1
|
Herring EZ, Graczyk EL, Memberg WD, Adams R, Fernandez Baca-Vaca G, Hutchison BC, Krall JT, Alexander BJ, Conlan EC, Alfaro KE, Bhat P, Ketting-Olivier AB, Haddix CA, Taylor DM, Tyler DJ, Sweet JA, Kirsch RF, Ajiboye AB, Miller JP. Reconnecting the Hand and Arm to the Brain: Efficacy of Neural Interfaces for Sensorimotor Restoration After Tetraplegia. Neurosurgery 2024; 94:864-874. [PMID: 37982637 DOI: 10.1227/neu.0000000000002769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/01/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Paralysis after spinal cord injury involves damage to pathways that connect neurons in the brain to peripheral nerves in the limbs. Re-establishing this communication using neural interfaces has the potential to bridge the gap and restore upper extremity function to people with high tetraplegia. We report a novel approach for restoring upper extremity function using selective peripheral nerve stimulation controlled by intracortical microelectrode recordings from sensorimotor networks, along with restoration of tactile sensation of the hand using intracortical microstimulation. METHODS A 27-year-old right-handed man with AIS-B (motor-complete, sensory-incomplete) C3-C4 tetraplegia was enrolled into the clinical trial. Six 64-channel intracortical microelectrode arrays were implanted into left hemisphere regions involved in upper extremity function, including primary motor and sensory cortices, inferior frontal gyrus, and anterior intraparietal area. Nine 16-channel extraneural peripheral nerve electrodes were implanted to allow targeted stimulation of right median, ulnar (2), radial, axillary, musculocutaneous, suprascapular, lateral pectoral, and long thoracic nerves, to produce selective muscle contractions on demand. Proof-of-concept studies were performed to demonstrate feasibility of using a brain-machine interface to read from and write to the brain for restoring motor and sensory functions of the participant's own arm and hand. RESULTS Multiunit neural activity that correlated with intended motor action was successfully recorded from intracortical arrays. Microstimulation of electrodes in somatosensory cortex produced repeatable sensory percepts of individual fingers for restoration of touch sensation. Selective electrical activation of peripheral nerves produced antigravity muscle contractions, resulting in functional movements that the participant was able to command under brain control to perform virtual and actual arm and hand movements. The system was well tolerated with no operative complications. CONCLUSION The combination of implanted cortical electrodes and nerve cuff electrodes has the potential to create bidirectional restoration of motor and sensory functions of the arm and hand after neurological injury.
Collapse
Affiliation(s)
- Eric Z Herring
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Emily L Graczyk
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
| | - William D Memberg
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
| | - Robert Adams
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Gaudalupe Fernandez Baca-Vaca
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Brianna C Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - John T Krall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Benjamin J Alexander
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Emily C Conlan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Kenya E Alfaro
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Preethisiri Bhat
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Aaron B Ketting-Olivier
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
| | - Chase A Haddix
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neuroscience, The Cleveland Clinic, Cleveland , Ohio , USA
| | - Dawn M Taylor
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
- Department of Neuroscience, The Cleveland Clinic, Cleveland , Ohio , USA
| | - Dustin J Tyler
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
| | - Jennifer A Sweet
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
| | - Robert F Kirsch
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
| | - A Bolu Ajiboye
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland , Ohio , USA
- Department of Neurosurgery, The Neurological Institute, University Hospital Cleveland Medical Center, Cleveland , Ohio , USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland , Ohio , USA
| |
Collapse
|
2
|
Greenspon CM, Shelchkova ND, Valle G, Hobbs TG, Berger-Wolf EI, Hutchison BC, Dogruoz E, Verbarschott C, Callier T, Sobinov AR, Okorokova EV, Jordan PM, Prasad D, He Q, Liu F, Kirsch RF, Miller JP, Lee RC, Satzer D, Gonzalez-Martinez J, Warnke PC, Miller LE, Boninger ML, Ajiboye AB, Graczyk EL, Downey JE, Collinger JL, Hatsopoulos NG, Gaunt RA, Bensmaia SJ. Tessellation of artificial touch via microstimulation of human somatosensory cortex. bioRxiv 2023:2023.06.23.545425. [PMID: 37425877 PMCID: PMC10327055 DOI: 10.1101/2023.06.23.545425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
When we interact with objects, we rely on signals from the hand that convey information about the object and our interaction with it. A basic feature of these interactions, the locations of contacts between the hand and object, is often only available via the sense of touch. Information about locations of contact between a brain-controlled bionic hand and an object can be signaled via intracortical microstimulation (ICMS) of somatosensory cortex (S1), which evokes touch sensations that are localized to a specific patch of skin. To provide intuitive location information, tactile sensors on the robotic hand drive ICMS through electrodes that evoke sensations at skin locations matching sensor locations. This approach requires that ICMS-evoked sensations be focal, stable, and distributed over the hand. To systematically investigate the localization of ICMS-evoked sensations, we analyzed the projected fields (PFs) of ICMS-evoked sensations - their location and spatial extent - from reports obtained over multiple years from three participants implanted with microelectrode arrays in S1. First, we found that PFs vary widely in their size across electrodes, are highly stable within electrode, are distributed over large swaths of each participant's hand, and increase in size as the amplitude or frequency of ICMS increases. Second, while PF locations match the locations of the receptive fields (RFs) of the neurons near the stimulating electrode, PFs tend to be subsumed by the corresponding RFs. Third, multi-channel stimulation gives rise to a PF that reflects the conjunction of the PFs of the component channels. By stimulating through electrodes with largely overlapping PFs, then, we can evoke a sensation that is experienced primarily at the intersection of the component PFs. To assess the functional consequence of this phenomenon, we implemented multichannel ICMS-based feedback in a bionic hand and demonstrated that the resulting sensations are more localizable than are those evoked via single-channel ICMS.
Collapse
Affiliation(s)
- Charles M Greenspon
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | | | - Giacomo Valle
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Taylor G Hobbs
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Ev I Berger-Wolf
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Brianna C Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Efe Dogruoz
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Ceci Verbarschott
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
| | - Thierri Callier
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Anton R Sobinov
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | | | - Patrick M Jordan
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Dillan Prasad
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Qinpu He
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
| | - Fang Liu
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Robert F Kirsch
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland, OH
- The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Ray C Lee
- Schwab Rehabilitation Hospital, Chicago, IL
| | - David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | | | - Peter C Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL
| | - Lee E Miller
- Department of Neuroscience, Northwestern University, Chicago, IL
- Department of Biomedical Engineering, Northwestern University, Evanston, IL
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
- Shirley Ryan Ability Lab, Chicago, IL
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Abidemi B Ajiboye
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Emily L Graczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - John E Downey
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Nicholas G Hatsopoulos
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL
- Committee on Computational Neuroscience, University of Chicago, Chicago, IL
- Neuroscience Institute, University of Chicago, Chicago, IL
| |
Collapse
|
3
|
Herring EZ, Graczyk EL, Memberg WD, Adams RD, Baca-Vaca GF, Hutchison BC, Krall JT, Alexander BJ, Conlan EC, Alfaro KE, Bhat PR, Ketting-Olivier AB, Haddix CA, Taylor DM, Tyler DJ, Kirsch RF, Ajiboye AB, Miller JP. Reconnecting the Hand and Arm to the Brain: Efficacy of Neural Interfaces for Sensorimotor Restoration after Tetraplegia. medRxiv 2023:2023.04.24.23288977. [PMID: 37162904 PMCID: PMC10168522 DOI: 10.1101/2023.04.24.23288977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Paralysis after spinal cord injury involves damage to pathways that connect neurons in the brain to peripheral nerves in the limbs. Re-establishing this communication using neural interfaces has the potential to bridge the gap and restore upper extremity function to people with high tetraplegia. Objective We report a novel approach for restoring upper extremity function using selective peripheral nerve stimulation controlled by intracortical microelectrode recordings from sensorimotor networks, along with restoration of tactile sensation of the hand using intracortical microstimulation. Methods A right-handed man with motor-complete C3-C4 tetraplegia was enrolled into the clinical trial. Six 64-channel intracortical microelectrode arrays were implanted into left hemisphere regions involved in upper extremity function, including primary motor and sensory cortices, inferior frontal gyrus, and anterior intraparietal area. Nine 16-channel extraneural peripheral nerve electrodes were implanted to allow targeted stimulation of right median, ulnar (2), radial, axillary, musculocutaneous, suprascapular, lateral pectoral, and long thoracic nerves, to produce selective muscle contractions on demand. Proof-of-concept studies were performed to demonstrate feasibility of a bidirectional brain-machine interface to restore function of the participant's own arm and hand. Results Multi-unit neural activity that correlated with intended motor action was successfully recorded from intracortical arrays. Microstimulation of electrodes in somatosensory cortex produced repeatable sensory percepts of individual fingers for restoration of touch sensation. Selective electrical activation of peripheral nerves produced antigravity muscle contractions. The system was well tolerated with no operative complications. Conclusion The combination of implanted cortical electrodes and nerve cuff electrodes has the potential to allow restoration of motor and sensory functions of the arm and hand after neurological injury.
Collapse
Affiliation(s)
- Eric Z Herring
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Emily L Graczyk
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - William D Memberg
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - Robert D Adams
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | | | - Brianna C Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - John T Krall
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Benjamin J Alexander
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Emily C Conlan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kenya E Alfaro
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Preethi R Bhat
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Chase A Haddix
- Department of Neuroscience, Lerner Research Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Dawn M Taylor
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
- Department of Neuroscience, Lerner Research Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Dustin J Tyler
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Robert F Kirsch
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - A Bolu Ajiboye
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| | - Jonathan P Miller
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- The Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, FES Center of Excellence, Cleveland, Ohio, USA
| |
Collapse
|
4
|
Bullard AJ, Hutchison BC, Lee J, Chestek CA, Patil PG. Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays. Neuromodulation 2019; 23:411-426. [DOI: 10.1111/ner.13069] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/05/2019] [Accepted: 09/10/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Autumn J. Bullard
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | | | - Jiseon Lee
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | - Cynthia A. Chestek
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Electrical Engineering and Computer Science University of Michigan Ann Arbor MI USA
| | - Parag G. Patil
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Neurosurgery University of Michigan Medical School Ann Arbor MI USA
| |
Collapse
|