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Quinn KN, Tian Y, Budde R, Irazoqui PP, Tuffaha S, Thakor NV. Neuromuscular implants: Interfacing with skeletal muscle for improved clinical translation of prosthetic limbs. Muscle Nerve 2024; 69:134-147. [PMID: 38126120 DOI: 10.1002/mus.28029] [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: 02/28/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
After an amputation, advanced prosthetic limbs can be used to interface with the nervous system and restore motor function. Despite numerous breakthroughs in the field, many of the recent research advancements have not been widely integrated into clinical practice. This review highlights recent innovations in neuromuscular implants-specifically those that interface with skeletal muscle-which could improve the clinical translation of prosthetic technologies. Skeletal muscle provides a physiologic gateway to harness and amplify signals from the nervous system. Recent surgical advancements in muscle reinnervation surgeries leverage the "bio-amplification" capabilities of muscle, enabling more intuitive control over a greater number of degrees of freedom in prosthetic limbs than previously achieved. We anticipate that state-of-the-art implantable neuromuscular interfaces that integrate well with skeletal muscle and novel surgical interventions will provide a long-term solution for controlling advanced prostheses. Flexible electrodes are expected to play a crucial role in reducing foreign body responses and improving the longevity of the interface. Additionally, innovations in device miniaturization and ongoing exploration of shape memory polymers could simplify surgical procedures for implanting such interfaces. Once implanted, wireless strategies for powering and transferring data from the interface can eliminate bulky external wires, reduce infection risk, and enhance day-to-day usability. By outlining the current limitations of neuromuscular interfaces along with potential future directions, this review aims to guide continued research efforts and future collaborations between engineers and specialists in the field of neuromuscular and musculoskeletal medicine.
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Affiliation(s)
- Kiara N Quinn
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yucheng Tian
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ryan Budde
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pedro P Irazoqui
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sami Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nitish V Thakor
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA
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Becerra-Fajardo L, Minguillon J, Krob MO, Rodrigues C, González-Sánchez M, Megía-García Á, Galán CR, Henares FG, Comerma A, Del-Ama AJ, Gil-Agudo A, Grandas F, Schneider-Ickert A, Barroso FO, Ivorra A. First-in-human demonstration of floating EMG sensors and stimulators wirelessly powered and operated by volume conduction. J Neuroeng Rehabil 2024; 21:4. [PMID: 38172975 PMCID: PMC10765656 DOI: 10.1186/s12984-023-01295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Recently we reported the design and evaluation of floating semi-implantable devices that receive power from and bidirectionally communicate with an external system using coupling by volume conduction. The approach, of which the semi-implantable devices are proof-of-concept prototypes, may overcome some limitations presented by existing neuroprostheses, especially those related to implant size and deployment, as the implants avoid bulky components and can be developed as threadlike devices. Here, it is reported the first-in-human acute demonstration of these devices for electromyography (EMG) sensing and electrical stimulation. METHODS A proof-of-concept device, consisting of implantable thin-film electrodes and a nonimplantable miniature electronic circuit connected to them, was deployed in the upper or lower limb of six healthy participants. Two external electrodes were strapped around the limb and were connected to the external system which delivered high frequency current bursts. Within these bursts, 13 commands were modulated to communicate with the implant. RESULTS Four devices were deployed in the biceps brachii and the gastrocnemius medialis muscles, and the external system was able to power and communicate with them. Limitations regarding insertion and communication speed are reported. Sensing and stimulation parameters were configured from the external system. In one participant, electrical stimulation and EMG acquisition assays were performed, demonstrating the feasibility of the approach to power and communicate with the floating device. CONCLUSIONS This is the first-in-human demonstration of EMG sensors and electrical stimulators powered and operated by volume conduction. These proof-of-concept devices can be miniaturized using current microelectronic technologies, enabling fully implantable networked neuroprosthetics.
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Affiliation(s)
- Laura Becerra-Fajardo
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
| | - Jesus Minguillon
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
- Research Centre for Information and Communications Technologies, University of Granada, Granada, 18014, Spain
- Department of Signal Theory, Telematics and Communications, University of Granada, Granada, 18014, Spain
| | - Marc Oliver Krob
- Fraunhofer Institute for Biomedical Engineering IBMT, 66280, Sulzbach, Germany
| | - Camila Rodrigues
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, 28002, Spain
- Systems Engineering and Automation Department, Carlos III University of Madrid, Madrid, 28903, Spain
| | - Miguel González-Sánchez
- Movement Disorders Unit, Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | - Álvaro Megía-García
- Biomechanics and Assistive Technology Unit, National Hospital for Paraplegics. Unit of Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), Unit associated to the CSIC, Toledo, Spain
| | - Carolina Redondo Galán
- Biomechanics and Assistive Technology Unit, National Hospital for Paraplegics. Unit of Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), Unit associated to the CSIC, Toledo, Spain
| | - Francisco Gutiérrez Henares
- Biomechanics and Assistive Technology Unit, National Hospital for Paraplegics. Unit of Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), Unit associated to the CSIC, Toledo, Spain
| | - Albert Comerma
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
| | - Antonio J Del-Ama
- School of Science and Technology, Department of Applied Mathematics, Materials Science and Engineering and Electronic Technology, Rey Juan Carlos University, Móstoles, 28933, Spain
| | - Angel Gil-Agudo
- Biomechanics and Assistive Technology Unit, National Hospital for Paraplegics. Unit of Neurorehabilitation, Biomechanics and Sensory-Motor Function (HNP-SESCAM), Unit associated to the CSIC, Toledo, Spain
- CSIC's Associated RDI Unit 'Unidad De Neurorehabilitación, Biomecánica Y Función Sensitivo-Motora', Madrid, Spain
| | - Francisco Grandas
- Movement Disorders Unit, Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, 28007, Spain
| | | | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, 28002, Spain
- CSIC's Associated RDI Unit 'Unidad De Neurorehabilitación, Biomecánica Y Función Sensitivo-Motora', Madrid, Spain
| | - Antoni Ivorra
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain.
- Serra Húnter Fellow Programme, Universitat Pompeu Fabra, Barcelona, 08018, Spain.
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Burton A, Wang Z, Song D, Tran S, Hanna J, Ahmad D, Bakall J, Clausen D, Anderson J, Peralta R, Sandepudi K, Benedetto A, Yang E, Basrai D, Miller LE, Tresch MC, Gutruf P. Fully implanted battery-free high power platform for chronic spinal and muscular functional electrical stimulation. Nat Commun 2023; 14:7887. [PMID: 38036552 PMCID: PMC10689769 DOI: 10.1038/s41467-023-43669-2] [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: 11/17/2022] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
Electrical stimulation of the neuromuscular system holds promise for both scientific and therapeutic biomedical applications. Supplying and maintaining the power necessary to drive stimulation chronically is a fundamental challenge in these applications, especially when high voltages or currents are required. Wireless systems, in which energy is supplied through near field power transfer, could eliminate complications caused by battery packs or external connections, but currently do not provide the harvested power and voltages required for applications such as muscle stimulation. Here, we introduce a passive resonator optimized power transfer design that overcomes these limitations, enabling voltage compliances of ± 20 V and power over 300 mW at device volumes of 0.2 cm2, thereby improving power transfer 500% over previous systems. We show that this improved performance enables multichannel, biphasic, current-controlled operation at clinically relevant voltage and current ranges with digital control and telemetry in freely behaving animals. Preliminary chronic results indicate that implanted devices remain operational over 6 weeks in both intact and spinal cord injured rats and are capable of producing fine control of spinal and muscle stimulation.
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Affiliation(s)
- Alex Burton
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Zhong Wang
- Department of Neuroscience, Northwestern University, Chicago, IL, 60611, USA
| | - Dan Song
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Sam Tran
- Department of Neuroscience, Northwestern University, Chicago, IL, 60611, USA
| | - Jessica Hanna
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Dhrubo Ahmad
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Jakob Bakall
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - David Clausen
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Jerry Anderson
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Roberto Peralta
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Kirtana Sandepudi
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Alex Benedetto
- Interdepartmental Neuroscience, Northwestern University, Chicago, IL, 60611, USA
| | - Ethan Yang
- Department of Neuroscience, Northwestern University, Chicago, IL, 60611, USA
| | - Diya Basrai
- Department of Neuroscience, Northwestern University, Chicago, IL, 60611, USA
| | - Lee E Miller
- Department of Neuroscience, Northwestern University, Chicago, IL, 60611, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Interdepartmental Neuroscience, Northwestern University, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA
| | - Matthew C Tresch
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA.
- Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Philipp Gutruf
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA.
- Bio5 Institute and Department of Neurology, University of Arizona, Tucson, AZ, 85721, USA.
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, AZ, 85721, USA.
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