The functional reanimation of paralyzed limbs

Wearable and Implantable Electroceuticals for Therapeutic Electrostimulations

Wearable and implantable electroceuticals (WIEs) for therapeutic electrostimulation (ES) have become indispensable medical devices in modern healthcare. In addition to functionality, device miniaturization, conformability, biocompatibility, and/or biodegradability are the main engineering targets for the development and clinical translation of WIEs. Recent innovations are mainly focused on wearable/implantable power sources, advanced conformable electrodes, and efficient ES on targeted organs and tissues. Herein, nanogenerators as a hotspot wearable/implantable energy-harvesting technique suitable for powering WIEs are reviewed. Then, electrodes for comfortable attachment and efficient delivery of electrical signals to targeted tissue/organ are introduced and compared. A few promising application directions of ES are discussed, including heart stimulation, nerve modulation, skin regeneration, muscle activation, and assistance to other therapeutic modalities.

Investigation of Low-Current Direct Stimulation for Rehabilitation Treatment Related to Muscle Function Loss Using Self-Powered TENG System

Muscle function loss is characterized as abnormal or completely lost muscle capabilities, and it can result from neurological disorders or nerve injuries. The currently available clinical treatment is to electrically stimulate the diseased muscles. Here, a self-powered system of a stacked-layer triboelectric nanogenerator (TENG) and a multiple-channel epimysial electrode to directly stimulate muscles is demonstrated. Then, the two challenges regarding direct TENG muscle stimulation are further investigated. For the first challenge of improving low-current TENG stimulation efficiency, it is found that the optimum stimulation efficiency can be achieved by conducting a systematic mapping with a multiple-channel epimysial electrode. The second challenge is TENG stimulation stability. It is found that the force output generated by TENGs is more stable than using the conventional square wave stimulation and enveloped high frequency stimulation. With modelling and in vivo measurements, it is confirmed that the two factors that account for the stable stimulation using TENGs are the long pulse duration and low current amplitude. The current waveform of TENGs can effectively avoid synchronous motoneuron recruitment at the two stimulation electrodes to reduce force fluctuation. Here, after investigating these two challenges, it is believed that TENG direct muscle stimulation could be used for rehabilitative and therapeutic purpose of muscle function loss treatment.

Self-Powered Direct Muscle Stimulation Using a Triboelectric Nanogenerator (TENG) Integrated with a Flexible Multiple-Channel Intramuscular Electrode

Muscle function loss can result from multiple nervous system diseases including spinal cord injury (SCI), stroke, and multiple sclerosis (MS). Electrical muscle stimulation is clinically employed for rehabilitative and therapeutic purpose and typically requires mA-level stimulation current. Here, we report electrical muscle stimulation, which is directly powered by a stacked-layer triboelectric nanogenerator (TENG) through a flexible multiple-channel intramuscular electrode. This multiple-channel intramuscular electrode allows mapping of motoneurons that is sparsely distributed in the muscle tissue and thus enables high efficiency TENG muscle stimulation, although the short-circuit current of the TENG is only 35 μA. With a stimulation efficiency matrix, we find the electrical muscle stimulation efficiency is affected by two factors, namely, the electrode-motoneuron position, and the stimulation waveform polarity. To test whether it is a universal phenomenon for electrical stimulation, we then further investigate with the conventional square wave current stimulation and confirm that the stimulation efficiency is also affected by these two factors. Thus, we develop a self-powered direct muscle stimulation system with a TENG as power source and waveform generator, and a multiple-channel intramuscular electrode to allow motoneuron mapping for stimulation efficiency optimization. We believe such self-powered system could be potentially used for rehabilitative and therapeutic purpose to treat muscle function loss.

On the development of optical peripheral nerve interfaces

Limb loss and spinal cord injury are two debilitating conditions that continue to grow in prevalence. Prosthetic limbs and limb reanimation present two ways of providing affected individuals with means to interact in the world. These techniques are both dependent on a robust interface with the peripheral nerve. Current methods for interfacing with the peripheral nerve tend to suffer from low specificity, high latency and insufficient robustness for a chronic implant. An optical peripheral nerve interface may solve some of these problems by decreasing invasiveness and providing single axon specificity. In order to implement such an interface three elements are required: (1) a transducer capable of translating light into a neural stimulus or translating neural activity into changes in fluorescence, (2) a means for delivering said transducer and (3) a microscope for providing the stimulus light and detecting the fluorescence change. There are continued improvements in both genetically encoded calcium and voltage indicators as well as new optogenetic actuators for stimulation. Similarly, improvements in specificity of viral vectors continue to improve expression in the axons of the peripheral nerve. Our work has recently shown that it is possible to virally transduce axons of the peripheral nerve for recording from small fibers. The improvements of these components make an optical peripheral nerve interface a rapidly approaching alternative to current methods.

Imaging of electrical activity in small diameter fibers of the murine peripheral nerve with virally-delivered GCaMP6f

Current neural interfaces are hampered by lack of specificity and selectivity for neural interrogation. A method that might improve these interfaces is an optical peripheral nerve interface which communicates with individual axons via optogenetic reporters. To determine the feasibility of such an interface, we delivered the genetically encoded calcium indicator GCaMP6f to the mouse peripheral nerve by intramuscular injection of adenoassociated viral vector (AAV1) under the control of the CAG (chicken beta actin- cytomegalovirus hybrid promoter). Small diameter axons in the common peroneal nerve were transduced and demonstrated electrically inducible calcium transients ex vivo. Responses to single electrical stimuli were resolvable, and increasing the number of stimuli resulted in a monotonic increase in maximum fluorescence and a prolongation of calcium transient kinetics. This work demonstrates the viability of using a virally-delivered, genetically-encoded calcium indicator to read-out from peripheral nerve axons.

Brain machine interface and limb reanimation technologies: restoring function after spinal cord injury through development of a bypass system

Functional restoration of limb movement after traumatic spinal cord injury (SCI) remains the ultimate goal in SCI treatment and directs the focus of current research strategies. To date, most investigations in the treatment of SCI focus on repairing the injury site. Although offering some promise, these efforts have met with significant roadblocks because treatment measures that are successful in animal trials do not yield similar results in human trials. In contrast to biologic therapies, there are now emerging neural interface technologies, such as brain machine interface (BMI) and limb reanimation through electrical stimulators, to create a bypass around the site of the SCI. The BMI systems analyze brain signals to allow control of devices that are used to assist SCI patients. Such devices may include a computer, robotic arm, or exoskeleton. Limb reanimation technologies, which include functional electrical stimulation, epidural stimulation, and intraspinal microstimulation systems, activate neuronal pathways below the level of the SCI. We present a concise review of recent advances in the BMI and limb reanimation technologies that provides the foundation for the development of a bypass system to improve functional outcome after traumatic SCI. We also discuss challenges to the practical implementation of such a bypass system in both these developing fields.

Are muscle synergies useful for neural control?

The observation that the activity of multiple muscles can be well approximated by a few linear synergies is viewed by some as a sign that such low-dimensional modules constitute a key component of the neural control system. Here, we argue that the usefulness of muscle synergies as a control principle should be evaluated in terms of errors produced not only in muscle space, but also in task space. We used data from a force-aiming task in two dimensions at the wrist, using an electromyograms (EMG)-driven virtual biomechanics technique that overcomes typical errors in predicting force from recorded EMG, to illustrate through simulation how synergy decomposition inevitably introduces substantial task space errors. Then, we computed the optimal pattern of muscle activation that minimizes summed-squared muscle activities, and demonstrated that synergy decomposition produced similar results on real and simulated data. We further assessed the influence of synergy decomposition on aiming errors (AEs) in a more redundant system, using the optimal muscle pattern computed for the elbow-joint complex (i.e., 13 muscles acting in two dimensions). Because EMG records are typically not available from all contributing muscles, we also explored reconstructions from incomplete sets of muscles. The redundancy of a given set of muscles had opposite effects on the goodness of muscle reconstruction and on task achievement; higher redundancy is associated with better EMG approximation (lower residuals), but with higher AEs. Finally, we showed that the number of synergies required to approximate the optimal muscle pattern for an arbitrary biomechanical system increases with task-space dimensionality, which indicates that the capacity of synergy decomposition to explain behavior depends critically on the scope of the original database. These results have implications regarding the viability of muscle synergy as a putative neural control mechanism, and also as a control algorithm to restore movements.

Muscle coordination is habitual rather than optimal

When sharing load among multiple muscles, humans appear to select an optimal pattern of activation that minimizes costs such as the effort or variability of movement. How the nervous system achieves this behavior, however, is unknown. Here we show that contrary to predictions from optimal control theory, habitual muscle activation patterns are surprisingly robust to changes in limb biomechanics. We first developed a method to simulate joint forces in real time from electromyographic recordings of the wrist muscles. When the model was altered to simulate the effects of paralyzing a muscle, the subjects simply increased the recruitment of all muscles to accomplish the task, rather than recruiting only the useful muscles. When the model was altered to make the force output of one muscle unusually noisy, the subjects again persisted in recruiting all muscles rather than eliminating the noisy one. Such habitual coordination patterns were also unaffected by real modifications of biomechanics produced by selectively damaging a muscle without affecting sensory feedback. Subjects naturally use different patterns of muscle contraction to produce the same forces in different pronation-supination postures, but when the simulation was based on a posture different from the actual posture, the recruitment patterns tended to agree with the actual rather than the simulated posture. The results appear inconsistent with computation of motor programs by an optimal controller in the brain. Rather, the brain may learn and recall command programs that result in muscle coordination patterns generated by lower sensorimotor circuitry that are functionally "good-enough."

Surface EMG analysis of tibialis anterior muscle in walking with FES in stroke subjects

In this work we have examined the effect of functional electrical stimulation (FES) in the management of drop foot in stroke subjects with surface electromyographic (sEMG) analysis from the tibialis anterior (TA) muscle. Ten subjects were assigned to FES therapy combined with conventional stroke rehabilitation program 5 days a week, 60 min a day, for 12-weeks in clinical settings. Baseline and post-treatment measurements were made for temporal and spectral parameters of EMG signals of TA muscle. The evaluation results reported an increase in mean-absolute-value (MAV), root-mean-square (RMS) and also improved the amplitude and median frequency (MF) of the sEMG power spectrum in monitoring the improvement of the tibialis anterior muscle during maximum voluntary contractions (MVC). We conclude that walking with FES system combined with a conventional rehabilitation program improves the muscle strength in stroke survivors.

BiosStep-assisted walking in spinal cord-injured patients: an evaluation report

BiosStep is a functional neuromuscular stimulation system designed to assist the gait of people with central nervous system injuries. It stimulates the quadriceps during the stance phase and the nerves in the popliteal space to produce the swing phase of the gait cycle. The gait obtained with BiosStep was assessed using kinematic analysis and it was compared with nondisabled gait. Moreover, the evolution of the physiological cost of walking using BiosStep was evaluated and compared with the gait obtained with mechanical orthoses. The kinematic analysis of the three lower limb joints showed that the angular excursion morphologies of BiosStep-assisted gait were similar to those obtained in healthy gait, but with minor amplitudes. The physiological cost indexes for the BiosStep-assisted gait were higher than those computed for the mechanical-orthoses-assisted gait. Results show the necessity to continue improving the strategies to obtain more functional movements and enhance the training of patients.

Development of a BIONic muscle spindle for prosthetic proprioception

The replacement of proprioceptive function, whether for conscious sensation or feedback control, is likely to be an important aspect of neural prosthetic restoration of limb movements. Thus far, however, it has been hampered by the absence of unobtrusive sensors. We propose a method whereby fully implanted, telemetrically operated BIONs monitor muscle movement, and thereby detect changes in joint angle(s) and/or limb posture without requiring the use of secondary components attached to limb segments or external reference frames. The sensor system is designed to detect variations in the electrical coupling between devices implanted in neighboring muscles that result from changes in their relative position as the muscles contract and stretch with joint motion. The goal of this study was to develop and empirically validate mathematical models of the sensing scheme and to use computer simulations to provide an early proof of concept and inform design of the overall sensor system. Results from experiments using paired dipoles in a saline bath and finite element simulations have given insight into the current distribution and potential gradients exhibited within bounded anisotropic environments similar to a human limb segment and demonstrated an anticipated signal to noise ratio of at least 8:1 for submillimeter resolution of relative implant movement over a range of implant displacements up to 15 cm.

Brain-Controlled Interfaces: Movement Restoration with Neural Prosthetics

Brain-controlled interfaces are devices that capture brain transmissions involved in a subject's intention to act, with the potential to restore communication and movement to those who are immobilized. Current devices record electrical activity from the scalp, on the surface of the brain, and within the cerebral cortex. These signals are being translated to command signals driving prosthetic limbs and computer displays. Somatosensory feedback is being added to this control as generated behaviors become more complex. New technology to engineer the tissue-electrode interface, electrode design, and extraction algorithms to transform the recorded signal to movement will help translate exciting laboratory demonstrations to patient practice in the near future.