The Evolution of Neuroprosthetic Interfaces

Advancing Prosthetic Hand Capabilities Through Biomimicry and Neural Interfaces

Background and ObjectivesProsthetic hand development is undergoing a transformative phase, blending biomimicry and neural interface technologies to redefine functionality and sensory feedback. This article explores the symbiotic relationship between biomimetic design principles and neural interface technology (NIT) in advancing prosthetic hand capabilities.MethodsDrawing inspiration from biological systems, researchers aim to replicate the intricate movements and capabilities of the human hand through innovative prosthetic designs. Central to this endeavor is NIT, facilitating seamless communication between artificial devices and the human nervous system. Recent advances in fabrication methods have propelled brain-computer interfaces, enabling precise control of prosthetic hands by decoding neural activity.ResultsAnatomical complexities of the human hand underscore the importance of understanding biomechanics, neuroanatomy, and control mechanisms for crafting effective prosthetic solutions. Furthermore, achieving the goal of a fully functional cyborg hand necessitates a multidisciplinary approach and biomimetic design to replicate the body's inherent capabilities. By incorporating the expertise of clinicians, tissue engineers, bioengineers, electronic and data scientists, the next generation of the implantable devices is not only anatomically and biomechanically accurate but also offer intuitive control, sensory feedback, and proprioception, thereby pushing the boundaries of current prosthetic technology.ConclusionBy integrating machine learning algorithms, biomechatronic principles, and advanced surgical techniques, prosthetic hands can achieve real-time control while restoring tactile sensation and proprioception. This manuscript contributes novel approaches to prosthetic hand development, with potential implications for enhancing the functionality, durability, and safety of the prosthetic limb.

Synergy of a Complimentary Ionic Biogel Network for Through-Hair Neurohaptics

Understanding the neural mechanisms underlying haptic sensations is crucial for advancing neuroprosthetics. However, achieving on-site amplification non-invasively through-hair neural recordings remains a significant challenge as it requires thermoreversible, bioadhesive, and semiconducting characteristics in the same material. Typical polymer composite compromises on complementary properties. To address this, we present a membraneless organelles - inspired ionic biogel that leverages liquid-liquid phase separation. This enables a unique synergy of complementary properties, including rapid thermoreversible transitions, p-type semiconductivity, thermoelectricity, enhanced electrochemical stability, self-healing, and bioadhesive capabilities. These characteristics enable to analyze the frequency dependence of event-related desynchronization during electrical stimulation over days mimicking the frequency response of mechanoreceptors sensation. This thermoresponsive, semiconducting ionic biogel also enables a phase-reversible, self-balancing, tip-shaped vertical organic electrochemical transistor with a high transconductance of 44 mS at 40°C. The ionic biogel demonstrates synergistic complementary properties to understand through-hair neurohaptics.

Interface-Mediated Neurogenic Signaling: The Impact of Surface Geometry and Chemistry on Neural Cell Behavior for Regenerative and Brain-Machine Interfacing Applications

Nanomaterial advancements have driven progress in central and peripheral nervous system applications such as tissue regeneration and brain-machine interfacing. Ideally, neural interfaces with native tissue shall seamlessly integrate, a process that is often mediated by the interfacial material properties. Surface topography and material chemistry are significant extracellular stimuli that can influence neural cell behavior to facilitate tissue integration and augment therapeutic outcomes. This review characterizes topographical modifications, including micropillars, microchannels, surface roughness, and porosity, implemented on regenerative scaffolding and brain-machine interfaces. Their impact on neural cell response is summarized through neurogenic outcome and mechanistic analysis. The effects of surface chemistry on neural cell signaling with common interfacing compounds like carbon-based nanomaterials, conductive polymers, and biologically inspired matrices are also reviewed. Finally, the impact of these extracellular mediated neural cues on intracellular signaling cascades is discussed to provide perspective on the manipulation of neuron and neuroglia cell microenvironments to drive therapeutic outcomes.

Organic Mixed Ionic-Electronic Conductors for Bioelectronic Sensors: Materials and Operation Mechanisms

The field of organic mixed ionic-electronic conductors (OMIECs) has gained significant attention due to their ability to transport both electrons and ions, making them promising candidates for various applications. Initially focused on inorganic materials, the exploration of mixed conduction has expanded to organic materials, especially polymers, owing to their advantages such as solution processability, flexibility, and property tunability. OMIECs, particularly in the form of polymers, possess both electronic and ionic transport functionalities. This review provides an overview of OMIECs in various aspects covering mechanisms of charge transport including electronic transport, ionic transport, and ionic-electronic coupling, as well as conducting/semiconducting conjugated polymers and their applications in organic bioelectronics, including (multi)sensors, neuromorphic devices, and electrochromic devices. OMIECs show promise in organic bioelectronics due to their compatibility with biological systems and the ability to modulate electronic conduction and ionic transport, resembling the principles of biological systems. Organic electrochemical transistors (OECTs) based on OMIECs offer significant potential for bioelectronic applications, responding to external stimuli through modulation of ionic transport. An in-depth review of recent research achievements in organic bioelectronic applications using OMIECs, categorized based on physical and chemical stimuli as well as neuromorphic devices and circuit applications, is presented.

Merging Humans and Neuroprosthetics through Regenerative Peripheral Nerve Interfaces

Limb amputations can be devastating and significantly affect an individual's independence, leading to functional and psychosocial challenges in nearly 2 million people in the United States alone. Over the past decade, robotic devices driven by neural signals such as neuroprostheses have shown great potential to restore the lost function of limbs, allowing amputees to regain movement and sensation. However, current neuroprosthetic interfaces have challenges in both signal quality and long-term stability. To overcome these limitations and work toward creating bionic limbs, the Neuromuscular Laboratory at University of Michigan Plastic Surgery has developed the Regenerative Peripheral Nerve Interface (RPNI). This surgical construct embeds a transected peripheral nerve into a free muscle graft, effectively amplifying small peripheral nerve signals to provide enhanced control signals for a neuroprosthetic limb. Furthermore, the RPNI has the potential to provide sensory feedback to the user and facilitate neuroprosthesis embodiment. This review focuses on the animal studies and clinical trials of the RPNI to recapitulate the promising trajectory toward neurobionics where the boundary between an artificial device and the human body becomes indistinct. This paper also sheds light on the prospects of the improvement and dissemination of the RPNI technology.

Neuromorphic applications in medicine

In recent years, there has been a growing demand for miniaturization, low power consumption, quick treatments, and non-invasive clinical strategies in the healthcare industry. To meet these demands, healthcare professionals are seeking new technological paradigms that can improve diagnostic accuracy while ensuring patient compliance. Neuromorphic engineering, which uses neural models in hardware and software to replicate brain-like behaviors, can help usher in a new era of medicine by delivering low power, low latency, small footprint, and high bandwidth solutions. This paper provides an overview of recent neuromorphic advancements in medicine, including medical imaging and cancer diagnosis, processing of biosignals for diagnosis, and biomedical interfaces, such as motor, cognitive, and perception prostheses. For each section, we provide examples of how brain-inspired models can successfully compete with conventional artificial intelligence algorithms, demonstrating the potential of neuromorphic engineering to meet demands and improve patient outcomes. Lastly, we discuss current struggles in fitting neuromorphic hardware with non-neuromorphic technologies and propose potential solutions for future bottlenecks in hardware compatibility.

Neurotechnology and international security: Predicting commercial and military adoption of brain-computer interfaces (BCIs) in the United States and China

In the past decade, international actors have launched "brain projects" or "brain initiatives." One of the emerging technologies enabled by these publicly funded programs is brain-computer interfaces (BCIs), which are devices that allow communication between the brain and external devices like a prosthetic arm or a keyboard. BCIs are poised to have significant impacts on public health, society, and national security. This research presents the first analytical framework that attempts to predict the dissemination of neurotechnologies to both the commercial and military sectors in the United States and China. While China started its project later with less funding, we find that it has other advantages that make earlier adoption more likely. We also articulate national security risks implicit in later adoption, including the inability to set international ethical and legal norms for BCI use, especially in wartime operating environments, and data privacy risks for citizens who use technology developed by foreign actors.

Vagus Nerve Stimulation: A Personalized Therapeutic Approach for Crohn's and Other Inflammatory Bowel Diseases

Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, are incurable autoimmune diseases characterized by chronic inflammation of the gastrointestinal tract. There is increasing evidence that inappropriate interaction between the enteric nervous system and central nervous system and/or low activity of the vagus nerve, which connects the enteric and central nervous systems, could play a crucial role in their pathogenesis. Therefore, it has been suggested that appropriate neuroprosthetic stimulation of the vagus nerve could lead to the modulation of the inflammation of the gastrointestinal tract and consequent long-term control of these autoimmune diseases. In the present paper, we provide a comprehensive overview of (1) the cellular and molecular bases of the immune system, (2) the way central and enteric nervous systems interact and contribute to the immune responses, (3) the pathogenesis of the inflammatory bowel disease, and (4) the therapeutic use of vagus nerve stimulation, and in particular, the transcutaneous stimulation of the auricular branch of the vagus nerve. Then, we expose the working hypotheses for the modulation of the molecular processes that are responsible for intestinal inflammation in autoimmune diseases and the way we could develop personalized neuroprosthetic therapeutic devices and procedures in favor of the patients.

Beyond the brain-computer interface: Decoding brain activity as a tool to understand neuronal mechanisms subtending cognition and behavior

One of the major challenges in system neurosciences consists in developing techniques for estimating the cognitive information content in brain activity. This has an enormous potential in different domains spanning from clinical applications, cognitive enhancement to a better understanding of the neural bases of cognition. In this context, the inclusion of machine learning techniques to decode different aspects of human cognition and behavior and its use to develop brain-computer interfaces for applications in neuroprosthetics has supported a genuine revolution in the field. However, while these approaches have been shown quite successful for the study of the motor and sensory functions, success is still far from being reached when it comes to covert cognitive functions such as attention, motivation and decision making. While improvement in this field of BCIs is growing fast, a new research focus has emerged from the development of strategies for decoding neural activity. In this review, we aim at exploring how the advanced in decoding of brain activity is becoming a major neuroscience tool moving forward our understanding of brain functions, providing a robust theoretical framework to test predictions on the relationship between brain activity and cognition and behavior.

Endless forms most beautiful 2.0: teleonomy and the bioengineering of chimaeric and synthetic organisms

The rich variety of biological forms and behaviours results from one evolutionary history on Earth, via frozen accidents and selection in specific environments. This ubiquitous baggage in natural, familiar model species obscures the plasticity and swarm intelligence of cellular collectives. Significant gaps exist in our understanding of the origin of anatomical novelty, of the relationship between genome and form, and of strategies for control of large-scale structure and function in regenerative medicine and bioengineering. Analysis of living forms that have never existed before is necessary to reveal deep design principles of life as it can be. We briefly review existing examples of chimaeras, cyborgs, hybrots and other beings along the spectrum containing evolved and designed systems. To drive experimental progress in multicellular synthetic morphology, we propose teleonomic (goal-seeking, problem-solving) behaviour in diverse problem spaces as a powerful invariant across possible beings regardless of composition or origin. Cybernetic perspectives on chimaeric morphogenesis erase artificial distinctions established by past limitations of technology and imagination. We suggest that a multi-scale competency architecture facilitates evolution of robust problem-solving, living machines. Creation and analysis of novel living forms will be an essential testbed for the emerging field of diverse intelligence, with numerous implications across regenerative medicine, robotics and ethics.

Biology, Buddhism, and AI: Care as the Driver of Intelligence

Intelligence is a central feature of human beings' primary and interpersonal experience. Understanding how intelligence originated and scaled during evolution is a key challenge for modern biology. Some of the most important approaches to understanding intelligence are the ongoing efforts to build new intelligences in computer science (AI) and bioengineering. However, progress has been stymied by a lack of multidisciplinary consensus on what is central about intelligence regardless of the details of its material composition or origin (evolved vs. engineered). We show that Buddhist concepts offer a unique perspective and facilitate a consilience of biology, cognitive science, and computer science toward understanding intelligence in truly diverse embodiments. In coming decades, chimeric and bioengineering technologies will produce a wide variety of novel beings that look nothing like familiar natural life forms; how shall we gauge their moral responsibility and our own moral obligations toward them, without the familiar touchstones of standard evolved forms as comparison? Such decisions cannot be based on what the agent is made of or how much design vs. natural evolution was involved in their origin. We propose that the scope of our potential relationship with, and so also our moral duty toward, any being can be considered in the light of Care-a robust, practical, and dynamic lynchpin that formalizes the concepts of goal-directedness, stress, and the scaling of intelligence; it provides a rubric that, unlike other current concepts, is likely to not only survive but thrive in the coming advances of AI and bioengineering. We review relevant concepts in basal cognition and Buddhist thought, focusing on the size of an agent's goal space (its cognitive light cone) as an invariant that tightly links intelligence and compassion. Implications range across interpersonal psychology, regenerative medicine, and machine learning. The Bodhisattva's vow ("for the sake of all sentient life, I shall achieve awakening") is a practical design principle for advancing intelligence in our novel creations and in ourselves.

Ethical implications of visual neuroprostheses-a systematic review

Objective. The aim of this review was to systematically identify the ethical implications of visual neuroprostheses.Approach. A systematic search was performed in both PubMed and Embase using a search string that combined synonyms for visual neuroprostheses, brain-computer interfaces (BCIs), cochlear implants (CIs), and ethics. We chose to include literature on BCIs and CIs, because of their ethically relavant similarities and functional parallels with visual neuroprostheses.Main results. We included 84 articles in total. Six focused specifically on visual prostheses. The other articles focused more broadly on neurotechnologies, on BCIs or CIs. We identified 169 ethical implications that have been categorized under seven main themes: (a) benefits for health and well-being; (b) harm and risk; (c) autonomy; (d) societal effects; (e) clinical research; (f) regulation and governance; and (g) involvement of experts, patients and the public.Significance. The development and clinical use of visual neuroprostheses is accompanied by ethical issues that should be considered early in the technological development process. Though there is ample literature on the ethical implications of other types of neuroprostheses, such as motor neuroprostheses and CIs, there is a significant gap in the literature regarding the ethical implications of visual neuroprostheses. Our findings can serve as a starting point for further research and normative analysis.

Electrocorticographic effects of acute ketamine on non-human primate brains

OBJECTIVE

Acute blockade of glutamate N-methyl-D-aspartate (NMDA) receptors by ketamine induces symptoms and electrophysiological changes similar to schizophrenia. Previous studies have shown that ketamine elicits aberrant gamma oscillations in several cortical areas and impairs coupling strength between the low-frequency phase and fast frequency amplitude (PAC), which plays an important role in integrating functional information.

APPROACH

This study utilized a customized wireless electrocorticography (ECoG) recording device to collect subdural signals from the somatosensory and primary auditory cortices in two monkeys. Ketamine was administered at a dose of 3 mg/kg (intramuscular) or 0.56 mg/kg (intravenous) to elicit brain oscillation reactions. We analyzed the raw data using methods such as power spectral density, time-frequency spectra, and PAC.

MAIN RESULTS

Acute ketamine triggered broadband gamma and high gamma oscillation power and decreased lower frequencies. The effect was stronger in the primary auditory cortex than in the somatosensory area. The coupling strength between the low phase of theta and the faster amplitude of gamma/high gamma bands was increased by a lower dose (0.56 mg/kg iv) and decreased with a higher dose (3 mg/kg im) ketamine.

SIGNIFICANCE

Our results showed that lower and higher doses of ketamine elicited differential effects on theta-gamma PAC. These findings support the utility of ECoG models as a translational platform for pharmacodynamic research in future research.

Soft Devices for High-Resolution Neuro-Stimulation: The Interplay Between Low-Rigidity and Resolution

The field of neurostimulation has evolved over the last few decades from a crude, low-resolution approach to a highly sophisticated methodology entailing the use of state-of-the-art technologies. Neurostimulation has been tested for a growing number of neurological applications, demonstrating great promise and attracting growing attention in both academia and industry. Despite tremendous progress, long-term stability of the implants, their large dimensions, their rigidity and the methods of their introduction and anchoring to sensitive neural tissue remain challenging. The purpose of this review is to provide a concise introduction to the field of high-resolution neurostimulation from a technological perspective and to focus on opportunities stemming from developments in materials sciences and engineering to reduce device rigidity while optimizing electrode small dimensions. We discuss how these factors may contribute to smaller, lighter, softer and higher electrode density devices.

Elective amputation and neuroprosthetic limbs

This paper explores the impact that developments in the field of neuroprosthetics will have on the ethical viability of healthy limb amputation, specifically in cases of Body Integrity Identity Disorder (BIID). Developments in the field have meant that the prospect of such artificial components matching the utility of their biological counterparts is now a possibility. As such, arguments against the provision of therapeutic, healthy limb amputation, which are grounded in the perceived resultant harm of disability, need to be reconsidered. Drawing on philosophical insights, as well as the field of disability studies and BIID research, this paper argues that such neuroprosthetics presents a challenge for the fundamental dichotomy between the disabled and non-disabled, including the latter's perceived superiority. It goes on to suggest that healthy limb amputation, for those with BIID, should not be dismissed simply because of the distastefulness of the procedure, but rather be evaluated based upon its own merits.

Development of optically controlled "living electrodes" with long-projecting axon tracts for a synaptic brain-machine interface

For implantable neural interfaces, functional/clinical outcomes are challenged by limitations in specificity and stability of inorganic microelectrodes. A biological intermediary between microelectrical devices and the brain may improve specificity and longevity through (i) natural synaptic integration with deep neural circuitry, (ii) accessibility on the brain surface, and (iii) optogenetic manipulation for targeted, light-based readout/control. Accordingly, we have developed implantable "living electrodes," living cortical neurons, and axonal tracts protected within soft hydrogel cylinders, for optobiological monitoring/modulation of brain activity. Here, we demonstrate fabrication, rapid axonal outgrowth, reproducible cytoarchitecture, and simultaneous optical stimulation and recording of these tissue engineered constructs in vitro. We also present their transplantation, survival, integration, and optical recording in rat cortex as an in vivo proof of concept for this neural interface paradigm. The creation and characterization of these functional, optically controllable living electrodes are critical steps in developing a new class of optobiological tools for neural interfacing.

Minimal Tissue Reaction after Chronic Subdural Electrode Implantation for Fully Implantable Brain-Machine Interfaces

There is a growing interest in the use of electrocorticographic (ECoG) signals in brain–machine interfaces (BMIs). However, there is still a lack of studies involving the long-term evaluation of the tissue response related to electrode implantation. Here, we investigated biocompatibility, including chronic tissue response to subdural electrodes and a fully implantable wireless BMI device. We implanted a half-sized fully implantable device with subdural electrodes in six beagles for 6 months. Histological analysis of the surrounding tissues, including the dural membrane and cortices, was performed to evaluate the effects of chronic implantation. Our results showed no adverse events, including infectious signs, throughout the 6-month implantation period. Thick connective tissue proliferation was found in the surrounding tissues in the epidural space and subcutaneous space. Quantitative measures of subdural reactive tissues showed minimal encapsulation between the electrodes and the underlying cortex. Immunohistochemical evaluation showed no significant difference in the cell densities of neurons, astrocytes, and microglia between the implanted sites and contralateral sites. In conclusion, we established a beagle model to evaluate cortical implantable devices. We confirmed that a fully implantable wireless device and subdural electrodes could be stably maintained with sufficient biocompatibility in vivo.

Innervation: the missing link for biofabricated tissues and organs

Innervation plays a pivotal role as a driver of tissue and organ development as well as a means for their functional control and modulation. Therefore, innervation should be carefully considered throughout the process of biofabrication of engineered tissues and organs. Unfortunately, innervation has generally been overlooked in most non-neural tissue engineering applications, in part due to the intrinsic complexity of building organs containing heterogeneous native cell types and structures. To achieve proper innervation of engineered tissues and organs, specific host axon populations typically need to be precisely driven to appropriate location(s) within the construct, often over long distances. As such, neural tissue engineering and/or axon guidance strategies should be a necessary adjunct to most organogenesis endeavors across multiple tissue and organ systems. To address this challenge, our team is actively building axon-based "living scaffolds" that may physically wire in during organ development in bioreactors and/or serve as a substrate to effectively drive targeted long-distance growth and integration of host axons after implantation. This article reviews the neuroanatomy and the role of innervation in the functional regulation of cardiac, skeletal, and smooth muscle tissue and highlights potential strategies to promote innervation of biofabricated engineered muscles, as well as the use of "living scaffolds" in this endeavor for both in vitro and in vivo applications. We assert that innervation should be included as a necessary component for tissue and organ biofabrication, and that strategies to orchestrate host axonal integration are advantageous to ensure proper function, tolerance, assimilation, and bio-regulation with the recipient post-implant.

Homecare Robotic Systems for Healthcare 4.0: Visions and Enabling Technologies

Powered by the technologies that have originated from manufacturing, the fourth revolution of healthcare technologies is happening (Healthcare 4.0). As an example of such revolution, new generation homecare robotic systems (HRS) based on the cyber-physical systems (CPS) with higher speed and more intelligent execution are emerging. In this article, the new visions and features of the CPS-based HRS are proposed. The latest progress in related enabling technologies is reviewed, including artificial intelligence, sensing fundamentals, materials and machines, cloud computing and communication, as well as motion capture and mapping. Finally, the future perspectives of the CPS-based HRS and the technical challenges faced in each technical area are discussed.

Neural Modulation of the Primary Auditory Cortex by Intracortical Microstimulation with a Bio-Inspired Electronic System

Nowadays, the majority of the progress in the development of implantable neuroprostheses has been achieved by improving the knowledge of brain functions so as to restore sensorial impairments. Intracortical microstimulation (ICMS) is a widely used technique to investigate site-specific cortical responses to electrical stimuli. Herein, we investigated the neural modulation induced in the primary auditory cortex (A1) by an acousto-electric transduction of ultrasonic signals using a bio-inspired intracortical microstimulator. The developed electronic system emulates the transduction of ultrasound signals in the cochlea, providing bio-inspired electrical stimuli. Firstly, we identified the receptive fields in the primary auditory cortex devoted to encoding ultrasonic waves at different frequencies, mapping each area with neurophysiological patterns. Subsequently, the activity elicited by bio-inspired ICMS in the previously identified areas, bypassing the sense organ, was investigated. The observed evoked response by microstimulation resulted as highly specific to the stimuli, and the spatiotemporal dynamics of neural oscillatory activity in the alpha, beta, and gamma waves were related to the stimuli preferred by the neurons at the stimulated site. The alpha waves modulated cortical excitability only during the activation of the specific tonotopic neuronal populations, inhibiting neural responses in unrelated areas. Greater neuronal activity in the posterior area of A1 was observed in the beta band, whereas a gamma rhythm was induced in the anterior A1. The results evidence that the proposed bio-inspired acousto-electric ICMS triggers high-frequency oscillations, encoding information about the stimulation sites and involving a large-scale integration in the brain.

Fully implantable neural recording and stimulation interfaces: Peripheral nerve interface applications

BACKGROUND

Peripheral nerve interfacing has many applications ranging from investigation of neural signals to therapeutic intervention for varied diseases. This need has driven technological advancements in the field of electrode arrays and wireless systems for in-vivo electrophysiological experiments. Hence we present our fully implantable, programmable miniaturized wireless stimulation and recording devices.

NEW METHOD

The method consists of technological advancements enabling implantable wireless recording up to 128 channels with a sampling rate of 50Khz and stimulation up to ±4 mA from 15 independent channels. The novelty of the technique consists of induction charging cages which enables freely moving small animals to undergo continuous electrophysiological and behavioral studies without any impediments. The biocompatible hermetic packaging technology for implantable capsules ensures stability for long-term chronic studies.

RESULTS

Electromyographs wirelessly recorded from leg muscles of a macaque and a rat using implantable technology are presented during different behavioral task studies. The device's simultaneous stimulation and recording capabilities are reported when interfaced with the vagus and pelvic nerves.

COMPARISON WITH EXISTING METHOD(S)

The wireless interfacing technology has a large number of recording and stimulating channels without compromising on the signal quality due to sampling rates or stimulating current output capabilities. The induction charging technology along with transceiver and software interface allows experiments on multiple animals to be carried out simultaneously.

CONCLUSIONS

This customizable technology using wireless power transmission, reduced battery size, and miniaturized electronics has paved way for a robust, fully implantable, hermetic neural interface system enabling the study of bioelectronic medical therapies.

Implantable Neural Interfaces and Wearable Tactile Systems for Bidirectional Neuroprosthetics Systems

Neuroprosthetics and neuromodulation represent a promising field for several related applications in the central and peripheral nervous system, such as the treatment of neurological disorders, the control of external robotic devices, and the restoration of lost tactile functions. These actions are allowed by the neural interface, a miniaturized implantable device that most commonly exploits electrical energy to fulfill these operations. A neural interface must be biocompatible, stable over time, low invasive, and highly selective; the challenge is to develop a safe, compact, and reliable tool for clinical applications. In case of anatomical impairments, neuroprosthetics is bound to the need of exploring the surrounding environment by fast-responsive and highly sensitive artificial tactile sensors that mimic the natural sense of touch. Tactile sensors and neural interfaces are closely interconnected since the readouts from the first are required to convey information to the neural implantable apparatus. The role of these devices is pivotal hence technical improvements are essential to ensure a secure system to be eventually adopted in daily life. This review highlights the fundamental criteria for the design and microfabrication of neural interfaces and artificial tactile sensors, their use in clinical applications, and future enhancements for the release of a second generation of devices.

Contrast Agents Delivery: An Up-to-Date Review of Nanodiagnostics in Neuroimaging

Neuroimaging is a highly important field of neuroscience, with direct implications for the early diagnosis and progression monitoring of brain-associated diseases. Neuroimaging techniques are categorized into structural, functional and molecular neuroimaging, each possessing advantages and disadvantages in terms of resolution, invasiveness, toxicity of contrast agents and costs. Nanotechnology-based approaches for neuroimaging mostly involve the development of nanocarriers for incorporating contrast agents or the use of nanomaterials as imaging agents. Inorganic and organic nanoparticles, liposomes, micelles, nanobodies and quantum dots are some of the most studied candidates for the delivery of contrast agents for neuroimaging. This paper focuses on describing the conventional modalities used for imaging and the applications of nanotechnology for developing novel strategies for neuroimaging. The aim is to highlight the roles of nanocarriers for enhancing and/or overcome the limitations associated with the most commonly utilized neuroimaging modalities. For future directions, several techniques that could benefit from the increased contrast induced by using imaging probes are presented.

Bioactive Neuroelectronic Interfaces

Within the neural engineering field, next-generation implantable neuroelectronic interfaces are being developed using biologically-inspired and/or biologically-derived materials to improve upon the stability and functional lifetime of current interfaces. These technologies use biomaterials, bioactive molecules, living cells, or some combination of these, to promote host neuronal survival, reduce the foreign body response, and improve chronic device-tissue integration. This article provides a general overview of the different strategies, milestones, and evolution of bioactive neural interfaces including electrode material properties, biological coatings, and "decoration" with living cells. Another such biohybrid approach developed in our lab uses preformed implantable micro-tissue featuring long-projecting axonal tracts encased within carrier biomaterial micro-columns. These so-called "living electrodes" have been engineered with carefully tailored material, mechanical, and biological properties to enable natural, synaptic based modulation of specific host circuitry while ultimately being under computer control. This article provides an overview of these living electrodes, including design and fabrication, performance attributes, as well as findings to date characterizing in vitro and in vivo functionality.

Challenges and demand for modeling disorders of consciousness following traumatic brain injury

Following severe traumatic brain injury (TBI), many patients experience coma - an unresponsive state lacking wakefulness or awareness. Coma rarely lasts more than two weeks, and emergence involves passing through a state of wakefulness without awareness of self or environment. Patients that linger in these Disorders of Consciousness (DoC) undergo clinical assessments of awareness for diagnosis into Unresponsive Wakefulness Syndrome (no awareness, also called vegetative state) or Minimally Conscious State (periodic increases in awareness). These diagnoses are notoriously inaccurate, offering little prognostic value. Recovery of awareness is unpredictable, returning within weeks, years, or never. This leaves patients' families with difficult decisions and little information on which to base them. Clinical studies have made significant advancements, but remain encumbered by high variability, limited data output, and a lack of necessary controls. Herein we discuss the clear and present need to establish a preclinical model of TBI-induced DoC, the significant challenges involved, and how such a model can be applied to support DoC research.

Exploiting Routine Clinical Measures to Inform Strategies for Better Hearing Performance in Cochlear Implant Users

Neuroprostheses designed to interface with the nervous system to replace injured or missing senses can significantly improve a patient's quality of life. The challenge remains to provide implants that operate optimally over several decades. Changes in the implant-tissue interface may precede performance problems. Tools to identify and characterize such changes using existing clinical measures would be highly valuable. Modern cochlear implant (CI) systems allow easy and regular measurements of electrode impedance (EI). This measure is routinely performed as a hardware integrity test, but it also allows a level of insight into the immune-mediated response to the implant, which is associated with performance outcomes. This study is a 5-year retrospective investigation of MED-EL CI users at the University of Southampton Auditory Implant Service including 176 adult ears (18-91) and 74 pediatric ears (1-17). The trend in EI in adults showed a decrease at apical electrodes. An increase was seen at the basal electrodes which are closest to the surgery site. The trend in the pediatric cohort was increasing EI over time for nearly all electrode positions, although this group showed greater variability and had a smaller sample size. We applied an outlier-labeling rule to statistically identify individuals that exhibit raised impedance. This highlighted 14 adult ears (8%) and 3 pediatric ears (5%) with impedance levels that deviated from the group distribution. The slow development of EI suggests intra-cochlear fibrosis and/or osteogenesis as the underlying mechanism. The usual clinical intervention for extreme impedance readings is to deactivate the relevant electrode. Our findings highlight some interesting clinical contradictions: some cases with raised (but not extreme) impedance had not prompted an electrode deactivation; and many cases of electrode deactivation had been informed by subjective patient reports. This emphasizes the need for improved objective evidence to inform electrode deactivations in borderline cases, for which our outlier-labeling approach is a promising candidate. A data extraction and analysis protocol that allows ongoing and automated statistical analysis of routinely collected data could benefit both the CI and wider neuroprosthetics communities. Our approach provides new tools to inform practice and to improve the function and longevity of neuroprosthetic devices.

Neurologic Medical Device Overview for Pathologists

Thorough morphologic evaluations of medical devices placed in or near the nervous system depend on many factors. Pathologists interpreting a neurologic device study must be familiar with the regulatory framework affecting device development, biocompatibility and safety determinants impacting nervous tissue responses, and appropriate study design, including the use of appropriate animal models, group design, device localization, euthanasia time points, tissue examination, sampling and processing, histochemistry and immunohistochemistry, and reporting. This overview contextualizes these features of neurologic medical devices for pathologists engaged in device evaluations.

A New Frontier: The Convergence of Nanotechnology, Brain Machine Interfaces, and Artificial Intelligence

A confluence of technological capabilities is creating an opportunity for machine learning and artificial intelligence (AI) to enable "smart" nanoengineered brain machine interfaces (BMI). This new generation of technologies will be able to communicate with the brain in ways that support contextual learning and adaptation to changing functional requirements. This applies to both invasive technologies aimed at restoring neurological function, as in the case of neural prosthesis, as well as non-invasive technologies enabled by signals such as electroencephalograph (EEG). Advances in computation, hardware, and algorithms that learn and adapt in a contextually dependent way will be able to leverage the capabilities that nanoengineering offers the design and functionality of BMI. We explore the enabling capabilities that these devices may exhibit, why they matter, and the state of the technologies necessary to build them. We also discuss a number of open technical challenges and problems that will need to be solved in order to achieve this.

Assessing functional connectivity across 3D tissue engineered axonal tracts using calcium fluorescence imaging

OBJECTIVE

Micro-tissue engineered neural networks (micro-TENNs) are anatomically-inspired constructs designed to structurally and functionally emulate white matter pathways in the brain. These 3D neural networks feature long axonal tracts spanning discrete neuronal populations contained within a tubular hydrogel, and are being developed to reconstruct damaged axonal pathways in the brain as well as to serve as physiologically-relevant in vitro experimental platforms. The goal of the current study was to characterize the functional properties of these neuronal and axonal networks.

APPROACH

Bidirectional micro-TENNs were transduced to express genetically-encoded calcium indicators, and spontaneous fluorescence activity was recorded using real-time microscopy at 20 Hz from specific regions-of-interest in the neuronal populations. Network activity patterns and functional connectivity across the axonal tracts were then assessed using various techniques from statistics and information theory including Pearson cross-correlation, phase synchronization matrices, power spectral analysis, directed transfer function, and transfer entropy.

MAIN RESULTS

Pearson cross-correlation, phase synchronization matrices, and power spectral analysis revealed high values of correlation and synchronicity between the spatially segregated neuronal clusters connected by axonal tracts. Specifically, phase synchronization revealed high synchronicity of  >0.8 between micro-TENN regions of interest. Normalized directed transfer function and transfer entropy matrices suggested robust information flow between the neuronal populations. Time varying power spectrum analysis revealed the strength of information propagation at various frequencies. Signal power strength was visible at elevated peak levels for dominant delta (1-4 Hz) and theta (4-8 Hz) frequency bands and progressively weakened at higher frequencies. These signal power strength results closely matched normalized directed transfer function analysis where near synchronous information flow was detected between frequencies of 2-5 Hz.

SIGNIFICANCE

To our knowledge, this is the first report using directed transfer function and transfer entropy methods based on fluorescent calcium activity to estimate functional connectivity of distinct neuronal populations via long-projecting, 3D axonal tracts in vitro. These functional data will further improve the design and optimization of implantable neural networks that could ultimately be deployed to reconstruct the nervous system to treat neurological disease and injury.

Microfabricated intracortical extracellular matrix-microelectrodes for improving neural interfaces

Intracortical neural microelectrodes, which can directly interface with local neural microcircuits with high spatial and temporal resolution, are critical for neuroscience research, emerging clinical applications, and brain computer interfaces (BCI). However, clinical applications of these devices remain limited mostly by their inability to mitigate inflammatory reactions and support dense neuronal survival at their interfaces. Herein we report the development of microelectrodes primarily composed of extracellular matrix (ECM) proteins, which act as a bio-compatible and an electrochemical interface between the microelectrodes and physiological solution. These ECM-microelectrodes are batch fabricated using a novel combination of micro-transfer-molding and excimer laser micromachining to exhibit final dimensions comparable to those of commercial silicon-based microelectrodes. These are further integrated with a removable insertion stent which aids in intracortical implantation. Results from electrochemical models and in vivo recordings from the rat's cortex indicate that ECM encapsulations have no significant effect on the electrochemical impedance characteristics of ECM-microelectrodes at neurologically relevant frequencies. ECM-microelectrodes are found to support a dense layer of neuronal somata and neurites on the electrode surface with high neuronal viability and exhibited markedly diminished neuroinflammation and glial scarring in early chronic experiments in rats.

Chronically Implanted Intracranial Electrodes: Tissue Reaction and Electrical Changes

The brain-electrode interface is arguably one of the most important areas of study in neuroscience today. A stronger foundation in this topic will allow us to probe the architecture of the brain in unprecedented functional detail and augment our ability to intervene in disease states. Over many years, significant progress has been made in this field, but some obstacles have remained elusive—notably preventing glial encapsulation and electrode degradation. In this review, we discuss the tissue response to electrode implantation on acute and chronic timescales, the electrical changes that occur in electrode systems over time, and strategies that are being investigated in order to minimize the tissue response to implantation and maximize functional electrode longevity. We also highlight the current and future clinical applications and relevance of electrode technology.

Engineered Axonal Tracts as "Living Electrodes" for Synaptic-Based Modulation of Neural Circuitry

Brain-computer interface and neuromodulation strategies relying on penetrating non-organic electrodes/optrodes are limited by an inflammatory foreign body response that ultimately diminishes performance. A novel "biohybrid" strategy is advanced, whereby living neurons, biomaterials, and microelectrode/optical technology are used together to provide a biologically-based vehicle to probe and modulate nervous-system activity. Microtissue engineering techniques are employed to create axon-based "living electrodes", which are columnar microstructures comprised of neuronal population(s) projecting long axonal tracts within the lumen of a hydrogel designed to chaperone delivery into the brain. Upon microinjection, the axonal segment penetrates to prescribed depth for synaptic integration with local host neurons, with the perikaryal segment remaining externalized below conforming electrical-optical arrays. In this paradigm, only the biological component ultimately remains in the brain, potentially attenuating a chronic foreign-body response. Axon-based living electrodes are constructed using multiple neuronal subtypes, each with differential capacity to stimulate, inhibit, and/or modulate neural circuitry based on specificity uniquely afforded by synaptic integration, yet ultimately computer controlled by optical/electrical components on the brain surface. Current efforts are assessing the efficacy of this biohybrid interface for targeted, synaptic-based neuromodulation, and the specificity, spatial density and long-term fidelity versus conventional microelectronic or optical substrates alone.

Connecting the Brain to Itself through an Emulation

Pilot clinical trials of human patients implanted with devices that can chronically record and stimulate ensembles of hundreds to thousands of individual neurons offer the possibility of expanding the substrate of cognition. Parallel trains of firing rate activity can be delivered in real-time to an array of intermediate external modules that in turn can trigger parallel trains of stimulation back into the brain. These modules may be built in software, VLSI firmware, or biological tissue as in vitro culture preparations or in vivo ectopic construct organoids. Arrays of modules can be constructed as early stage whole brain emulators, following canonical intra- and inter-regional circuits. By using machine learning algorithms and classic tasks known to activate quasi-orthogonal functional connectivity patterns, bedside testing can rapidly identify ensemble tuning properties and in turn cycle through a sequence of external module architectures to explore which can causatively alter perception and behavior. Whole brain emulation both (1) serves to augment human neural function, compensating for disease and injury as an auxiliary parallel system, and (2) has its independent operation bootstrapped by a human-in-the-loop to identify optimal micro- and macro-architectures, update synaptic weights, and entrain behaviors. In this manner, closed-loop brain-computer interface pilot clinical trials can advance strong artificial intelligence development and forge new therapies to restore independence in children and adults with neurological conditions.

Anatomically Inspired Three-dimensional Micro-tissue Engineered Neural Networks for Nervous System Reconstruction, Modulation, and Modeling

Functional recovery rarely occurs following injury or disease-induced degeneration within the central nervous system (CNS) due to the inhibitory environment and the limited capacity for neurogenesis. We are developing a strategy to simultaneously address neuronal and axonal pathway loss within the damaged CNS. This manuscript presents the fabrication protocol for micro-tissue engineered neural networks (micro-TENNs), implantable constructs consisting of neurons and aligned axonal tracts spanning the extracellular matrix (ECM) lumen of a preformed hydrogel cylinder hundreds of microns in diameter that may extend centimeters in length. Neuronal aggregates are delimited to the extremes of the three-dimensional encasement and are spanned by axonal projections. Micro-TENNs are uniquely poised as a strategy for CNS reconstruction, emulating aspects of brain connectome cytoarchitecture and potentially providing means for network replacement. The neuronal aggregates may synapse with host tissue to form new functional relays to restore and/or modulate missing or damaged circuitry. These constructs may also act as pro-regenerative "living scaffolds" capable of exploiting developmental mechanisms for cell migration and axonal pathfinding, providing synergistic structural and soluble cues based on the state of regeneration. Micro-TENNs are fabricated by pouring liquid hydrogel into a cylindrical mold containing a longitudinally centered needle. Once the hydrogel has gelled, the needle is removed, leaving a hollow micro-column. An ECM solution is added to the lumen to provide an environment suitable for neuronal adhesion and axonal outgrowth. Dissociated neurons are mechanically aggregated for precise seeding within one or both ends of the micro-column. This methodology reliably produces self-contained miniature constructs with long-projecting axonal tracts that may recapitulate features of brain neuroanatomy. Synaptic immunolabeling and genetically encoded calcium indicators suggest that micro-TENNs possess extensive synaptic distribution and intrinsic electrical activity. Consequently, micro-TENNs represent a promising strategy for targeted neurosurgical reconstruction of brain pathways and may also be applied as biofidelic models to study neurobiological phenomena in vitro.

Functional and Histological Effects of Chronic Neural Electrode Implantation

Objectives

Permanent injury to the cranial nerves can often result in a substantial reduction in quality of life. Novel and innovative interventions can help restore form and function in nerve paralysis, with bioelectric interfaces among the more promising of these approaches. The foreign body response is an important consideration for any bioelectric device as it influences the function and effectiveness of the implant. The purpose of this review is to describe tissue and functional effects of chronic neural implantation among the different categories of neural implants and highlight advances in peripheral and cranial nerve stimulation.

Data Sources: PubMed, IEEE, and Web of Science literature search.

Review Methods: A review of the current literature was conducted to examine functional and histologic effects of bioelectric interfaces for neural implants.

Results

Bioelectric devices can be characterized as intraneural, epineural, perineural, intranuclear, or cortical depending on their placement relative to nerves and neuronal cell bodies. Such devices include nerve‐specific stimulators, neuroprosthetics, brainstem implants, and deep brain stimulators. Regardless of electrode location and interface type, acute and chronic histological, macroscopic and functional changes can occur as a result of both passive and active tissue responses to the bioelectric implant.

Conclusion

A variety of chronically implantable electrodes have been developed to treat disorders of the peripheral and cranial nerves, to varying degrees of efficacy. Consideration and mitigation of detrimental effects at the neural interface with further optimization of functional nerve stimulation will facilitate the development of these technologies and translation to the clinic.

Level of Evidence

3.