive framework for investigating efferent commands to 14 extrinsic and intrinsic hand muscles. We extend previous studies (limited to a few muscles) on common synaptic input among pools of motor neurons in a large number of muscles. APPROACH Seven subjects performed sinusoidal isometric contractions to complete seven types of grasps, with each finger and with three combinations of fingers in opposition with the thumb. High-density surface EMG (HD-sEMG) signals (384 channels in total) recorded from the 14 muscles were decomposed into the constituent motor unit action potentials. This provided a non-invasive framework for the investigation of motor neuron discharge patterns, muscle coordination and efferent commands of the hand muscles during grasping. Moreover, during grasping tasks, it was possible to identify common neural information among pools of motor neurons innervating the investigated muscles. For this purpose, principal component analysis (PCA) was applied to the smoothed discharge rates of the decoded motor units. MAIN RESULTS We found that the first principal component (PC1) of the ensemble of decoded motor neuron spike trains explained a variance of (53.0 ± 10.9) % and was positively correlated with force (R = 0.67 ± 0.10 across all subjects and tasks). By grouping the pools of motor neurons from extrinsic or intrinsic muscles, the PC1 explained a proportion of variance of (57.1 ± 11.3) % and (56.9 ± 11.8) %, respectively, and was correlated with force with R = 0.63 ± 0.13 and 0.63 ± 0.13, respectively. SIGNIFICANCE These observations demonstrate a low dimensional control of motor neurons across multiple muscles that can be exploited for extracting control signals in neural interfacing. The proposed framework was designed for hand rehabilitation perspectives, such as post-stroke rehabilitation and hand-exoskeleton control.
Collapse
Affiliation(s)
- Simone Tanzarella
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | | | | | | | | |
Collapse
|
17
|
Konstantin A, Yu T, Le Carpentier E, Aoustin Y, Farina D. Simulation of Motor Unit Action Potential Recordings From Intramuscular Multichannel Scanning Electrodes. IEEE Trans Biomed Eng 2020; 67:2005-2014. [DOI: 10.1109/tbme.2019.2953680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
18
|
Holt R, Murray S. Prosthesis and the engineered imagination: reading augmentation and disability across cultural theory, representation and product design. MEDICAL HUMANITIES 2020; 46:55-61. [PMID: 30894401 PMCID: PMC7042967 DOI: 10.1136/medhum-2018-011583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
This article argues for the value of considering the interaction of literary/cultural studies, disability studies and engineering/design studies in the ongoing development of a critical medical humanities research frame. With a specific focus on prosthesis, but also considerations of embodiment, technology and augmentation as concepts in both cultural/disability theory and engineering/design, we note how the shifting and plastic ideas of 'the prosthetic' as used within cultural studies have never been in conversation with scholars who work on prostheses in engineering design or the processes through which such technologies are produced. Additionally, we show that the increased use of systems engineering in the design and construction of prostheses creates fractured ideas of disabled bodies that frequently ignore both the cultural meaning and lived experience of technology use. In design and engineering, prostheses are literal objects, often made to order for a diverse range of clients and produced across different working platforms; in cultural studies, the word creates multiple resonances around both augmented bodies and non-embodied states increasingly understood in terms of assemblage and supplementarity. Working from this, we outline how questions of metaphor, materiality and systems weave through the different disciplines. The article claims that a critical dialogue between the working methods of literary/cultural studies and engineering/design, for all their obvious differences, possesses the potential to create informed and sophisticated accounts of disability embodiment. Our conclusion brings the strands of the enquiry together and points to the merits of engineering the imagination, and imagining engineering, as both a subject and method in future medical humanities research.
Collapse
Affiliation(s)
- Raymond Holt
- Mechanical Engineering, University of Leeds, Leeds, UK
| | | |
Collapse
|
19
|
Aman M, Bergmeister KD, Festin C, Sporer ME, Russold MF, Gstoettner C, Podesser BK, Gail A, Farina D, Cederna P, Aszmann OC. Experimental Testing of Bionic Peripheral Nerve and Muscle Interfaces: Animal Model Considerations. Front Neurosci 2020; 13:1442. [PMID: 32116485 PMCID: PMC7025572 DOI: 10.3389/fnins.2019.01442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/23/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction: Man-machine interfacing remains the main challenge for accurate and reliable control of bionic prostheses. Implantable electrodes in nerves and muscles may overcome some of the limitations by significantly increasing the interface's reliability and bandwidth. Before human application, experimental preclinical testing is essential to assess chronic in-vivo biocompatibility and functionality. Here, we analyze available animal models, their costs and ethical challenges in special regards to simulating a potentially life-long application in a short period of time and in non-biped animals. Methods: We performed a literature analysis following the PRISMA guidelines including all animal models used to record neural or muscular activity via implantable electrodes, evaluating animal models, group size, duration, origin of publication as well as type of interface. Furthermore, behavioral, ethical, and economic considerations of these models were analyzed. Additionally, we discuss experience and surgical approaches with rat, sheep, and primate models and an approach for international standardized testing. Results: Overall, 343 studies matched the search terms, dominantly originating from the US (55%) and Europe (34%), using mainly small animal models (rat: 40%). Electrode placement was dominantly neural (77%) compared to muscular (23%). Large animal models had a mean duration of 135 ± 87.2 days, with a mean of 5.3 ± 3.4 animals per trial. Small animal models had a mean duration of 85 ± 11.2 days, with a mean of 12.4 ± 1.7 animals. Discussion: Only 37% animal models were by definition chronic tests (>3 months) and thus potentially provide information on long-term performance. Costs for large animals were up to 45 times higher than small animals. However, costs are relatively small compared to complication costs in human long-term applications. Overall, we believe a combination of small animals for preliminary primary electrode testing and large animals to investigate long-term biocompatibility, impedance, and tissue regeneration parameters provides sufficient data to ensure long-term human applications.
Collapse
Affiliation(s)
- Martin Aman
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias E Sporer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | | | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Bruno K Podesser
- Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Alexander Gail
- Cognitive Neuroscience Lab, German Primate Center, Göttingen, Germany
| | - Dario Farina
- Department of Bioengineering, Imperial College, London, United Kingdom
| | - Paul Cederna
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
20
|
Hruby LA, Gstoettner C, Sturma A, Salminger S, Mayer JA, Aszmann OC. Bionic Upper Limb Reconstruction: A Valuable Alternative in Global Brachial Plexus Avulsion Injuries-A Case Series. J Clin Med 2019; 9:jcm9010023. [PMID: 31861941 PMCID: PMC7019829 DOI: 10.3390/jcm9010023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/15/2022] Open
Abstract
Global brachial plexopathies including multiple nerve root avulsions may result in complete upper limb paralysis despite surgical treatment. Bionic reconstruction, which includes the elective amputation of the functionless hand and its replacement with a mechatronic device, has been described for the transradial level. Here, we present for the first time that patients with global brachial plexus avulsion injuries and lack of biological shoulder and elbow function benefit from above-elbow amputation and prosthetic rehabilitation. Between 2012 and 2017, forty-five patients with global brachial plexus injuries approached our centre, of which nineteen (42.2%) were treated with bionic reconstruction. While fourteen patients were amputated at the transradial level, the entire upper limb was replaced with a prosthetic arm in a total of five patients. Global upper extremity function before and after bionic arm substitution was assessed using two objective hand function tests, the action research arm test (ARAT), and the Southampton hand assessment procedure (SHAP). Other outcome measures included the DASH questionnaire, VAS to assess deafferentation pain and the SF-36 health survey to evaluate changes in quality of life. Using a hybrid prosthetic arm mean ARAT scores improved from 0.6 ± 1.3 to 11.0 ± 6.7 (p = 0.042) and mean SHAP scores increased from 4.0 ± 3.7 to 13.8 ± 9.2 (p = 0.058). After prosthetic arm replacement mean DASH scores improved from 52.5 ± 9.4 to 31.2 ± 9.8 (p = 0.003). Deafferentation pain decreased from mean VAS 8.5 ± 1.0 to 6.7 ± 2.1 (p = 0.055), while the physical and mental component summary scale as part of the SF-36 health survey improved from 32.9 ± 6.4 to 40.4 ± 9.4 (p = 0.058) and 43.6 ± 8.9 to 57.3 ± 5.5 (p = 0.021), respectively. Bionic reconstruction can restore simple but robust arm and hand function in longstanding brachial plexus patients with lack of treatment alternatives.
Collapse
Affiliation(s)
- Laura A Hruby
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Johannes A Mayer
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| |
Collapse
|
21
|
Lancashire HT, Al Ajam Y, Dowling RP, Pendegrass CJ, Blunn GW. Hard-wired Epimysial Recordings from Normal and Reinnervated Muscle Using a Bone-anchored Device. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2391. [PMID: 31741811 PMCID: PMC6799399 DOI: 10.1097/gox.0000000000002391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/07/2019] [Indexed: 12/02/2022]
Abstract
A combined approach for prosthetic attachment and control using a transcutaneous bone-anchored device and implanted muscle electrodes can improve function for upper-limb amputees. The bone-anchor provides a transcutaneous feed-through for muscle signal recording. This approach can be combined with targeted muscle reinnervation (TMR) to further improve myoelectric control. METHODS A bone-anchored device was implanted trans-tibially in n = 8 sheep with a bipolar recording electrode secured epimysially to the peroneus tertius muscle. TMR was carried out in a single animal: the peroneus tertius was deinnervated and the distal portion of the transected nerve to the peroneus muscle was coapted to a transected nerve branch previously supplying the tibialis anterior muscle. For 12 weeks (TMR) or 19 weeks (standard procedure), epimysial muscle signals were recorded while animals walked at 2 km·h-1. RESULTS After 19 weeks implantation following standard procedure, epimysial recording signal-to-noise ratio (SNR) was 18.7 dB (± 6.4 dB, 95% CI) with typical recordings falling in the range 10-25 dB. Recoveries in gait and muscle signals were coincident 6 weeks post-TMR; initial muscle activity was identifiable 3 weeks post-TMR though with low signal amplitude and signal-to-noise ratio compared with normal muscle recordings. CONCLUSIONS Following recovery, muscle signals were recorded reliably over 19 weeks following implantation. In this study, targeted reinnervation was successful in parallel with bone-anchor implantation, with recovery identified 6 weeks after surgery.
Collapse
Affiliation(s)
- Henry T. Lancashire
- From the Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Yazan Al Ajam
- Research Department of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Royal Free Hospital, London, UK
| | - Robert P. Dowling
- Research Department of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Catherine J. Pendegrass
- Research Department of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Gordon W. Blunn
- Research Department of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| |
Collapse
|
22
|
Sun W, Tang R, Lang Y, He J, Qiang H. Decomposing single-channel intramuscular electromyography signal sampled at a low frequency into its motor unit action potential trains with a generative adversarial network. J Electromyogr Kinesiol 2019; 48:187-196. [PMID: 31408753 DOI: 10.1016/j.jelekin.2019.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/10/2019] [Accepted: 07/30/2019] [Indexed: 12/21/2022] Open
Abstract
Conventional methods decompose single-channel intramuscular electromyography (iEMG) signals into their constituent motor unit action potential trains (MUAPTs) by detecting and clustering individual motor unit action potentials (MUAPs). However, these methods are not applicable for iEMG signals recorded by electrodes with a large sensing areas or iEMG signals sampled at a low frequency, in which detecting and clustering individual MUAPs are difficult due to superimpositions of the MUAPs and the loss of MUAP morphological characteristics. In this study, we propose an approach based on a generative adversarial network to decompose iEMG signals, which does not depend on detecting and clustering individual MUAPs from the iEMG signal. The proposed approach decomposes the iEMG signal into its MUAPTs based on Bayes' law and a Wasserstein generative adversarial network with gradient penalty (WGAN-GP). MUAPTs generated by the WGAN-GP were used to decompose the iEMG signal to maximize the posterior probability of the generated MUAPTs given the iEMG signal. The accuracy of the proposed approach is analysed directly by decomposing the simulated iEMG signal with seven gold-standard motor units. The results showed that the proposed approach achieved a 53% accuracy in capturing the firing regularities of the MUs, while the conventional method achieved a 37% accuracy on the same task.
Collapse
Affiliation(s)
- Wentao Sun
- Key Laboratory of Biomimetic Robots and Systems, Ministry of Education, Beijing, China; School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | - Rongyu Tang
- Beijing Innovation Center for Intelligent Robots and Systems, Beijing, China.
| | - Yiran Lang
- Beijing Innovation Center for Intelligent Robots and Systems, Beijing, China
| | - Jiping He
- Key Laboratory of Biomimetic Robots and Systems, Ministry of Education, Beijing, China
| | - Huang Qiang
- Key Laboratory of Biomimetic Robots and Systems, Ministry of Education, Beijing, China
| |
Collapse
|
23
|
Salminger S, Sturma A, Hofer C, Evangelista M, Perrin M, Bergmeister KD, Roche AD, Hasenoehrl T, Dietl H, Farina D, Aszmann OC. Long-term implant of intramuscular sensors and nerve transfers for wireless control of robotic arms in above-elbow amputees. Sci Robot 2019; 4:4/32/eaaw6306. [PMID: 33137771 DOI: 10.1126/scirobotics.aaw6306] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/20/2019] [Indexed: 11/02/2022]
Abstract
Targeted muscle reinnervation (TMR) amplifies the electrical activity of nerves at the stump of amputees by redirecting them in remnant muscles above the amputation. The electrical activity of the reinnervated muscles can be used to extract natural control signals. Nonetheless, current control systems, mainly based on noninvasive muscle recordings, fail to provide accurate and reliable control over time. This is one of the major reasons for prosthetic abandonment. This prospective interventional study includes three unilateral above-elbow amputees and reports the long-term (2.5 years) implant of wireless myoelectric sensors in the reinnervation sites after TMR and their use for control of robotic arms in daily life. It therefore demonstrates the clinical viability of chronically implanted myoelectric interfaces that amplify nerve activity through TMR. The patients showed substantial functional improvements using the implanted system compared with control based on surface electrodes. The combination of TMR and chronically implanted sensors may drastically improve robotic limb replacement in above-elbow amputees.
Collapse
Affiliation(s)
- S Salminger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - A Sturma
- Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Department of Bioengineering, Royal School of Mines, Imperial College London, South Kensington Campus, Kensington, London SW7 2AZ, UK
| | - C Hofer
- Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Otto Bock Healthcare Products GmbH, Brehmstraße 16, A-1110 Vienna, Austria
| | - M Evangelista
- Alfred Mann Foundation, 25134 Rye Canyon Loop #200, Valencia, CA 91355, USA
| | - M Perrin
- Alfred Mann Foundation, 25134 Rye Canyon Loop #200, Valencia, CA 91355, USA
| | - K D Bergmeister
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - A D Roche
- Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Deanery of Clinical Sciences, The University of Edinburgh, Scotland, UK.,Department of Plastic & Reconstructive Surgery, NHS Lothian, Scotland, UK
| | - T Hasenoehrl
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - H Dietl
- Otto Bock Healthcare Products GmbH, Brehmstraße 16, A-1110 Vienna, Austria
| | - D Farina
- Department of Bioengineering, Royal School of Mines, Imperial College London, South Kensington Campus, Kensington, London SW7 2AZ, UK
| | - O C Aszmann
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. .,Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| |
Collapse
|
24
|
Aman M, Festin C, Sporer ME, Gstoettner C, Prahm C, Bergmeister KD, Aszmann OC. Bionic reconstruction : Restoration of extremity function with osseointegrated and mind-controlled prostheses. Wien Klin Wochenschr 2019; 131:599-607. [PMID: 31201567 PMCID: PMC6908564 DOI: 10.1007/s00508-019-1518-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 05/22/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022]
Abstract
Background Loss of an extremity at any level has a major impact on a patient’s life. Using bionic reconstruction, extremity function can be restored and the patient reintegrated into daily life. Surgical procedures including selective nerve transfer and anchoring of prostheses into bone are combined with structured rehabilitation and modern prosthetic fitting. The patient is thereby able to use the prostheses intuitively and with multiple degrees of freedom. Methods This article presents the concept and approach for modern bionic reconstruction in detail and the relevant literature. The nerve transfer matrices for targeted muscle reinnervation (TMR) and the concept of osseointegration to optimally fit a patient with a modern prosthesis are described in detail. As a clinical example, the case of a patient who suffered from traumatic amputation and subsequently received TMR in combination with an osseointegrated implant and structured rehabilitation is presented. Results Using bionic reconstruction, basic hand functions can be restored and bimanual dexterity can expand the range of daily activities. Besides this approach to bionic reconstruction, its advantages and disadvantages are compared to hand transplantation. The limitations and perspectives of modern bionic reconstruction are also discussed. Conclusions Bionic reconstruction is a sophisticated method for restoring extremity function and nowadays can be considered a standard of care for all levels of upper extremity amputations. An interdisciplinary approach and structured rehabilitation are necessary to master prosthetic function to ultimately reintegrate patients into daily life.
Collapse
Affiliation(s)
- Martin Aman
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Christopher Festin
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias E Sporer
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Clemens Gstoettner
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Cosima Prahm
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Konstantin D Bergmeister
- Division of Biomedical Research, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria. .,Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria. .,Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| |
Collapse
|
25
|
Aman M, Sporer ME, Gstoettner C, Prahm C, Hofer C, Mayr W, Farina D, Aszmann OC. Bionic hand as artificial organ: Current status and future perspectives. Artif Organs 2019; 43:109-118. [PMID: 30653695 DOI: 10.1111/aor.13422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/20/2022]
Abstract
Even though the hand comprises only 1% of our body weight, about 30% of our central nervous systems (CNS) capacity is related to its control. The loss of a hand thus presents not only the loss of the most important tool allowing us to interact with our environment, but also leaves a dramatic sensory-motor deficit that challenges our CNS. Reconstruction of hand function is therefore not only an essential part of restoring body integrity and functional wholeness but also closes the loop of our neural circuits diminishing phantom sensation and neural pain. If biology fails to restore meaningful function, today we can resort to complex mechatronic replacement that have functional capabilities that in some respects even outperform biological alternatives, such as hand transplantation. As with replantation and transplantations, the challenge of bionic replacement is connecting the target with the CNS to achieve natural and intuitive control. In recent years, we have developed a number of strategies to improve neural interfacing, signal extraction, interpretation and stable mechanical attachment that are important parts of our current research. This work gives an overview of recent advances in bionic reconstruction, surgical refinements over technological interfacing, skeletal fixation, and modern rehabilitation tools that allow quick integration of prosthetic replacement.
Collapse
Affiliation(s)
- Martin Aman
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Matthias E Sporer
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Clemens Gstoettner
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Cosima Prahm
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Winfried Mayr
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, UK
| | - Oskar C Aszmann
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
26
|
Muceli S, Poppendieck W, Hoffmann KP, Dosen S, Benito-León J, Barroso FO, Pons JL, Farina D. A thin-film multichannel electrode for muscle recording and stimulation in neuroprosthetics applications. J Neural Eng 2019; 16:026035. [PMID: 30721892 DOI: 10.1088/1741-2552/ab047a] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We propose, design and test a novel thin-film multichannel electrode that can be used for both recording from and stimulating a muscle in acute implants. APPROACH The system is built on a substrate of polyimide and contains 12 recording and three stimulation sites made of platinum. The structure is 420 µm wide, 20 µm thick and embeds the recording and stimulation contacts on the two sides of the polyimide over an approximate length of 2 cm. We show representative applications in healthy individuals as well as tremor patients. The designed system was tested by a psychometric characterization of the stimulation contacts in six tremor patients and three healthy individuals determining the perception threshold and current limit as well as the success rate in discriminating elicited sensations (electrotactile feedback). Also, we investigated the possibility of using the intramuscular electrode for reducing tremor in one patient by electrical stimulation delivered with timing based on the electromyographic activity recorded with the same electrode. MAIN RESULTS In the tremor patients, the current corresponding to the perception threshold and the current limit were 0.7 ± 0.2 and 1.4 ± 0.7 mA for the wrist flexor muscles and 0.4 ± 0.2 and 1.5 ± 0.7 mA for the extensors. In one patient, closed-loop stimulation resulted in a decrease of the tremor power >50%. In healthy individuals the perception threshold and current limits were 0.9 ± 0.6 and 2.1 ± 0.6 mA for the extensor carpi radialis muscle. The subjects could distinguish four or six stimulation patterns (two or three stimulation sites × two stimulation current amplitudes) with true positive rate >80% (two subjects) and >60% (one subject), respectively. SIGNIFICANCE The proposed electrode provides a compact multichannel interface for recording electromyogram and delivering electrical stimulation in applications such as neuroprostheses for tremor suppression and closed-loop myoelectric prostheses.
Collapse
Affiliation(s)
- Silvia Muceli
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Chen C, Chai G, Guo W, Sheng X, Farina D, Zhu X. Prediction of finger kinematics from discharge timings of motor units: implications for intuitive control of myoelectric prostheses. J Neural Eng 2019; 16:026005. [DOI: 10.1088/1741-2552/aaf4c3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
28
|
Sturma A, Hruby LA, Prahm C, Mayer JA, Aszmann OC. Rehabilitation of Upper Extremity Nerve Injuries Using Surface EMG Biofeedback: Protocols for Clinical Application. Front Neurosci 2018; 12:906. [PMID: 30564090 PMCID: PMC6288367 DOI: 10.3389/fnins.2018.00906] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/19/2018] [Indexed: 11/13/2022] Open
Abstract
Motor recovery following nerve transfer surgery depends on the successful re-innervation of the new target muscle by regenerating axons. Cortical plasticity and motor relearning also play a major role during functional recovery. Successful neuromuscular rehabilitation requires detailed afferent feedback. Surface electromyographic (sEMG) biofeedback has been widely used in the rehabilitation of stroke, however, has not been described for the rehabilitation of peripheral nerve injuries. The aim of this paper was to present structured rehabilitation protocols in two different patient groups with upper extremity nerve injuries using sEMG biofeedback. The principles of sEMG biofeedback were explained and its application in a rehabilitation setting was described. Patient group 1 included nerve injury patients who received nerve transfers to restore biological upper limb function (n = 5) while group 2 comprised patients where biological reconstruction was deemed impossible and hand function was restored by prosthetic hand replacement, a concept today known as bionic reconstruction (n = 6). The rehabilitation protocol for group 1 included guided sEMG training to facilitate initial movements, to increase awareness of the new target muscle, and later, to facilitate separation of muscular activities. In patient group 2 sEMG biofeedback helped identify EMG activity in biologically "functionless" limbs and improved separation of EMG signals upon training. Later, these sEMG signals translated into prosthetic function. Feasibility of the rehabilitation protocols for the two different patient populations was illustrated. Functional outcome measures were assessed with standardized upper extremity outcome measures [British Medical Research Council (BMRC) scale for group 1 and Action Research Arm Test (ARAT) for group 2] showing significant improvements in motor function after sEMG training. Before actual movements were possible, sEMG biofeedback could be used. Patients reported that this visualization of muscle activity helped them to stay motivated during rehabilitation and facilitated their understanding of the re-innervation process. sEMG biofeedback may help in the cognitively demanding process of establishing new motor patterns. After standard nerve transfers individually tailored sEMG biofeedback can facilitate early sensorimotor re-education by providing visual cues at a stage when muscle activation cannot be detected otherwise.
Collapse
Affiliation(s)
- Agnes Sturma
- Christian Doppler Laboratory for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Health Assisting Engineering, University of Applied Sciences FH Campus Wien, Vienna, Austria.,Neuromechanics and Rehabilitation Technology Group, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Laura A Hruby
- Christian Doppler Laboratory for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Cosima Prahm
- Christian Doppler Laboratory for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes A Mayer
- Christian Doppler Laboratory for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- Christian Doppler Laboratory for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
29
|
Muceli S, Bergmeister KD, Hoffmann KP, Aman M, Vukajlija I, Aszmann OC, Farina D. Decoding motor neuron activity from epimysial thin-film electrode recordings following targeted muscle reinnervation. J Neural Eng 2018; 16:016010. [PMID: 30524045 DOI: 10.1088/1741-2552/aaed85] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Surface electromyography (EMG) is currently used as a control signal for active prostheses in amputees who underwent targeted muscle reinnervation (TMR) surgery. Recent research has shown that it is possible to access the spiking activity of spinal motor neurons from multi-channel surface EMG. In this study, we propose the use of multi-channel epimysial EMG electrodes as an interface for decoding motor neurons activity following TMR. APPROACH We tested multi-channel epimysial electrodes (48 detection sites) built with thin-film technology in an animal model of TMR. Eight animals were tested 12 weeks after reinnervation of the biceps brachii lateral head by the ulnar nerve. We identified the position of the innervation zone and the muscle fiber conduction velocity of motor units decoded from the multi-channel epimysial recordings. Moreover, we characterized the pick-up volume by the distribution of the motor unit action potential amplitude over the epimysium surface. MAIN RESULTS The electrodes provided high quality signals with average signal-to-noise ratio >30 dB across 95 identified motor units. The motor unit action potential amplitude decreased with increasing distance of the electrode from the muscle fibers (P [Formula: see text] 0.001). The decrease was more pronounced for bipolar compared to monopolar derivations. The average muscle fiber conduction velocity was 2.46 ± 0.83 m s-1. Most of the neuromuscular junctions were close to the region where the nerve was neurotized, as observed from the EMG recordings and imaging data. SIGNIFICANCE These results show that epimysial electrodes can be used for selective recordings of motor unit activities with a pick-up volume that included the entire muscle in the rat hindlimb. Epimysial electrodes can thus be used for detecting motor unit activity in muscles with specific fascicular territories associated to different functions following TMR surgery.
Collapse
Affiliation(s)
- Silvia Muceli
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
30
|
Chen M, Zhang X, Lu Z, Li X, Zhou P. Two-Source Validation of Progressive FastICA Peel-Off for Automatic Surface EMG Decomposition in Human First Dorsal Interosseous Muscle. Int J Neural Syst 2018; 28:1850019. [PMID: 29909721 DOI: 10.1142/s0129065718500193] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study aims to assess the accuracy of a novel high density surface electromyogram (SEMG) decomposition method, namely automatic progressive FastICA peel-off (APFP), for automatic decomposition of experimental electrode array SEMG signals. A two-source method was performed by simultaneous concentric needle EMG and electrode array SEMG recordings from the human first dorsal interosseous (FDI) muscle, using a protocol commonly applied in clinical EMG examination. The electrode array SEMG was automatically decomposed by the APFP while the motor unit action potential (MUAP) trains were also independently identified from the concentric needle EMG. The degree of agreement of the common motor unit (MU) discharge timings decomposed from the two different categories of EMG signals was assessed. A total of 861 and 217 MUs were identified from the 114 trials of simultaneous high density SEMG and concentric needle EMG recordings, respectively. Among them 168 common (MUs) were found with a high average matching rate of [Formula: see text] for the discharge timings. The outcomes of this study show that the APFP can reliably decompose at least a subset of MUs in the high density SEMG signals recorded from the human FDI muscle during low contraction levels using a protocol analog to clinical EMG examination.
Collapse
Affiliation(s)
- Maoqi Chen
- Biomedical Engineering Program, University of Science and Technology of China, Hefei, P. R. China
- Guangdong Work Injury Rehabilitation Center, Guangzhou, P. R. China
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, USA
- TIRR Memorial Hermann Hospital, Houston, USA
| | - Xu Zhang
- Biomedical Engineering Program, University of Science and Technology of China, Hefei, P. R. China
| | - Zhiyuan Lu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, USA
- TIRR Memorial Hermann Hospital, Houston, USA
| | - Xiaoyan Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, USA
- TIRR Memorial Hermann Hospital, Houston, USA
| | - Ping Zhou
- Guangdong Work Injury Rehabilitation Center, Guangzhou, P. R. China
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, USA
- TIRR Memorial Hermann Hospital, Houston, USA
| |
Collapse
|