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Nanivadekar AC, Bose R, Petersen BA, Okorokova EV, Sarma D, Madonna TJ, Barra B, Farooqui J, Dalrymple AN, Levy I, Helm ER, Miele VJ, Boninger ML, Capogrosso M, Bensmaia SJ, Weber DJ, Fisher LE. Restoration of sensory feedback from the foot and reduction of phantom limb pain via closed-loop spinal cord stimulation. Nat Biomed Eng 2023:10.1038/s41551-023-01153-8. [PMID: 38097809 DOI: 10.1038/s41551-023-01153-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/27/2023] [Indexed: 12/30/2023]
Abstract
Restoring somatosensory feedback in individuals with lower-limb amputations would reduce the risk of falls and alleviate phantom limb pain. Here we show, in three individuals with transtibial amputation (one traumatic and two owing to diabetic peripheral neuropathy), that sensations from the missing foot, with control over their location and intensity, can be evoked via lateral lumbosacral spinal cord stimulation with commercially available electrodes and by modulating the intensity of stimulation in real time on the basis of signals from a wireless pressure-sensitive shoe insole. The restored somatosensation via closed-loop stimulation improved balance control (with a 19-point improvement in the composite score of the Sensory Organization Test in one individual) and gait stability (with a 5-point improvement in the Functional Gait Assessment in one individual). And over the implantation period of the stimulation leads, the three individuals experienced a clinically meaningful decrease in phantom limb pain (with an average reduction of nearly 70% on a visual analogue scale). Our findings support the further clinical assessment of lower-limb neuroprostheses providing somatosensory feedback.
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Affiliation(s)
- Ameya C Nanivadekar
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Rohit Bose
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Bailey A Petersen
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Elizaveta V Okorokova
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Devapratim Sarma
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tyler J Madonna
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatrice Barra
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, Switzerland
| | - Juhi Farooqui
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Ashley N Dalrymple
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Isaiah Levy
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric R Helm
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vincent J Miele
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marco Capogrosso
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Douglas J Weber
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA.
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.
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2
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Malesevic N, Lindén F, Fureby L, Rudervall C, Björkman A, Antfolk C. Exploration of sensations evoked during electrical stimulation of the median nerve at the wrist level. J Neural Eng 2023; 20:066025. [PMID: 38029427 DOI: 10.1088/1741-2552/ad10d0] [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: 06/30/2023] [Accepted: 11/29/2023] [Indexed: 12/01/2023]
Abstract
Objective.Nerve rehabilitation following nerve injury or surgery at the wrist level is a lengthy process during which not only peripheral nerves regrow towards receptors and muscles, but also the brain undergoes plastic changes. As a result, at the time when nerves reach their targets, the brain might have already allocated some of the areas within the somatosensory cortex that originally processed hand signals to some other regions of the body. The aim of this study is to show that it is possible to evoke a variety of somatotopic sensations related to the hand while stimulating proximally to the injury, therefore, providing the brain with the relevant inputs from the hand regions affected by the nerve damage.Approach.This study included electrical stimulation of 28 able-bodied participants where an electrode that acted as a cathode was placed above the Median nerve at the wrist level. The parameters of electrical stimulation, amplitude, frequency, and pulse shape, were modulated within predefined ranges to evaluate their influence on the evoked sensations.Main results.Using this methodology, the participants reported a wide variety of somatotopic sensations from the hand regions distal to the stimulation electrode.Significance.Furthermore, to propose an accelerated stimulation tuning procedure that could be implemented in a clinical protocol and/or standalone device for providing meaningful sensations to the somatosensory cortex during nerve regeneration, we trained machine-learning techniques using the gathered data to predict the location/area, naturalness, and sensation type of the evoked sensations following different stimulation patterns.
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Affiliation(s)
- Nebojsa Malesevic
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Frida Lindén
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Lycke Fureby
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Carolina Rudervall
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Anders Björkman
- Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Antfolk
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
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3
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Valle G, Iberite F, Strauss I, D'Anna E, Granata G, Di Iorio R, Stieglitz T, Raspopovic S, Petrini FM, Rossini PM, Micera S. A Psychometric Platform to Collect Somatosensory Sensations for Neuroprosthetic Use. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:619280. [PMID: 35047903 PMCID: PMC8757828 DOI: 10.3389/fmedt.2021.619280] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Somatosensory neuroprostheses exploit invasive and non-invasive feedback technologies to restore sensorimotor functions lost to disease or trauma. These devices use electrical stimulation to communicate sensory information to the brain. A sensation characterization procedure is thus necessary to determine the appropriate stimulation parameters and to establish a clear personalized map of the sensations that can be restored. Several questionnaires have been described in the literature to collect the quality, type, location, and intensity of the evoked sensations, but there is still no standard psychometric platform. Here, we propose a new psychometric system containing previously validated questionnaires on evoked sensations, which can be applied to any kind of somatosensory neuroprosthesis. The platform collects stimulation parameters used to elicit sensations and records subjects' percepts in terms of sensation location, type, quality, perceptual threshold, and intensity. It further collects data using standardized assessment questionnaires and scales, performs measurements over time, and collects phantom limb pain syndrome data. The psychometric platform is user-friendly and provides clinicians with all the information needed to assess the sensory feedback. The psychometric platform was validated with three trans-radial amputees. The platform was used to assess intraneural sensory feedback provided through implanted peripheral nerve interfaces. The proposed platform could act as a new standardized assessment toolbox to homogenize the reporting of results obtained with different technologies in the field of somatosensory neuroprosthetics.
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Affiliation(s)
- Giacomo Valle
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
| | | | - Ivo Strauss
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Edoardo D'Anna
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Institute of Bioengineering, Lausanne, Switzerland
| | - Giuseppe Granata
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Policlinic A. Gemelli Foundation, Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Di Iorio
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Policlinic A. Gemelli Foundation, Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center, BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany
| | - Stanisa Raspopovic
- Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
| | - Francesco M Petrini
- Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
| | - Paolo M Rossini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Policlinic A. Gemelli Foundation, Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Institute of Bioengineering, Lausanne, Switzerland
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4
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Demofonti A, Scarpelli A, Cordella F, Zollo L. Modulation of sensation intensity in the lower limb via Transcutaneous Electrical Nerve Stimulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6470-6474. [PMID: 34892592 DOI: 10.1109/embc46164.2021.9630871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Commercially available lower limb prostheses do not restore sensory feedback in amputees. Literature suggests that Transcutaneous Electrical Nerve Stimulation (TENS) is a valid non-invasive, somatotopic technique to elicit tactile sensations, but no studies have been performed to investigate the capability of discriminating stimulus intensity via TENS in the foot. The aim of the study is to investigate how TENS can be used in order to restore sensations in the lower limb with different levels of intensity. Two experimental protocols were developed and tested on 8 healthy subjects: Mapping protocol is addressed to a fully characterization of the evoked tactile sensations; the Stimulus Intensity Discrimination one aims at investigating the best stimulation parameter to modulate for allowing the recognition of different levels of intensity. The results showed how elicited sensations were mostly described as an almost natural and superficial. A variation of the referred sensation (from nothing to vibration) and its intensity (ρ=0.6431) occurred when a higher quantity of charge was injected. Among the three modulated stimulation parameters, Pulse Amplitude (PA) has the best performance in terms of success rate (90%) and has a statistically significant difference with Pulse Frequency (PF) (PPA-PF = 0.0073<0.016). In the future, PA modulation will be tested on a larger number of healthy subjects and on amputees.
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5
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Hughes CL, Flesher SN, Weiss JM, Boninger M, Collinger JL, Gaunt RA. Perception of microstimulation frequency in human somatosensory cortex. eLife 2021; 10:65128. [PMID: 34313221 PMCID: PMC8376245 DOI: 10.7554/elife.65128] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/22/2021] [Indexed: 12/11/2022] Open
Abstract
Microstimulation in the somatosensory cortex can evoke artificial tactile percepts and can be incorporated into bidirectional brain–computer interfaces (BCIs) to restore function after injury or disease. However, little is known about how stimulation parameters themselves affect perception. Here, we stimulated through microelectrode arrays implanted in the somatosensory cortex of two human participants with cervical spinal cord injury and varied the stimulus amplitude, frequency, and train duration. Increasing the amplitude and train duration increased the perceived intensity on all tested electrodes. Surprisingly, we found that increasing the frequency evoked more intense percepts on some electrodes but evoked less-intense percepts on other electrodes. These different frequency–intensity relationships were divided into three groups, which also evoked distinct percept qualities at different stimulus frequencies. Neighboring electrode sites were more likely to belong to the same group. These results support the idea that stimulation frequency directly controls tactile perception and that these different percepts may be related to the organization of somatosensory cortex, which will facilitate principled development of stimulation strategies for bidirectional BCIs.
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Affiliation(s)
- Christopher L Hughes
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, United States
| | - Sharlene N Flesher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, United States.,Department of Neurosurgery, Stanford University, Stanford, United States.,Department of Electrical Engineering, Stanford University, Stanford, United States
| | - Jeffrey M Weiss
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States
| | - Michael Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States.,Human Engineering Research Laboratories, VA Center of Excellence, Department of Veterans Affairs, Pittsburgh, United States
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States.,Human Engineering Research Laboratories, VA Center of Excellence, Department of Veterans Affairs, Pittsburgh, United States
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States
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6
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Raspopovic S, Valle G, Petrini FM. Sensory feedback for limb prostheses in amputees. NATURE MATERIALS 2021; 20:925-939. [PMID: 33859381 DOI: 10.1038/s41563-021-00966-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Commercial prosthetic devices currently do not provide natural sensory information on the interaction with objects or movements. The subsequent disadvantages include unphysiological walking with a prosthetic leg and difficulty in controlling the force exerted with a prosthetic hand, thus creating health issues. Restoring natural sensory feedback from the prosthesis to amputees is an unmet clinical need. An optimal device should be able to elicit natural sensations of touch or proprioception, by delivering the complex signals to the nervous system that would be produced by skin, muscles and joints receptors. This Review covers the various neurotechnological approaches that have been proposed for the development of the optimal sensory feedback restoration device for arm and leg amputees.
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Affiliation(s)
- Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland.
| | - Giacomo Valle
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
| | - Francesco Maria Petrini
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zurich, Switzerland
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7
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Scarpelli A, Demofonti A, Terracina F, Ciancio AL, Zollo L. Evoking Apparent Moving Sensation in the Hand via Transcutaneous Electrical Nerve Stimulation. Front Neurosci 2020; 14:534. [PMID: 32625047 PMCID: PMC7314928 DOI: 10.3389/fnins.2020.00534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/30/2020] [Indexed: 12/25/2022] Open
Abstract
The restoration of sensory feedback in amputees plays a fundamental role in the prosthesis control and in the communication on the afferent channel between hand and brain. The literature shows that transcutaneous electrical nerve stimulation (TENS) can be a promising non-invasive technique to elicit sensory feedback in amputees, especially in the lower limb through the phenomenon of apparent moving sensation (AMS). It consists of delivering a sensation that moves along a specific part of the body. This study proposes to use TENS to elicit tactile sensations and adopt AMS to reproduce moving sensations on the hand, such as those related to an object moving in the hand or slipping upward or downward. To this purpose, the developed experimental protocol consists of two phases: (i) the mapping of the evoked sensations and (ii) the generation of the AMS. In the latter phase, the pulse amplitude variation (PAV), the pulse width variation (PWV), and the interstimulus delay modulation (ISDM) methods were compared. For the comparative analysis, the Wilcoxon-Mann-Whitney test with Bonferroni correction (P < 0.016) was carried out on the success rate and on the ranking of methods expressed by the subjects. Results from the mapping protocol show that the delivered sensations were mostly described by the subjects as almost natural and superficial tingling. Results from the AMS protocol show that, for each movement direction, the success rate of ISDM method is higher than that of PWV and PAV and significantly higher than that of PAV for the ulnar-median direction. It recreates an AMS in the hand that effectively allows discriminating the type of sensation and distinguishing the movement direction. Moreover, ISDM was ranked by the subjects as the favorite method for recreating a well-defined and comfortable moving sensation only in the median-ulnar direction. For the ranking results, there was not a statistically significant difference among the methods. The experiments confirmed the good potential of recreating an AMS in the hand through TENS. This encourages to push forward this study on amputees and integrate it in the closed-loop control of a prosthetic system, in order to enable full control of grasp stability and prevent the objects from slippage.
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Affiliation(s)
- Alessia Scarpelli
- Research Unit of Advanced Robotics and Human-Centred Technologies, Università Campus Bio-Medico di Roma, Rome, Italy
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8
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Bidirectional Control of Myoelectric Prostheses in Upper Limb Amputees: Current Results and Expectations. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The most common causes of upper-limb amputations include traumatic etiology and malignity, followed by peripheral vascular diseases. Prosthetic fitting along with conducting a rehabilitation program provide the greatest possible degree of independence to the upper-limb amputees in performing their daily tasks, occupational, recreational and work activities. Despite recent advance in strategies of design and control, the lack of sensory feedback is, according to patients, one of the most important characteristics lacked by commercial myoelectric prostheses. This reason has led to the need for the development of comprehensive prosthetic part which would provide intuitive control and realistic sensory feedback to the amputees enabling them thus to more easily accomplish the tasks which are essential for easier performance of activities of daily life. Electromyography, and recently, electroneurography signals have been used for the development of more efficacious upper-limb prosthetic control. Several recent studies have demonstrated the efficacy of homologous and somatotopic approach in upper-limb amputees, by applying implanted and surface electrodes. This work presents novel methods for effective bidirectional control of myoelectric prostheses in patients with upper-limb amputations using motor control and sensory feedback. The above-mentioned approaches are applicable and have good prospects in further clinical use. The intraneural, extraneural and surface approach can be more or less applicable depending on the etiology and the level of amputation. From a clinical point of view, various approaches should be combined for obtaining more efficient control of bidirectional prostheses and corresponding sensory feedback.
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9
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Petrini FM, Valle G, Bumbasirevic M, Barberi F, Bortolotti D, Cvancara P, Hiairrassary A, Mijovic P, Sverrisson AÖ, Pedrocchi A, Divoux JL, Popovic I, Lechler K, Mijovic B, Guiraud D, Stieglitz T, Alexandersson A, Micera S, Lesic A, Raspopovic S. Enhancing functional abilities and cognitive integration of the lower limb prosthesis. Sci Transl Med 2019; 11:11/512/eaav8939. [DOI: 10.1126/scitranslmed.aav8939] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 09/09/2019] [Indexed: 12/15/2022]
Abstract
Lower limb amputation (LLA) destroys the sensory communication between the brain and the external world during standing and walking. Current prostheses do not restore sensory feedback to amputees, who, relying on very limited haptic information from the stump-socket interaction, are forced to deal with serious issues: the risk of falls, decreased mobility, prosthesis being perceived as an external object (low embodiment), and increased cognitive burden. Poor mobility is one of the causes of eventual device abandonment. Restoring sensory feedback from the missing leg of above-knee (transfemoral) amputees and integrating the sensory feedback into the sensorimotor loop would markedly improve the life of patients. In this study, we developed a leg neuroprosthesis, which provided real-time tactile and emulated proprioceptive feedback to three transfemoral amputees through nerve stimulation. The feedback was exploited in active tasks, which proved that our approach promoted improved mobility, fall prevention, and agility. We also showed increased embodiment of the lower limb prosthesis (LLP), through phantom leg displacement perception and questionnaires, and ease of the cognitive effort during a dual-task paradigm, through electroencephalographic recordings. Our results demonstrate that induced sensory feedback can be integrated at supraspinal levels to restore functional abilities of the missing leg. This work paves the way for further investigations about how the brain interprets different artificial feedback strategies and for the development of fully implantable sensory-enhanced leg neuroprostheses, which could drastically ameliorate life quality in people with disability.
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Petrini FM, Bumbasirevic M, Valle G, Ilic V, Mijović P, Čvančara P, Barberi F, Katic N, Bortolotti D, Andreu D, Lechler K, Lesic A, Mazic S, Mijović B, Guiraud D, Stieglitz T, Alexandersson A, Micera S, Raspopovic S. Sensory feedback restoration in leg amputees improves walking speed, metabolic cost and phantom pain. Nat Med 2019; 25:1356-1363. [PMID: 31501600 DOI: 10.1038/s41591-019-0567-3] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/31/2019] [Indexed: 11/09/2022]
Abstract
Conventional leg prostheses do not convey sensory information about motion or interaction with the ground to above-knee amputees, thereby reducing confidence and walking speed in the users that is associated with high mental and physical fatigue1-4. The lack of physiological feedback from the remaining extremity to the brain also contributes to the generation of phantom limb pain from the missing leg5,6. To determine whether neural sensory feedback restoration addresses these issues, we conducted a study with two transfemoral amputees, implanted with four intraneural stimulation electrodes7 in the remaining tibial nerve (ClinicalTrials.gov identifier NCT03350061). Participants were evaluated while using a neuroprosthetic device consisting of a prosthetic leg equipped with foot and knee sensors. These sensors drive neural stimulation, which elicits sensations of knee motion and the sole of the foot touching the ground. We found that walking speed and self-reported confidence increased while mental and physical fatigue decreased for both participants during neural sensory feedback compared to the no stimulation trials. Furthermore, participants exhibited reduced phantom limb pain with neural sensory feedback. The results from these proof-of-concept cases provide the rationale for larger population studies investigating the clinical utility of neuroprostheses that restore sensory feedback.
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Affiliation(s)
- Francesco Maria Petrini
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland.,SensArs Neuroprosthetics, Lausanne, Switzerland.,Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Marko Bumbasirevic
- Orthopaedic Surgery Department, School of Medicine University of Belgrade, Belgrade, Serbia.,Clinic of Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Giacomo Valle
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,The BioRobotics Institute, SantAnna School of Advanced Studies, Pisa, Italy
| | - Vladimir Ilic
- Faculty of Sport and Physical Education, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Paul Čvančara
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany
| | - Federica Barberi
- SensArs Neuroprosthetics, Lausanne, Switzerland.,Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,The BioRobotics Institute, SantAnna School of Advanced Studies, Pisa, Italy
| | | | | | - David Andreu
- Inria, University of Montpellier, Montpellier, France
| | | | - Aleksandar Lesic
- Orthopaedic Surgery Department, School of Medicine University of Belgrade, Belgrade, Serbia.,Clinic of Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Sanja Mazic
- Institute of Medical Physiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - David Guiraud
- Inria, University of Montpellier, Montpellier, France
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, Freiburg, Germany.,Cluster of Excellence BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany.,Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | | | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,The BioRobotics Institute, SantAnna School of Advanced Studies, Pisa, Italy
| | - Stanisa Raspopovic
- Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland. .,SensArs Neuroprosthetics, Lausanne, Switzerland.
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Petrini FM, Valle G, Strauss I, Granata G, Di Iorio R, D'Anna E, Čvančara P, Mueller M, Carpaneto J, Clemente F, Controzzi M, Bisoni L, Carboni C, Barbaro M, Iodice F, Andreu D, Hiairrassary A, Divoux JL, Cipriani C, Guiraud D, Raffo L, Fernandez E, Stieglitz T, Raspopovic S, Rossini PM, Micera S. Six-Month Assessment of a Hand Prosthesis with Intraneural Tactile Feedback. Ann Neurol 2018; 85:137-154. [DOI: 10.1002/ana.25384] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Francesco M. Petrini
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering; Swiss Federal Institute of Technology of Lausanne (EPFL); Lausanne Switzerland
| | - Giacomo Valle
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering; Swiss Federal Institute of Technology of Lausanne (EPFL); Lausanne Switzerland
- Biorobotics Institute; Sant'Anna School of Advanced Studies (SSSA); Pisa Italy
| | - Ivo Strauss
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering; Swiss Federal Institute of Technology of Lausanne (EPFL); Lausanne Switzerland
- Biorobotics Institute; Sant'Anna School of Advanced Studies (SSSA); Pisa Italy
| | - Giuseppe Granata
- Institute of Neurology; Catholic University; Rome Italy
- Department of Geriatrics, Neuroscience, and Orthopedics; Policlinic A. Gemelli Foundation-IRCCS; Rome Italy
| | - Riccardo Di Iorio
- Institute of Neurology; Catholic University; Rome Italy
- Department of Geriatrics, Neuroscience, and Orthopedics; Policlinic A. Gemelli Foundation-IRCCS; Rome Italy
| | - Edoardo D'Anna
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering; Swiss Federal Institute of Technology of Lausanne (EPFL); Lausanne Switzerland
| | - Paul Čvančara
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg and BrainLinks-BrainTools Center; University of Freiburg; Freiburg Germany
| | - Matthias Mueller
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg and BrainLinks-BrainTools Center; University of Freiburg; Freiburg Germany
| | - Jacopo Carpaneto
- Biorobotics Institute; Sant'Anna School of Advanced Studies (SSSA); Pisa Italy
| | - Francesco Clemente
- Biorobotics Institute; Sant'Anna School of Advanced Studies (SSSA); Pisa Italy
| | - Marco Controzzi
- Biorobotics Institute; Sant'Anna School of Advanced Studies (SSSA); Pisa Italy
| | - Lorenzo Bisoni
- Department of Electrical and Electronic Engineering; University of Cagliari; Cagliari Italy
| | - Caterina Carboni
- Department of Electrical and Electronic Engineering; University of Cagliari; Cagliari Italy
| | - Massimo Barbaro
- Department of Electrical and Electronic Engineering; University of Cagliari; Cagliari Italy
| | - Francesco Iodice
- Institute of Neurology; Catholic University; Rome Italy
- Department of Geriatrics, Neuroscience, and Orthopedics; Policlinic A. Gemelli Foundation-IRCCS; Rome Italy
| | - David Andreu
- INRIA, CAMIN Team; University of Montpellier; Montpellier France
| | | | | | - Christian Cipriani
- Biorobotics Institute; Sant'Anna School of Advanced Studies (SSSA); Pisa Italy
| | - David Guiraud
- INRIA, CAMIN Team; University of Montpellier; Montpellier France
| | - Luigi Raffo
- Department of Electrical and Electronic Engineering; University of Cagliari; Cagliari Italy
| | - Eduardo Fernandez
- Institute of Neurology; Catholic University; Rome Italy
- Department of Geriatrics, Neuroscience, and Orthopedics; Policlinic A. Gemelli Foundation-IRCCS; Rome Italy
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg and BrainLinks-BrainTools Center; University of Freiburg; Freiburg Germany
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology; Institute for Robotics and Intelligent Systems; ETH Zürich, Zürich Switzerland
| | - Paolo M. Rossini
- Institute of Neurology; Catholic University; Rome Italy
- Department of Geriatrics, Neuroscience, and Orthopedics; Policlinic A. Gemelli Foundation-IRCCS; Rome Italy
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering; Swiss Federal Institute of Technology of Lausanne (EPFL); Lausanne Switzerland
- Biorobotics Institute; Sant'Anna School of Advanced Studies (SSSA); Pisa Italy
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12
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Blustein D, Wilson A, Sensinger J. Assessing the quality of supplementary sensory feedback using the crossmodal congruency task. Sci Rep 2018; 8:6203. [PMID: 29670188 PMCID: PMC5906608 DOI: 10.1038/s41598-018-24560-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/06/2018] [Indexed: 12/29/2022] Open
Abstract
Advanced neural interfaces show promise in making prosthetic limbs more biomimetic and ultimately more intuitive and useful for patients. However, approaches to assess these emerging technologies are limited in scope and the insight they provide. When outfitting a prosthesis with a feedback system, such as a peripheral nerve interface, it would be helpful to quantify its physiological correspondence, i.e. how well the prosthesis feedback mimics the perceived feedback in an intact limb. Here we present an approach to quantify this aspect of feedback quality using the crossmodal congruency effect (CCE) task. We show that CCE scores are sensitive to feedback modality, an important characteristic for assessment purposes, but are confounded by the spatial separation between the expected and perceived location of a stimulus. Using data collected from 60 able-bodied participants trained to control a bypass prosthesis, we present a model that results in adjusted-CCE scores that are unaffected by percept misalignment which may result from imprecise neural stimulation. The adjusted-CCE score serves as a proxy for a feedback modality's physiological correspondence or 'naturalness'. This quantification approach gives researchers a tool to assess an aspect of emerging augmented feedback systems that is not measurable with current motor assessments.
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Affiliation(s)
- Daniel Blustein
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada.
| | - Adam Wilson
- Department of Electrical and Computer Engineering, University of New Brunswick, Fredericton, NB, Canada
| | - Jon Sensinger
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada
- Department of Electrical and Computer Engineering, University of New Brunswick, Fredericton, NB, Canada
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