1
|
Rogers ER, Capogrosso M, Lempka SF. Biophysics of frequency-dependent variation in paresthesia and pain relief during spinal cord stimulation. J Neurosci 2024:e2199232024. [PMID: 38744531 DOI: 10.1523/jneurosci.2199-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
The neurophysiological effects of spinal cord stimulation (SCS) for chronic pain are poorly understood, resulting in inefficient failure-prone programming protocols and inadequate pain relief. Nonetheless, novel stimulation patterns are regularly introduced and adopted clinically. Traditionally, paresthetic sensation is considered necessary for pain relief, although novel paradigms provide analgesia without paresthesia. However, like pain relief, the neurophysiological underpinnings of SCS-induced paresthesia are unknown. Here, we paired biophysical modeling with clinical paresthesia thresholds (of both sexes) to investigate how stimulation frequency affects the neural response to SCS relevant to paresthesia and analgesia. Specifically, we modeled the dorsal column (DC) axonal response, dorsal column nucleus (DCN) synaptic transmission, conduction failure within DC fiber collaterals, and dorsal horn network output. Importantly, we found that high-frequency stimulation reduces DC fiber activation thresholds, which in turn accurately predicts clinical paresthesia perception thresholds. Furthermore, we show that high-frequency SCS produces asynchronous DC fiber spiking and ultimately asynchronous DCN output, offering a plausible biophysical basis for why high-frequency SCS is less comfortable and produces qualitatively different sensation than low-frequency stimulation. Finally, we demonstrate that model dorsal horn network output is sensitive to SCS-inherent variations in spike timing, which could contribute to heterogeneous pain relief across patients. Importantly, we show that model DC fiber collaterals cannot reliably follow high-frequency stimulation, strongly affecting network output and typically producing anti-nociceptive effects at high frequencies. Altogether, these findings clarify how SCS affects the nervous system and provide insight into the biophysics of paresthesia generation and pain relief.Significance Statement The effects of spinal cord stimulation (SCS) on the nervous system are poorly understood, resulting in inadequate clinical success rates. Here, we use a biophysical modeling approach to investigate the neural response to SCS. We demonstrate that low- and high-frequency stimulation produce contrasting responses in the dorsal columns, brainstem, and dorsal horn. Importantly, our modeling approach was able to accurately predict clinical paresthesia thresholds as a function of frequency, as well as provide plausible biophysical explanations for frequency-dependent effects on paresthesia quality and pain relief. Overall, our results greatly enhance our understanding of the neural response to SCS, thereby offering context for interpreting clinical observations and crucial insight for development of future SCS systems.
Collapse
Affiliation(s)
- Evan R Rogers
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA, 48109
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA, 48109
| | - Marco Capogrosso
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA, 15213
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA, 48109
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA, 48109
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA, 48109
| |
Collapse
|
2
|
Katic Secerovic N, Balaguer JM, Gorskii O, Pavlova N, Liang L, Ho J, Grigsby E, Gerszten PC, Karal-Ogly D, Bulgin D, Orlov S, Pirondini E, Musienko P, Raspopovic S, Capogrosso M. Neural population dynamics reveals disruption of spinal circuits' responses to proprioceptive input during electrical stimulation of sensory afferents. Cell Rep 2024; 43:113695. [PMID: 38245870 PMCID: PMC10962447 DOI: 10.1016/j.celrep.2024.113695] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/08/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
Abstract
While neurostimulation technologies are rapidly approaching clinical applications for sensorimotor disorders, the impact of electrical stimulation on network dynamics is still unknown. Given the high degree of shared processing in neural structures, it is critical to understand if neurostimulation affects functions that are related to, but not targeted by, the intervention. Here, we approach this question by studying the effects of electrical stimulation of cutaneous afferents on unrelated processing of proprioceptive inputs. We recorded intraspinal neural activity in four monkeys while generating proprioceptive inputs from the radial nerve. We then applied continuous stimulation to the radial nerve cutaneous branch and quantified the impact of the stimulation on spinal processing of proprioceptive inputs via neural population dynamics. Proprioceptive pulses consistently produce neural trajectories that are disrupted by concurrent cutaneous stimulation. This disruption propagates to the somatosensory cortex, suggesting that electrical stimulation can perturb natural information processing across the neural axis.
Collapse
Affiliation(s)
- Natalija Katic Secerovic
- School of Electrical Engineering, University of Belgrade, 11000 Belgrade, Serbia; The Mihajlo Pupin Institute, University of Belgrade, 11060 Belgrade, Serbia; Laboratory for Neuroengineering, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Oleg Gorskii
- Institute of Translational Biomedicine, Saint-Petersburg State University, 199034 Saint-Petersburg, Russia; Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint-Petersburg, Russia; National University of Science and Technology "MISIS," 4 Leninskiy Pr., 119049 Moscow, Russia
| | - Natalia Pavlova
- Institute of Translational Biomedicine, Saint-Petersburg State University, 199034 Saint-Petersburg, Russia
| | - Lucy Liang
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Jonathan Ho
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Erinn Grigsby
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Dzhina Karal-Ogly
- National Research Centre "Kurchatov Institute," 123098 Moscow, Russia
| | - Dmitry Bulgin
- National Research Centre "Kurchatov Institute," 123098 Moscow, Russia; Sirius University of Science and Technology, 354340 Sochi, Russia
| | - Sergei Orlov
- National Research Centre "Kurchatov Institute," 123098 Moscow, Russia
| | - Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Pavel Musienko
- Institute of Translational Biomedicine, Saint-Petersburg State University, 199034 Saint-Petersburg, Russia; Sirius University of Science and Technology, 354340 Sochi, Russia; Life Improvement by Future Technologies Center "LIFT," 143025 Moscow, Russia
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland.
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Center for Neural Basis of Cognition, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| |
Collapse
|
3
|
Rogers ER, Lempka SF, Capogrosso M. Does high-frequency stimulation of sensory axons break the causal link between pain relief and paresthesia? Neuron 2024; 112:331-333. [PMID: 38330897 DOI: 10.1016/j.neuron.2024.01.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
Neurostimulation produces unnatural cutaneous sensations with potent analgesic effects in pain syndromes. In this issue of Neuron, Sagalajev et al.1 demonstrate that these sensations are an epiphenomenon and explain how high-frequency stimulation can provide analgesia without these unnecessary sensations.
Collapse
Affiliation(s)
- Evan R Rogers
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
4
|
Capogrosso M, Balaguer JM, Prat-Ortega G, Verma N, Yadav P, Sorensen E, de Freitas R, Ensel S, Borda L, Donadio S, Liang L, Ho J, Damiani A, Grigsby E, Fields D, Gonzalez-Martinez J, Gerszten P, Weber D, Pirondini E. Supraspinal control of motoneurons after paralysis enabled by spinal cord stimulation. Res Sq 2024:rs.3.rs-3650257. [PMID: 38260333 PMCID: PMC10802737 DOI: 10.21203/rs.3.rs-3650257/v1] [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: 01/24/2024]
Abstract
Spinal cord stimulation (SCS) restores motor control after spinal cord injury (SCI) and stroke. This evidence led to the hypothesis that SCS facilitates residual supraspinal inputs to spinal motoneurons. Instead, here we show that SCS does not facilitate residual supraspinal inputs but directly triggers motoneurons action potentials. However, supraspinal inputs can shape SCS-mediated activity, mimicking volitional control of motoneuron firing. Specifically, by combining simulations, intraspinal electrophysiology in monkeys and single motor unit recordings in humans with motor paralysis, we found that residual supraspinal inputs transform subthreshold SCS-induced excitatory postsynaptic potentials into suprathreshold events. We then demonstrated that only a restricted set of stimulation parameters enables volitional control of motoneuron firing and that lesion severity further restricts the set of effective parameters. Our results explain the facilitation of voluntary motor control during SCS while predicting the limitations of this neurotechnology in cases of severe loss of supraspinal axons.
Collapse
Affiliation(s)
| | - Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Nanivadekar AC, Bose R, Petersen BA, Okorokova EV, Sarma D, Madonna TJ, Barra B, Farooqui J, Dalrymple AN, Levy I, Helm ER, Miele VJ, Boninger ML, Capogrosso M, Bensmaia SJ, Weber DJ, Fisher LE. Publisher Correction: Restoration of sensory feedback from the foot and reduction of phantom limb pain via closed-loop spinal cord stimulation. Nat Biomed Eng 2023:10.1038/s41551-023-01175-2. [PMID: 38155296 DOI: 10.1038/s41551-023-01175-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Affiliation(s)
- Ameya C Nanivadekar
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Rohit Bose
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Bailey A Petersen
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Elizaveta V Okorokova
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Devapratim Sarma
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tyler J Madonna
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatrice Barra
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, Switzerland
| | - Juhi Farooqui
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Ashley N Dalrymple
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Isaiah Levy
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric R Helm
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vincent J Miele
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marco Capogrosso
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Douglas J Weber
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA.
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
6
|
Mahrous AA, Liang L, Balaguer JM, Ho JC, Hari K, Grigsby EM, Karapetyan V, Damiani A, Fields DP, Gonzalez-Martinez JA, Gerszten PC, Bennett DJ, Heckman CJ, Pirondini E, Capogrosso M. GABA Increases Sensory Transmission In Monkeys. bioRxiv 2023:2023.12.28.573467. [PMID: 38234767 PMCID: PMC10793394 DOI: 10.1101/2023.12.28.573467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Sensory input flow is central to voluntary movements. For almost a century, GABA was believed to modulate this flow by inhibiting sensory axons in the spinal cord to sculpt neural inputs into skilled motor output. Instead, here we show that GABA can also facilitate sensory transmission in monkeys and consequently increase spinal and cortical neural responses to sensory inputs challenging our understanding of generation and perception of movement.
Collapse
|
7
|
Nanivadekar AC, Bose R, Petersen BA, Okorokova EV, Sarma D, Madonna TJ, Barra B, Farooqui J, Dalrymple AN, Levy I, Helm ER, Miele VJ, Boninger ML, Capogrosso M, Bensmaia SJ, Weber DJ, Fisher LE. Restoration of sensory feedback from the foot and reduction of phantom limb pain via closed-loop spinal cord stimulation. Nat Biomed Eng 2023:10.1038/s41551-023-01153-8. [PMID: 38097809 DOI: 10.1038/s41551-023-01153-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/27/2023] [Indexed: 12/30/2023]
Abstract
Restoring somatosensory feedback in individuals with lower-limb amputations would reduce the risk of falls and alleviate phantom limb pain. Here we show, in three individuals with transtibial amputation (one traumatic and two owing to diabetic peripheral neuropathy), that sensations from the missing foot, with control over their location and intensity, can be evoked via lateral lumbosacral spinal cord stimulation with commercially available electrodes and by modulating the intensity of stimulation in real time on the basis of signals from a wireless pressure-sensitive shoe insole. The restored somatosensation via closed-loop stimulation improved balance control (with a 19-point improvement in the composite score of the Sensory Organization Test in one individual) and gait stability (with a 5-point improvement in the Functional Gait Assessment in one individual). And over the implantation period of the stimulation leads, the three individuals experienced a clinically meaningful decrease in phantom limb pain (with an average reduction of nearly 70% on a visual analogue scale). Our findings support the further clinical assessment of lower-limb neuroprostheses providing somatosensory feedback.
Collapse
Affiliation(s)
- Ameya C Nanivadekar
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Rohit Bose
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Bailey A Petersen
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Elizaveta V Okorokova
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Devapratim Sarma
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tyler J Madonna
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatrice Barra
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, Switzerland
| | - Juhi Farooqui
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Ashley N Dalrymple
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Isaiah Levy
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric R Helm
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vincent J Miele
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marco Capogrosso
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sliman J Bensmaia
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Douglas J Weber
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA.
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
8
|
Ho JC, Grigsby EM, Damiani A, Liang L, Balaguer JM, Kallakuri S, Barrios-Martinez J, Karapetyan V, Fields D, Gerszten PC, Kevin Hitchens T, Constantine T, Adams GM, Crammond DJ, Capogrosso M, Gonzalez-Martinez JA, Pirondini E. POTENTIATION OF CORTICO-SPINAL OUTPUT VIA TARGETED ELECTRICAL STIMULATION OF THE MOTOR THALAMUS. medRxiv 2023:2023.03.08.23286720. [PMID: 36945514 PMCID: PMC10029067 DOI: 10.1101/2023.03.08.23286720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Cerebral white matter lesions prevent cortico-spinal descending inputs from effectively activating spinal motoneurons, leading to loss of motor control. However, in most cases, the damage to cortico-spinal axons is incomplete offering a potential target for new therapies aimed at improving volitional muscle activation. Here we hypothesized that, by engaging direct excitatory connections to cortico-spinal motoneurons, stimulation of the motor thalamus could facilitate activation of surviving cortico-spinal fibers thereby potentiating motor output. To test this hypothesis, we identified optimal thalamic targets and stimulation parameters that enhanced upper-limb motor evoked potentials and grip forces in anesthetized monkeys. This potentiation persisted after white matter lesions. We replicated these results in humans during intra-operative testing. We then designed a stimulation protocol that immediately improved voluntary grip force control in a patient with a chronic white matter lesion. Our results show that electrical stimulation targeting surviving neural pathways can improve motor control after white matter lesions.
Collapse
Affiliation(s)
- Jonathan C. Ho
- School of Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA, USA 15213
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
| | - Erinn M. Grigsby
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA, USA, 15213
| | - Arianna Damiani
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Lucy Liang
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Josep-Maria Balaguer
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Sridula Kallakuri
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Neuroscience, University of Pittsburgh, A210 Langley Hall, Pittsburgh, PA, USA, 15260
| | - Jessica Barrios-Martinez
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Vahagn Karapetyan
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
| | - Daryl Fields
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Peter C. Gerszten
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - T. Kevin Hitchens
- Department of Neurobiology, University of Pittsburgh, 200 Lothrop Street, Room E1440, Pittsburgh, PA, USA, 15213
| | - Theodora Constantine
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Gregory M. Adams
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Donald J. Crammond
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Marco Capogrosso
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
| | - Jorge A. Gonzalez-Martinez
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
- Department of Neurobiology, University of Pittsburgh, 200 Lothrop Street, Room E1440, Pittsburgh, PA, USA, 15213
| | - Elvira Pirondini
- Rehab Neural Engineering Labs, University of Pittsburgh, 3520 Fifth Avenue, Suite 300, Pittsburgh, PA, USA, 15213
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA, USA, 15213
- Department of Bioengineering, University of Pittsburgh, 151 Benedum Hall, Pittsburgh, PA, USA, 15261
- Center for the Neural Basis of Cognition, 4400 Fifth Avenue, Suite 115, Pittsburgh, PA, USA, 15213
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, suite b-400, Pittsburgh, PA, USA, 15213
- Department of Neurobiology, University of Pittsburgh, 200 Lothrop Street, Room E1440, Pittsburgh, PA, USA, 15213
| |
Collapse
|
9
|
Balaguer JM, Prat-Ortega G, Verma N, Yadav P, Sorensen E, de Freitas R, Ensel S, Borda L, Donadio S, Liang L, Ho J, Damiani A, Grigsby E, Fields DP, Gonzalez-Martinez JA, Gerszten PC, Fisher LE, Weber DJ, Pirondini E, Capogrosso M. SUPRASPINAL CONTROL OF MOTONEURONS AFTER PARALYSIS ENABLED BY SPINAL CORD STIMULATION. medRxiv 2023:2023.11.29.23298779. [PMID: 38076797 PMCID: PMC10705627 DOI: 10.1101/2023.11.29.23298779] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Spinal cord stimulation (SCS) restores motor control after spinal cord injury (SCI) and stroke. This evidence led to the hypothesis that SCS facilitates residual supraspinal inputs to spinal motoneurons. Instead, here we show that SCS does not facilitate residual supraspinal inputs but directly triggers motoneurons action potentials. However, supraspinal inputs can shape SCS-mediated activity, mimicking volitional control of motoneuron firing. Specifically, by combining simulations, intraspinal electrophysiology in monkeys and single motor unit recordings in humans with motor paralysis, we found that residual supraspinal inputs transform subthreshold SCS-induced excitatory postsynaptic potentials into suprathreshold events. We then demonstrated that only a restricted set of stimulation parameters enables volitional control of motoneuron firing and that lesion severity further restricts the set of effective parameters. Our results explain the facilitation of voluntary motor control during SCS while predicting the limitations of this neurotechnology in cases of severe loss of supraspinal axons.
Collapse
Affiliation(s)
- Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Genis Prat-Ortega
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Nikhil Verma
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Prakarsh Yadav
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Erynn Sorensen
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Roberto de Freitas
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Scott Ensel
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Luigi Borda
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Serena Donadio
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
| | - Lucy Liang
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Jonathan Ho
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- School of Medicine, University of Pittsburgh, Pittsburgh, US
| | - Arianna Damiani
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
| | - Erinn Grigsby
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
| | - Daryl P. Fields
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | | | - Peter C. Gerszten
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| | - Lee E. Fisher
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
- Dept. of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, US
| | - Douglas J. Weber
- Dept. of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, US
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, US
| | - Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, US
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, US
- Dept. of Bioengineering, University of Pittsburgh, Pittsburgh, US
- Dept. of Neurological Surgery, University of Pittsburgh, Pittsburgh, US
| |
Collapse
|
10
|
Milekovic T, Moraud EM, Macellari N, Moerman C, Raschellà F, Sun S, Perich MG, Varescon C, Demesmaeker R, Bruel A, Bole-Feysot LN, Schiavone G, Pirondini E, YunLong C, Hao L, Galvez A, Hernandez-Charpak SD, Dumont G, Ravier J, Le Goff-Mignardot CG, Mignardot JB, Carparelli G, Harte C, Hankov N, Aureli V, Watrin A, Lambert H, Borton D, Laurens J, Vollenweider I, Borgognon S, Bourre F, Goillandeau M, Ko WKD, Petit L, Li Q, Buschman R, Buse N, Yaroshinsky M, Ledoux JB, Becce F, Jimenez MC, Bally JF, Denison T, Guehl D, Ijspeert A, Capogrosso M, Squair JW, Asboth L, Starr PA, Wang DD, Lacour SP, Micera S, Qin C, Bloch J, Bezard E, Courtine G. A spinal cord neuroprosthesis for locomotor deficits due to Parkinson's disease. Nat Med 2023; 29:2854-2865. [PMID: 37932548 DOI: 10.1038/s41591-023-02584-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/08/2023] [Indexed: 11/08/2023]
Abstract
People with late-stage Parkinson's disease (PD) often suffer from debilitating locomotor deficits that are resistant to currently available therapies. To alleviate these deficits, we developed a neuroprosthesis operating in closed loop that targets the dorsal root entry zones innervating lumbosacral segments to reproduce the natural spatiotemporal activation of the lumbosacral spinal cord during walking. We first developed this neuroprosthesis in a non-human primate model that replicates locomotor deficits due to PD. This neuroprosthesis not only alleviated locomotor deficits but also restored skilled walking in this model. We then implanted the neuroprosthesis in a 62-year-old male with a 30-year history of PD who presented with severe gait impairments and frequent falls that were medically refractory to currently available therapies. We found that the neuroprosthesis interacted synergistically with deep brain stimulation of the subthalamic nucleus and dopaminergic replacement therapies to alleviate asymmetry and promote longer steps, improve balance and reduce freezing of gait. This neuroprosthesis opens new perspectives to reduce the severity of locomotor deficits in people with PD.
Collapse
Affiliation(s)
- Tomislav Milekovic
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eduardo Martin Moraud
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Nicolo Macellari
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Charlotte Moerman
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Flavio Raschellà
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- NeuroX Institute, School of Bioengineering, EPFL, Lausanne, Switzerland
| | - Shiqi Sun
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Matthew G Perich
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Camille Varescon
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Robin Demesmaeker
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Alice Bruel
- Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Léa N Bole-Feysot
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Giuseppe Schiavone
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Laboratory for Soft Bioelectronic Interfaces (LSBI), NeuroX Institute, EPFL, Lausanne, Switzerland
| | - Elvira Pirondini
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cheng YunLong
- Motac Neuroscience, UK-M15 6WE, Manchester, UK
- China Academy of Medical Sciences, Beijing, China
- Institute of Laboratory Animal Sciences, Beijing, China
| | - Li Hao
- Motac Neuroscience, UK-M15 6WE, Manchester, UK
- China Academy of Medical Sciences, Beijing, China
- Institute of Laboratory Animal Sciences, Beijing, China
| | - Andrea Galvez
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Sergio Daniel Hernandez-Charpak
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Gregory Dumont
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Jimmy Ravier
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Camille G Le Goff-Mignardot
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Jean-Baptiste Mignardot
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Gaia Carparelli
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Cathal Harte
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Nicolas Hankov
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Viviana Aureli
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | | | | | - David Borton
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
- School of Engineering, Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Jean Laurens
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Isabelle Vollenweider
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Simon Borgognon
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - François Bourre
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Michel Goillandeau
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Wai Kin D Ko
- Motac Neuroscience, UK-M15 6WE, Manchester, UK
- China Academy of Medical Sciences, Beijing, China
- Institute of Laboratory Animal Sciences, Beijing, China
| | - Laurent Petit
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Qin Li
- Motac Neuroscience, UK-M15 6WE, Manchester, UK
- China Academy of Medical Sciences, Beijing, China
- Institute of Laboratory Animal Sciences, Beijing, China
| | | | | | - Maria Yaroshinsky
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jean-Baptiste Ledoux
- Department of Diagnostic and Interventional Radiology, CHUV/UNIL, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, CHUV/UNIL, Lausanne, Switzerland
| | | | - Julien F Bally
- Department of Neurology, CHUV/UNIL, Lausanne, Switzerland
| | | | - Dominique Guehl
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Auke Ijspeert
- Institute of Bioengineering, School of Engineering, EPFL, Lausanne, Switzerland
| | - Marco Capogrosso
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan W Squair
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Leonie Asboth
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Doris D Wang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Stéphanie P Lacour
- NeuroX Institute, School of Bioengineering, EPFL, Lausanne, Switzerland
- Laboratory for Soft Bioelectronic Interfaces (LSBI), NeuroX Institute, EPFL, Lausanne, Switzerland
| | - Silvestro Micera
- NeuroX Institute, School of Bioengineering, EPFL, Lausanne, Switzerland
- Department of Excellence in Robotics and AI, Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Chuan Qin
- China Academy of Medical Sciences, Beijing, China
| | - Jocelyne Bloch
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.
- Department of Neurosurgery, CHUV, Lausanne, Switzerland.
| | - Erwan Bezard
- Motac Neuroscience, UK-M15 6WE, Manchester, UK.
- China Academy of Medical Sciences, Beijing, China.
- Institute of Laboratory Animal Sciences, Beijing, China.
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
| | - G Courtine
- NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
- NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.
- Department of Neurosurgery, CHUV, Lausanne, Switzerland.
| |
Collapse
|
11
|
Liang L, Damiani A, Del Brocco M, Rogers ER, Jantz MK, Fisher LE, Gaunt RA, Capogrosso M, Lempka SF, Pirondini E. A systematic review of computational models for the design of spinal cord stimulation therapies: from neural circuits to patient-specific simulations. J Physiol 2023; 601:3103-3121. [PMID: 36409303 PMCID: PMC10259770 DOI: 10.1113/jp282884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/08/2022] [Indexed: 08/02/2023] Open
Abstract
Seventy years ago, Hodgkin and Huxley published the first mathematical model to describe action potential generation, laying the foundation for modern computational neuroscience. Since then, the field has evolved enormously, with studies spanning from basic neuroscience to clinical applications for neuromodulation. Computer models of neuromodulation have evolved in complexity and personalization, advancing clinical practice and novel neurostimulation therapies, such as spinal cord stimulation. Spinal cord stimulation is a therapy widely used to treat chronic pain, with rapidly expanding indications, such as restoring motor function. In general, simulations contributed dramatically to improve lead designs, stimulation configurations, waveform parameters and programming procedures and provided insight into potential mechanisms of action of electrical stimulation. Although the implementation of neural models are relentlessly increasing in number and complexity, it is reasonable to ask whether this observed increase in complexity is necessary for improved accuracy and, ultimately, for clinical efficacy. With this aim, we performed a systematic literature review and a qualitative meta-synthesis of the evolution of computational models, with a focus on complexity, personalization and the use of medical imaging to capture realistic anatomy. Our review showed that increased model complexity and personalization improved both mechanistic and translational studies. More specifically, the use of medical imaging enabled the development of patient-specific models that can help to transform clinical practice in spinal cord stimulation. Finally, we combined our results to provide clear guidelines for standardization and expansion of computational models for spinal cord stimulation.
Collapse
Affiliation(s)
- Lucy Liang
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Arianna Damiani
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matteo Del Brocco
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Evan R Rogers
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Maria K Jantz
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Lee E Fisher
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert A Gaunt
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marco Capogrosso
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Elvira Pirondini
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
12
|
Powell MP, Verma N, Sorensen E, Carranza E, Boos A, Fields DP, Roy S, Ensel S, Barra B, Balzer J, Goldsmith J, Friedlander RM, Wittenberg GF, Fisher LE, Krakauer JW, Gerszten PC, Pirondini E, Weber DJ, Capogrosso M. Epidural stimulation of the cervical spinal cord for post-stroke upper-limb paresis. Nat Med 2023; 29:689-699. [PMID: 36807682 DOI: 10.1038/s41591-022-02202-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/22/2022] [Indexed: 02/22/2023]
Abstract
Cerebral strokes can disrupt descending commands from motor cortical areas to the spinal cord, which can result in permanent motor deficits of the arm and hand. However, below the lesion, the spinal circuits that control movement remain intact and could be targeted by neurotechnologies to restore movement. Here we report results from two participants in a first-in-human study using electrical stimulation of cervical spinal circuits to facilitate arm and hand motor control in chronic post-stroke hemiparesis ( NCT04512690 ). Participants were implanted for 29 d with two linear leads in the dorsolateral epidural space targeting spinal roots C3 to T1 to increase excitation of arm and hand motoneurons. We found that continuous stimulation through selected contacts improved strength (for example, grip force +40% SCS01; +108% SCS02), kinematics (for example, +30% to +40% speed) and functional movements, thereby enabling participants to perform movements that they could not perform without spinal cord stimulation. Both participants retained some of these improvements even without stimulation and no serious adverse events were reported. While we cannot conclusively evaluate safety and efficacy from two participants, our data provide promising, albeit preliminary, evidence that spinal cord stimulation could be an assistive as well as a restorative approach for upper-limb recovery after stroke.
Collapse
Affiliation(s)
- Marc P Powell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nikhil Verma
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Erynn Sorensen
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erick Carranza
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Boos
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daryl P Fields
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Souvik Roy
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Ensel
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatrice Barra
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey Balzer
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeff Goldsmith
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Robert M Friedlander
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - George F Wittenberg
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
- Veterans Affairs HS, Pittsburgh, PA, USA
| | - Lee E Fisher
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - John W Krakauer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
- The Santa Fe Institute, Santa Fe, NM, USA
| | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
- NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, USA
- The Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Marco Capogrosso
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
13
|
Dalrymple AN, Hooper CA, Kuriakose MG, Capogrosso M, Weber DJ. Using a high-frequency carrier does not improve comfort of transcutaneous spinal cord stimulation. J Neural Eng 2023; 20. [PMID: 36595241 DOI: 10.1088/1741-2552/acabe8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Objective.Spinal cord neuromodulation has gained much attention for demonstrating improved motor recovery in people with spinal cord injury, motivating the development of clinically applicable technologies. Among them, transcutaneous spinal cord stimulation (tSCS) is attractive because of its non-invasive profile. Many tSCS studies employ a high-frequency (10 kHz) carrier, which has been reported to reduce stimulation discomfort. However, these claims have come under scrutiny in recent years. The purpose of this study was to determine whether using a high-frequency carrier for tSCS is more comfortable at therapeutic amplitudes, which evoke posterior root-muscle (PRM) reflexes.Approach.In 16 neurologically intact participants, tSCS was delivered using a 1 ms long monophasic pulse with and without a high-frequency carrier. Stimulation amplitude and pulse duration were varied and PRM reflexes were recorded from the soleus, gastrocnemius, and tibialis anterior muscles. Participants rated their discomfort during stimulation from 0 to 10 at PRM reflex threshold.Main Results.At PRM reflex threshold, the addition of a high-frequency carrier (0.87 ± 0.2) was equally comfortable as conventional stimulation (1.03 ± 0.18) but required approximately double the charge to evoke the PRM reflex (conventional: 32.4 ± 9.2µC; high-frequency carrier: 62.5 ± 11.1µC). Strength-duration curves for tSCS with a high-frequency carrier had a rheobase that was 4.8× greater and a chronaxie that was 5.7× narrower than the conventional monophasic pulse, indicating that the addition of a high-frequency carrier makes stimulation less efficient in recruiting neural activity in spinal roots.Significance.Using a high-frequency carrier for tSCS is equally as comfortable and less efficient as conventional stimulation at amplitudes required to stimulate spinal dorsal roots.
Collapse
Affiliation(s)
- Ashley N Dalrymple
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America.,NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Charli Ann Hooper
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America.,NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, United States of America.,Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Minna G Kuriakose
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America.,Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Marco Capogrosso
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America.,Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America.,Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, United States of America.,Center for Neural Basis of Cognition, Pittsburgh, PA, United States of America
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America.,NeuroMechatronics Lab, Carnegie Mellon University, Pittsburgh, PA, United States of America.,Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, United States of America
| |
Collapse
|
14
|
Pirondini E, Carranza E, Balaguer JM, Sorensen E, Weber DJ, Krakauer JW, Capogrosso M. Poststroke arm and hand paresis: should we target the cervical spinal cord? Trends Neurosci 2022; 45:568-578. [PMID: 35659414 DOI: 10.1016/j.tins.2022.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/18/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
Despite advances in understanding of corticospinal motor control and stroke pathophysiology, current rehabilitation therapies for poststroke upper limb paresis have limited efficacy at the level of impairment. To address this problem, we make the conceptual case for a new treatment approach. We first summarize current understanding of motor control deficits in the arm and hand after stroke and their shared physiological mechanisms with spinal cord injury (SCI). We then review studies of spinal cord stimulation (SCS) for recovery of locomotion after SCI, which provide convincing evidence for enhancement of residual corticospinal function. By extrapolation, we argue for using cervical SCS to restore upper limb motor control after stroke.
Collapse
Affiliation(s)
- Elvira Pirondini
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Erick Carranza
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Josep-Maria Balaguer
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erynn Sorensen
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA; Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - John W Krakauer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA; The Santa Fe Institute, Santa Fe, CA, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA.
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
15
|
Fang X, Collins S, Nanivadekar AC, Jantz M, Gaunt RA, Capogrosso M. An Open-source Computational Model of Neurostimulation of the Spinal Pudendo-Vesical Reflex for the Recovery of Bladder Control After Spinal Cord Injury. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:1607-1610. [PMID: 36086204 DOI: 10.1109/embc48229.2022.9871195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Spinal cord stimulation (SCS) could be used to restore control of the bladder after spinal cord injury, but substantial development is still required to tailor this technology for bladder function. Computational models could be utilized to accelerate these efforts enabling in-silico optimization of stimulation parameters. However, no model of the spinal pudendo-vesical reflex can simulate the effect of stimulation amplitude on neuron recruitment. This limitation hinders accurate prediction of bladder pressure changes for different stimulation configurations. Here., we implemented an open-source realistic spiking neural network model of the pudendo-vesical reflex enabling exploration of the impact of stimulation amplitude and frequency on bladder pressure changes. We used the o2S2 PARC platform to design a parallel implementation of the bladder reflex circuits with NEURON. Our model successfully reproduced and expanded previous studies., producing a decrease in bladder pressure at low stimulation frequency (10 Hz) and excitation at high stimulation frequency (≥33 Hz) in isovolumetric experiments. We then explored the effect of mixed nerve recruitment., simulating a common case of poorly selective spinal cord stimulation. We found that high recruitments of pudendal nerve axons are necessary to maintain this bi-modal behavior., regardless of stimulation specificity. Our framework is fully open-source and can be used to simulate any type of axon stimulations such as SCS and peripheral nerve stimulation.
Collapse
|
16
|
Jantz MK, Liang L, Damiani A, Fisher LE, Newton T, Neufeld E, Hitchens TK, Pirondini E, Capogrosso M, Gaunt RA. A Computational Study of Lower Urinary Tract Nerve Recruitment with Epidural Stimulation of the Lumbosacral Spinal Cord. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:744-747. [PMID: 36086335 DOI: 10.1109/embc48229.2022.9871292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Bladder dysfunction is a major health risk for people with spinal cord injury. Recently, we have demonstrated that epidural sacral spinal cord stimulation (SCS) can be used to activate lower urinary tract nerves and provide both major components of bladder control: voiding and continence. To effectively control these functions, it is necessary to selectively recruit the afferents of the pudendal nerve that evoke these distinct bladder reflexes. Translation of this innovation to clinical practice requires an understanding of optimal electrode placements and stimulation parameters to guide surgical practice and therapy design. Computational modeling is an important tool to address many of these experimentally intractable stimulation optimization questions. Here, we built a realistic MRI-based finite element computational model of the feline sacral spinal cord which included realistic axon trajectories in the dorsal and ventral roots. We coupled the model with biophysical simulations of membrane dynamics of afferent and efferent axons that project to the lower urinary tract through the pelvic and pudendal nerves. We simulated the electromagnetic fields arising from stimulation through SCS electrodes and calculated the expected recruitment of pelvic and pudendal fibers. We found that SCS can selectively recruit pudendal afferents, in agreement with our experimental data in cats. Our results suggest that SCS is a promising technology to improve bladder function after spinal cord injury, and computational modeling unlocks the potential for highly optimized, selective stimulation. Clinical Relevance - This model provides a method to non-invasively establish electrode placement and stimulation parameters for improving bladder function with epidural spinal cord stimulation.
Collapse
|
17
|
Ho JC, Liang L, Grigsby EM, Balaguer JM, Karapetyan V, Schaeffer DJ, Silva AC, Hitchens TK, Capogrosso M, Gerszten PC, Gonzalez-Martinez JA, Pirondini E. Robot Assisted Neurosurgery for High-Accuracy, Minimally-Invasive Deep Brain Electrophysiology in Monkeys. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:3115-3118. [PMID: 36086018 DOI: 10.1109/embc48229.2022.9871520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Traditional methods to access subcortical structures involve the use of anatomical atlases and high precision stereotaxic frames but suffer from significant variations in implantation accuracy. Here, we leveraged the use of the ROSA One(R) Robot Assistance Platform in non-human primates to study electrophysiological interactions of the corticospinal tract with spinal cord circuits. We were able to target and stimulate the corticospinal tract within the internal capsule with high accuracy and efficiency while recording spinal local field potentials and multi-unit spikes. Our method can be extended to any subcortical structure and allows implantation of multiple deep brain stimulation probes at the same time. Clinical Relevance- Our method will allow us to elucidate further roles of the corticospinal tract and its interactions with other processing centers in intact animals and in motor syndromes in the future.
Collapse
|
18
|
Farooqui J, Nanivadekar A, Capogrosso M, Lempka S, Fisher L. ID:16347 Modelling Selective Recruitment of Afferents by Stimulation of the Dorsal Root Ganglion. Neuromodulation 2022. [DOI: 10.1016/j.neurom.2022.02.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Fisher L, Nanivadekar A, Farooqui J, Weber D, Gaunt R, Capogrosso M, Lempka S. ID:16233 Selective Stimulation of the Dorsal Root Ganglia With Epineural Macroelectrodes. Neuromodulation 2022. [DOI: 10.1016/j.neurom.2022.02.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
20
|
Barra B, Conti S, Perich MG, Zhuang K, Schiavone G, Fallegger F, Galan K, James ND, Barraud Q, Delacombaz M, Kaeser M, Rouiller EM, Milekovic T, Lacour S, Bloch J, Courtine G, Capogrosso M. Epidural electrical stimulation of the cervical dorsal roots restores voluntary upper limb control in paralyzed monkeys. Nat Neurosci 2022; 25:924-934. [PMID: 35773543 DOI: 10.1038/s41593-022-01106-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/19/2022] [Indexed: 11/09/2022]
Abstract
Regaining arm control is a top priority for people with paralysis. Unfortunately, the complexity of the neural mechanisms underlying arm control has limited the effectiveness of neurotechnology approaches. Here, we exploited the neural function of surviving spinal circuits to restore voluntary arm and hand control in three monkeys with spinal cord injury, using spinal cord stimulation. Our neural interface leverages the functional organization of the dorsal roots to convey artificial excitation via electrical stimulation to relevant spinal segments at appropriate movement phases. Stimulation bursts targeting specific spinal segments produced sustained arm movements, enabling monkeys with arm paralysis to perform an unconstrained reach-and-grasp task. Stimulation specifically improved strength, task performances and movement quality. Electrophysiology suggested that residual descending inputs were necessary to produce coordinated movements. The efficacy and reliability of our approach hold realistic promises of clinical translation.
Collapse
Affiliation(s)
- Beatrice Barra
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland.,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sara Conti
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Matthew G Perich
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Katie Zhuang
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Giuseppe Schiavone
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Katia Galan
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Nicholas D James
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Quentin Barraud
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Maude Delacombaz
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Mélanie Kaeser
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Eric M Rouiller
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Tomislav Milekovic
- Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Stephanie Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Jocelyne Bloch
- Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), University Hospital Lausanne (CHUV), University of Lausanne (UNIL) and École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Department of Neurosurgery, CHUV, Lausanne, Switzerland
| | - Marco Capogrosso
- Platform of Translational Neuroscience, Department of Neuroscience and Movement Sciences, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland. .,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
21
|
de Freitas RM, Capogrosso M, Nomura T, Milosevic M. Optimizing sensory fiber activation during cervical transcutaneous spinal stimulation using different electrode configurations: A computational analysis. Artif Organs 2022; 46:2015-2026. [PMID: 35642297 DOI: 10.1111/aor.14323] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/21/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cervical transcutaneous spinal cord stimulation (tSCS) is a rehabilitation tool which has been used to promote upper-limb motor recovery after spinal cord injury. Importantly, optimizing sensory fiber activation at specific spinal segments could enable activity-dependent neuromodulation during rehabilitation. METHODS An anatomically realistic cervical tSCS computational model was used to analyze the activation of α-motor and Aα-sensory fibers at C7 and C8 spinal segments using nine cathode electrode configurations. Specifically, the cathode was simulated at three vertebral level positions: C6, C7, and T1; and in three sizes: 5.0 x 5.0, 3.5 x 3.5; and 2.5 x 2.5 cm2 , while the anode was on the anterior neck. Finite element method was used to estimate the electric potential distribution along α-motor and Aα-sensory fibers, and computational models were applied to simulate the fiber membrane dynamics during tSCS. The minimum stimulation intensity necessary to activate the fibers (activation threshold) was estimated and compared across cathode configurations in an effort to optimize sensory fiber activation. RESULTS Our results showed that nerve fibers at both C7 and C8 spinal segments were recruited at lower stimulation intensities when the cathode was positioned over the C7 or T1 vertebra compared with the C6 position. Sensory fibers were activated at lower stimulation intensities using smaller electrodes, which could also affect the degree of nerve fiber activation across different positions. Importantly, Aα-sensory fibers were consistently recruited before α-motor fibers. CONCLUSIONS These results imply that cathode positioning could help optimize preferential activation of hand muscles during cervical tSCS.
Collapse
Affiliation(s)
- Roberto M de Freitas
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Japan
| | - Marco Capogrosso
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA.,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Japan
| | - Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Japan
| |
Collapse
|
22
|
de Freitas RM, Capogrosso M, Nomura T, Milosevic M. Preferential activation of proprioceptive and cutaneous sensory fibers compared to motor fibers during cervical transcutaneous spinal cord stimulation: A computational study. J Neural Eng 2022; 19. [PMID: 35472720 DOI: 10.1088/1741-2552/ac6a7c] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/25/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Cervical transcutaneous spinal cord stimulation (tSCS) is a promising technology that can support motor function recovery of upper-limbs after spinal cord injury. Its efficacy may depend on the ability to recruit sensory afferents, conveying excitatory inputs onto motoneurons. Therefore, understanding its physiological mechanisms is critical to accelerate its development towards clinical applications. In this study, we used an anatomically realistic cervical tSCS computational model to compare α-motor, Aα-sensory, and Aβ-sensory fiber activation thresholds and activation sites. APPROACH We developed a 3D geometry of the cervical body and tSCS electrodes with a cathode centred at the C7 spinous process and an anode placed over the anterior neck. The geometrical model was used to estimate the electric potential distributions along motor and sensory fiber trajectories at the C7 spinal level using a finite element method. We implemented dedicated motor and sensory fiber models to simulate the α-motor and Aα-sensory fibers using 12, 16, and 20 µm diameter fibers, and Aβ-sensory fibers using 6, 9, and 12 µm diameter fibers. We estimated nerve fiber activation thresholds and sites for a 2 ms monophasic stimulating pulse and compared them across the fiber groups. MAIN RESULTS Our results showed lower activation thresholds of Aα- and Aβ-sensory fibers compared with α-motor fibers, suggesting preferential sensory fiber activation. We also found no differences between activation thresholds of Aα-sensory and large Aβ-sensory fibers, implying their co-activation. The activation sites were located at the dorsal and ventral root levels. SIGNIFICANCE Using a realistic computational model, we demonstrated preferential activation of dorsal root Aα- and Aβ-sensory fibers compared with ventral root α-motor fibers during cervical tSCS. These findings suggest high proprioceptive and cutaneous contributions to neural activations during cervical tSCS, which inform the underlying mechanisms of upper-limb functional motor recovery.
Collapse
Affiliation(s)
- Roberto M de Freitas
- Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama-cho, Toyonaka, 560-8531, JAPAN
| | - Marco Capogrosso
- University of Pittsburgh, 3520, Fifth Av., Pittsburgh, Pennsylvania, 15261, UNITED STATES
| | - Taishin Nomura
- Department of Mechanical Science and Bioengineering, Osaka University, Machikaneyama 1-3, Toyonaka City, Osaka 560- 8531, Toyonaka, 5608531, JAPAN
| | - Matija Milosevic
- Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama-cho, J520, Toyonaka, Osaka, 560-8531, JAPAN
| |
Collapse
|
23
|
Losanno E, Badi M, Wurth S, Borgognon S, Courtine G, Capogrosso M, Rouiller EM, Micera S. Bayesian optimization of peripheral intraneural stimulation protocols to evoke distal limb movements. J Neural Eng 2021; 18. [PMID: 34874320 DOI: 10.1088/1741-2552/ac3f6c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/02/2021] [Indexed: 11/12/2022]
Abstract
Objective.Motor neuroprostheses require the identification of stimulation protocols that effectively produce desired movements. Manual search for these protocols can be very time-consuming and often leads to suboptimal solutions, as several stimulation parameters must be personalized for each subject for a variety of target motor functions. Here, we present an algorithm that efficiently tunes peripheral intraneural stimulation protocols to elicit functionally relevant distal limb movements.Approach.We developed the algorithm using Bayesian optimization (BO) with multi-output Gaussian Processes (GPs) and defined objective functions based on coordinated muscle recruitment. We applied the algorithm offline to data acquired in rats for walking control and in monkeys for hand grasping control and compared different GP models for these two systems. We then performed a preliminary online test in a monkey to experimentally validate the functionality of our method.Main results.Offline, optimal intraneural stimulation protocols for various target motor functions were rapidly identified in both experimental scenarios. Using the model that performed best, the algorithm converged to stimuli that evoked functionally consistent movements with an average number of actions equal to 20% of the search space size in both the rat and monkey animal models. Online, the algorithm quickly guided the observations to stimuli that elicited functional hand gestures, although more selective motor outputs could have been achieved by refining the objective function used.Significance.These results demonstrate that BO can reliably and efficiently automate the tuning of peripheral neurostimulation protocols, establishing a translational framework to configure peripheral motor neuroprostheses in clinical applications. The proposed method can also potentially be applied to optimize motor functions using other stimulation modalities.
Collapse
Affiliation(s)
- E Losanno
- The Biorobotics Institute and Department of Excellent in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - M Badi
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - S Wurth
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - S Borgognon
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland.,Center for Neuroprosthetics and BrainMind Institute, School of Life Sciences, Eécole Polytechnique Feédeérale de Lausanne (EPFL), Lausanne, Switzerland
| | - G Courtine
- Center for Neuroprosthetics and BrainMind Institute, School of Life Sciences, Eécole Polytechnique Feédeérale de Lausanne (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL, University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - M Capogrosso
- Department of Neurological Surgery, Rehabilitation and Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - E M Rouiller
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - S Micera
- The Biorobotics Institute and Department of Excellent in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| |
Collapse
|
24
|
Seáñez I, Capogrosso M. Motor improvements enabled by spinal cord stimulation combined with physical training after spinal cord injury: review of experimental evidence in animals and humans. Bioelectron Med 2021; 7:16. [PMID: 34706778 PMCID: PMC8555080 DOI: 10.1186/s42234-021-00077-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022] Open
Abstract
Electrical spinal cord stimulation (SCS) has been gaining momentum as a potential therapy for motor paralysis in consequence of spinal cord injury (SCI). Specifically, recent studies combining SCS with activity-based training have reported unprecedented improvements in motor function in people with chronic SCI that persist even without stimulation. In this work, we first provide an overview of the critical scientific advancements that have led to the current uses of SCS in neurorehabilitation: e.g. the understanding that SCS activates dormant spinal circuits below the lesion by recruiting large-to-medium diameter sensory afferents within the posterior roots. We discuss how this led to the standardization of implant position which resulted in consistent observations by independent clinical studies that SCS in combination with physical training promotes improvements in motor performance and neurorecovery. While all reported participants were able to move previously paralyzed limbs from day 1, recovery of more complex motor functions was gradual, and the timeframe for first observations was proportional to the task complexity. Interestingly, individuals with SCI classified as AIS B and C regained motor function in paralyzed joints even without stimulation, but not individuals with motor and sensory complete SCI (AIS A). Experiments in animal models of SCI investigating the potential mechanisms underpinning this neurorecovery suggest a synaptic reorganization of cortico-reticulo-spinal circuits that correlate with improvements in voluntary motor control. Future experiments in humans and animal models of paralysis will be critical to understand the potential and limits for functional improvements in people with different types, levels, timeframes, and severities of SCI.
Collapse
Affiliation(s)
- Ismael Seáñez
- Biomedical Engineering, Washington University in St. Louis, St. Louis, USA. .,Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, USA.
| | - Marco Capogrosso
- Neurological Surgery, University of Pittsburgh, Pittsburgh, USA.,Department of Physical Medicine and Rehabilitation, Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA
| |
Collapse
|
25
|
Badi M, Wurth S, Scarpato I, Roussinova E, Losanno E, Bogaard A, Delacombaz M, Borgognon S, C Vanc Ara P, Fallegger F, Su DK, Schmidlin E, Courtine G, Bloch J, Lacour SP, Stieglitz T, Rouiller EM, Capogrosso M, Micera S. Intrafascicular peripheral nerve stimulation produces fine functional hand movements in primates. Sci Transl Med 2021; 13:eabg6463. [PMID: 34705521 DOI: 10.1126/scitranslmed.abg6463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Marion Badi
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Sophie Wurth
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Ilaria Scarpato
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Evgenia Roussinova
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Elena Losanno
- Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56025 Pisa, Italy
| | - Andrew Bogaard
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Maude Delacombaz
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Simon Borgognon
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland.,Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, EPFL, 1015 Lausanne, Switzerland
| | - Paul C Vanc Ara
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg, and BrainLinks-BrainTools Center, University of Freiburg, 79110 Freiburg, Germany
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, 1202 Geneva, Switzerland
| | - David K Su
- Neurological Surgery, Harborview Medical Center, Seattle, WA 98104, USA
| | - Eric Schmidlin
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, EPFL, 1015 Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL, University Hospital of Lausanne (CHUV), and University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Jocelyne Bloch
- Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL, University Hospital of Lausanne (CHUV), and University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, 1202 Geneva, Switzerland
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center Freiburg, and BrainLinks-BrainTools Center, University of Freiburg, 79110 Freiburg, Germany
| | - Eric M Rouiller
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Marco Capogrosso
- Department of Neuroscience and Movement Sciences, Platform of Translational Neurosciences, Section of Medicine, Faculty of Sciences and Medicine, University of Fribourg, 1700 Fribourg, Switzerland.,Department of Neurological Surgery, Rehabilitation and Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics, and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.,Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56025 Pisa, Italy
| |
Collapse
|
26
|
Squair JW, Gautier M, Mahe L, Soriano JE, Rowald A, Bichat A, Cho N, Anderson MA, James ND, Gandar J, Incognito AV, Schiavone G, Sarafis ZK, Laskaratos A, Bartholdi K, Demesmaeker R, Komi S, Moerman C, Vaseghi B, Scott B, Rosentreter R, Kathe C, Ravier J, McCracken L, Kang X, Vachicouras N, Fallegger F, Jelescu I, Cheng Y, Li Q, Buschman R, Buse N, Denison T, Dukelow S, Charbonneau R, Rigby I, Boyd SK, Millar PJ, Moraud EM, Capogrosso M, Wagner FB, Barraud Q, Bezard E, Lacour SP, Bloch J, Courtine G, Phillips AA. Neuroprosthetic baroreflex controls haemodynamics after spinal cord injury. Nature 2021; 590:308-314. [PMID: 33505019 DOI: 10.1038/s41586-020-03180-w] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/11/2020] [Indexed: 01/30/2023]
Abstract
Spinal cord injury (SCI) induces haemodynamic instability that threatens survival1-3, impairs neurological recovery4,5, increases the risk of cardiovascular disease6,7, and reduces quality of life8,9. Haemodynamic instability in this context is due to the interruption of supraspinal efferent commands to sympathetic circuits located in the spinal cord10, which prevents the natural baroreflex from controlling these circuits to adjust peripheral vascular resistance. Epidural electrical stimulation (EES) of the spinal cord has been shown to compensate for interrupted supraspinal commands to motor circuits below the injury11, and restored walking after paralysis12. Here, we leveraged these concepts to develop EES protocols that restored haemodynamic stability after SCI. We established a preclinical model that enabled us to dissect the topology and dynamics of the sympathetic circuits, and to understand how EES can engage these circuits. We incorporated these spatial and temporal features into stimulation protocols to conceive a clinical-grade biomimetic haemodynamic regulator that operates in a closed loop. This 'neuroprosthetic baroreflex' controlled haemodynamics for extended periods of time in rodents, non-human primates and humans, after both acute and chronic SCI. We will now conduct clinical trials to turn the neuroprosthetic baroreflex into a commonly available therapy for people with SCI.
Collapse
Affiliation(s)
- Jordan W Squair
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland.,Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,MD/PhD Training Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada.,RestoreNetwork, Hotchkiss Brain Institute, Libin Cardiovascular Institute, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthieu Gautier
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Lois Mahe
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Jan Elaine Soriano
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,RestoreNetwork, Hotchkiss Brain Institute, Libin Cardiovascular Institute, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andreas Rowald
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Arnaud Bichat
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Newton Cho
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland.,Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Mark A Anderson
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Nicholas D James
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Jerome Gandar
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Anthony V Incognito
- RestoreNetwork, Hotchkiss Brain Institute, Libin Cardiovascular Institute, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Giuseppe Schiavone
- Centre for Neuroprosthetics, Institute of Microengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Zoe K Sarafis
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Achilleas Laskaratos
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Kay Bartholdi
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Robin Demesmaeker
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Salif Komi
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Charlotte Moerman
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Bita Vaseghi
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Berkeley Scott
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,RestoreNetwork, Hotchkiss Brain Institute, Libin Cardiovascular Institute, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ryan Rosentreter
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,RestoreNetwork, Hotchkiss Brain Institute, Libin Cardiovascular Institute, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claudia Kathe
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Jimmy Ravier
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Laura McCracken
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Xiaoyang Kang
- Centre for Neuroprosthetics, Institute of Microengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Nicolas Vachicouras
- Centre for Neuroprosthetics, Institute of Microengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Florian Fallegger
- Centre for Neuroprosthetics, Institute of Microengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Ileana Jelescu
- Center for Biomedical Imaging, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | | | - Qin Li
- Motac Neuroscience Ltd, Manchester, UK
| | | | | | - Tim Denison
- Department of Engineering Science and Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sean Dukelow
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,RestoreNetwork, Hotchkiss Brain Institute, Libin Cardiovascular Institute, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca Charbonneau
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,RestoreNetwork, Hotchkiss Brain Institute, Libin Cardiovascular Institute, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ian Rigby
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven K Boyd
- Department of Radiology, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Philip J Millar
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Eduardo Martin Moraud
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Marco Capogrosso
- Faculty of Biology, University of Fribourg, Fribourg, Switzerland
| | - Fabien B Wagner
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland.,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR, 5293, Bordeaux, France
| | - Quentin Barraud
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Erwan Bezard
- Motac Neuroscience Ltd, Manchester, UK.,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR, 5293, Bordeaux, France.,Institut des Maladies Neurodégénératives, CNRS, UMR, 5293, Bordeaux, France
| | - Stéphanie P Lacour
- Centre for Neuroprosthetics, Institute of Microengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Jocelyne Bloch
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland. .,Department of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland. .,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland. .,Defitech Center for Interventional Neurotherapies (.NeuroRestore), CHUV/UNIL/EPFL, Lausanne, Switzerland.
| | - Aaron A Phillips
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada. .,RestoreNetwork, Hotchkiss Brain Institute, Libin Cardiovascular Institute, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
27
|
Greiner N, Barra B, Schiavone G, Lorach H, James N, Conti S, Kaeser M, Fallegger F, Borgognon S, Lacour S, Bloch J, Courtine G, Capogrosso M. Recruitment of upper-limb motoneurons with epidural electrical stimulation of the cervical spinal cord. Nat Commun 2021; 12:435. [PMID: 33469022 PMCID: PMC7815834 DOI: 10.1038/s41467-020-20703-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022] Open
Abstract
Epidural electrical stimulation (EES) of lumbosacral sensorimotor circuits improves leg motor control in animals and humans with spinal cord injury (SCI). Upper-limb motor control involves similar circuits, located in the cervical spinal cord, suggesting that EES could also improve arm and hand movements after quadriplegia. However, the ability of cervical EES to selectively modulate specific upper-limb motor nuclei remains unclear. Here, we combined a computational model of the cervical spinal cord with experiments in macaque monkeys to explore the mechanisms of upper-limb motoneuron recruitment with EES and characterize the selectivity of cervical interfaces. We show that lateral electrodes produce a segmental recruitment of arm motoneurons mediated by the direct activation of sensory afferents, and that muscle responses to EES are modulated during movement. Intraoperative recordings suggested similar properties in humans at rest. These modelling and experimental results can be applied for the development of neurotechnologies designed for the improvement of arm and hand control in humans with quadriplegia. The efficacy of epidural electrical stimulation (EES) to engage arm muscles and improve movement after spinal cord injury is still unclear. Here, the authors investigated how EES can recruit upper-limb motor neurons by combining computational modelling with experiments in non-human primates.
Collapse
Affiliation(s)
- Nathan Greiner
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland. .,Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
| | - Beatrice Barra
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Giuseppe Schiavone
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Henri Lorach
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), Lausanne, Switzerland
| | - Nicholas James
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
| | - Sara Conti
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Melanie Kaeser
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Simon Borgognon
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.,Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Stéphanie Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Jocelyne Bloch
- Defitech Center for Interventional Neurotherapies (NeuroRestore), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marco Capogrosso
- Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland. .,Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA. .,Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
28
|
Mirzakhalili E, Barra B, Capogrosso M, Lempka SF. Biophysics of Temporal Interference Stimulation. Cell Syst 2020; 11:557-572.e5. [PMID: 33157010 DOI: 10.1016/j.cels.2020.10.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/21/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
Temporal interference (TI) is a non-invasive neurostimulation technique that utilizes high-frequency external electric fields to stimulate deep neuronal structures without affecting superficial, off-target structures. TI represents a potential breakthrough for treating conditions, such as Parkinson's disease and chronic pain. However, early clinical work on TI stimulation was met with mixed outcomes challenging its fundamental mechanisms and applications. Here, we apply established physics to study the mechanisms of TI with the goal of optimizing it for clinical use. We argue that TI stimulation cannot work via passive membrane filtering, as previously hypothesized. Instead, TI stimulation requires an ion-channel mediated signal rectification process. Unfortunately, this mechanism is also responsible for high-frequency conduction block in off-target tissues, thus challenging clinical applications of TI. In consequence, we propose a set of experimental controls that should be performed in future experiments to refine our understanding and practice of TI stimulation. A record of this paper's transparent peer review process is included in the Supplemental Information.
Collapse
Affiliation(s)
- Ehsan Mirzakhalili
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Beatrice Barra
- Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, Switzerland; Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Marco Capogrosso
- Rehab and Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA.
| |
Collapse
|
29
|
Kibleur P, Tata SR, Greiner N, Conti S, Barra B, Zhuang K, Kaeser M, Ijspeert A, Capogrosso M. Spatiotemporal Maps of Proprioceptive Inputs to the Cervical Spinal Cord During Three-Dimensional Reaching and Grasping. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1668-1677. [DOI: 10.1109/tnsre.2020.2986491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
30
|
Abstract
Efficient identification of effective neurostimulation strategies is critical due to the growing number of clinical applications and the increasing complexity of the corresponding technology. In consequence, investigators are encouraged to accelerate translational research of neurostimulation technologies and move quickly to clinical applications. However, this process is hampered by rigorous, but necessary, regulations and lack of a mechanistic understanding of the interactions between electric fields and neural circuits. Here we discuss how computational models have influenced the field of neurostimulation for pain and movement recovery, deep brain stimulation, and even device regulations. Finally, we propose our vision on how computational models will be key to accelerate clinical developments through mechanistic understanding.
Collapse
Affiliation(s)
- Marco Capogrosso
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA USA.,Rehabilitation Neural Engineering Laboratories, University of Pittsburgh, Pittsburgh, PA USA
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, MI USA
| |
Collapse
|
31
|
Schiavone G, Fallegger F, Kang X, Barra B, Vachicouras N, Roussinova E, Furfaro I, Jiguet S, Seáñez I, Borgognon S, Rowald A, Li Q, Qin C, Bézard E, Bloch J, Courtine G, Capogrosso M, Lacour SP. Soft, Implantable Bioelectronic Interfaces for Translational Research. Adv Mater 2020; 32:e1906512. [PMID: 32173913 DOI: 10.1002/adma.201906512] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/19/2019] [Indexed: 06/10/2023]
Abstract
The convergence of materials science, electronics, and biology, namely bioelectronic interfaces, leads novel and precise communication with biological tissue, particularly with the nervous system. However, the translation of lab-based innovation toward clinical use calls for further advances in materials, manufacturing and characterization paradigms, and design rules. Herein, a translational framework engineered to accelerate the deployment of microfabricated interfaces for translational research is proposed and applied to the soft neurotechnology called electronic dura mater, e-dura. Anatomy, implant function, and surgical procedure guide the system design. A high-yield, silicone-on-silicon wafer process is developed to ensure reproducible characteristics of the electrodes. A biomimetic multimodal platform that replicates surgical insertion in an anatomy-based model applies physiological movement, emulates therapeutic use of the electrodes, and enables advanced validation and rapid optimization in vitro of the implants. Functionality of scaled e-dura is confirmed in nonhuman primates, where epidural neuromodulation of the spinal cord activates selective groups of muscles in the upper limbs with unmet precision. Performance stability is controlled over 6 weeks in vivo. The synergistic steps of design, fabrication, and biomimetic in vitro validation and in vivo evaluation in translational animal models are of general applicability and answer needs in multiple bioelectronic designs and medical technologies.
Collapse
Affiliation(s)
- Giuseppe Schiavone
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| | - Xiaoyang Kang
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| | - Beatrice Barra
- Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, 1700, Switzerland
| | - Nicolas Vachicouras
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| | - Evgenia Roussinova
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| | - Ivan Furfaro
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| | - Sébastien Jiguet
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| | - Ismael Seáñez
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland
| | - Simon Borgognon
- Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, 1700, Switzerland
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland
| | - Andreas Rowald
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland
| | - Qin Li
- Institute of Lab Animal Sciences, China Academy of Medical Sciences, Beijing, 100021, China
- Motac Neuroscience Ltd, Manchester, SK10 4TF, UK
| | - Chuan Qin
- Institute of Lab Animal Sciences, China Academy of Medical Sciences, Beijing, 100021, China
| | - Erwan Bézard
- Institute of Lab Animal Sciences, China Academy of Medical Sciences, Beijing, 100021, China
- Motac Neuroscience Ltd, Manchester, SK10 4TF, UK
- Institut des Maladies Neurodégénératives, University of Bordeaux, Bordeaux, UMR 5293, France
- CNRS, Institut des Maladies Neurodégénératives, Bordeaux, UMR 5293, France
| | - Jocelyne Bloch
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore), Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore), Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marco Capogrosso
- Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, 1700, Switzerland
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| |
Collapse
|
32
|
Barra B, Badi M, Perich MG, Conti S, Mirrazavi Salehian SS, Moreillon F, Bogaard A, Wurth S, Kaeser M, Passeraub P, Milekovic T, Billard A, Micera S, Capogrosso M. A versatile robotic platform for the design of natural, three-dimensional reaching and grasping tasks in monkeys. J Neural Eng 2019; 17:016004. [PMID: 31597123 DOI: 10.1088/1741-2552/ab4c77] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Translational studies on motor control and neurological disorders require detailed monitoring of sensorimotor components of natural limb movements in relevant animal models. However, available experimental tools do not provide a sufficiently rich repertoire of behavioral signals. Here, we developed a robotic platform that enables the monitoring of kinematics, interaction forces, and neurophysiological signals during user-defined upper limb tasks for monkeys. APPROACH We configured the platform to position instrumented objects in a three-dimensional workspace and provide an interactive dynamic force-field. MAIN RESULTS We show the relevance of our platform for fundamental and translational studies with three example applications. First, we study the kinematics of natural grasp in response to variable interaction forces. We then show simultaneous and independent encoding of kinematic and forces in single unit intra-cortical recordings from sensorimotor cortical areas. Lastly, we demonstrate the relevance of our platform to develop clinically relevant brain computer interfaces in a kinematically unconstrained motor task. SIGNIFICANCE Our versatile control structure does not depend on the specific robotic arm used and allows for the design and implementation of a variety of tasks that can support both fundamental and translational studies of motor control.
Collapse
Affiliation(s)
- B Barra
- Department of Neuroscience and Movement Science, Platform of Translational Neurosciences, University of Fribourg, Fribourg, Switzerland. Co-first authors
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Schiavone G, Wagner F, Fallegger F, Kang X, Vachicouras N, Barra B, Capogrosso M, Bloch J, Courtine G, Lacour SP. Long-term functionality of a soft electrode array for epidural spinal cord stimulation in a minipig model. Annu Int Conf IEEE Eng Med Biol Soc 2019; 2018:1432-1435. [PMID: 30440661 DOI: 10.1109/embc.2018.8512584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Long-term biointegration of man-made neural interfaces is influenced by the mechanical properties of the implant materials. Substantial experimental work currently aims at replacing conventional hard implant materials with soft alternatives that can favour a lower immune response. Here we assess the performance of a soft electrode array implanted in the spinal epidural space of a minipig model for a period of 6 months. The electrode array includes platinum-silicone electrode contacts and elastic thin-film gold interconnects embedded in silicone. textbfIn-vivo electrode impedance and voltage transients were monitored over time. Following implantation, epidural stimulation produced muscle-specific evoked potentials and visible muscle contractions. Over time, postoperative and stimulation induced changes in electrode impedance were observed. Such trends provide a basis for future technological improvements aiming at ensuring the stability of soft implantable electrodes for neural interfacing.
Collapse
|
34
|
Capogrosso M, Gandar J, Greiner N, Moraud EM, Wenger N, Shkorbatova P, Musienko P, Minev I, Lacour S, Courtine G. Advantages of soft subdural implants for the delivery of electrochemical neuromodulation therapies to the spinal cord. J Neural Eng 2019; 15:026024. [PMID: 29339580 DOI: 10.1088/1741-2552/aaa87a] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE We recently developed soft neural interfaces enabling the delivery of electrical and chemical stimulation to the spinal cord. These stimulations restored locomotion in animal models of paralysis. Soft interfaces can be placed either below or above the dura mater. Theoretically, the subdural location combines many advantages, including increased selectivity of electrical stimulation, lower stimulation thresholds, and targeted chemical stimulation through local drug delivery. However, these advantages have not been documented, nor have their functional impact been studied in silico or in a relevant animal model of neurological disorders using a multimodal neural interface. APPROACH We characterized the recruitment properties of subdural interfaces using a realistic computational model of the rat spinal cord that included explicit representation of the spinal roots. We then validated and complemented computer simulations with electrophysiological experiments in rats. We additionally performed behavioral experiments in rats that received a lateral spinal cord hemisection and were implanted with a soft interface. MAIN RESULTS In silico and in vivo experiments showed that the subdural location decreased stimulation thresholds compared to the epidural location while retaining high specificity. This feature reduces power consumption and risks of long-term damage in the tissues, thus increasing the clinical safety profile of this approach. The hemisection induced a transient paralysis of the leg ipsilateral to the injury. During this period, the delivery of electrical stimulation restricted to the injured side combined with local chemical modulation enabled coordinated locomotor movements of the paralyzed leg without affecting the non-impaired leg in all tested rats. Electrode properties remained stable over time, while anatomical examinations revealed excellent bio-integration properties. SIGNIFICANCE Soft neural interfaces inserted subdurally provide the opportunity to deliver electrical and chemical neuromodulation therapies using a single, bio-compatible and mechanically compliant device that effectively alleviates locomotor deficits after spinal cord injury.
Collapse
Affiliation(s)
- Marco Capogrosso
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland. Department of Medicine, Platform of Translational Neuroscience, University of Fribourg, Fribourg, Switzerland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Petrini FM, Mazzoni A, Rigosa J, Giambattistelli F, Granata G, Barra B, Pampaloni A, Guglielmelli E, Zollo L, Capogrosso M, Micera S, Raspopovic S. Microneurography as a tool to develop decoding algorithms for peripheral neuro-controlled hand prostheses. Biomed Eng Online 2019; 18:44. [PMID: 30961620 PMCID: PMC6454621 DOI: 10.1186/s12938-019-0659-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The usability of dexterous hand prostheses is still hampered by the lack of natural and effective control strategies. A decoding strategy based on the processing of descending efferent neural signals recorded using peripheral neural interfaces could be a solution to such limitation. Unfortunately, this choice is still restrained by the reduced knowledge of the dynamics of human efferent signals recorded from the nerves and associated to hand movements. FINDINGS To address this issue, in this work we acquired neural efferent activities from healthy subjects performing hand-related tasks using ultrasound-guided microneurography, a minimally invasive technique, which employs needles, inserted percutaneously, to record from nerve fibers. These signals allowed us to identify neural features correlated with force and velocity of finger movements that were used to decode motor intentions. We developed computational models, which confirmed the potential translatability of these results showing how these neural features hold in absence of feedback and when implantable intrafascicular recording, rather than microneurography, is performed. CONCLUSIONS Our results are a proof of principle that microneurography could be used as a useful tool to assist the development of more effective hand prostheses.
Collapse
Affiliation(s)
- Francesco M. Petrini
- Neuroengineering Lab, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, TAN E 2, Tannenstrasse 1, 8092 Zurich, Switzerland
- Center for Neuroprosthetics, Ecole Polytechnique Federale de Lausanne, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
- Bertarelli Foundation Chair in Translational NeuroEngineering, Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
- Laboratory of Biomedical Robotics & Biomicrosystems, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
- IRCCS S.Raffale-Pisana, Via della Pisana 235, 00163 Rome, Italy
| | - Alberto Mazzoni
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Italy
| | - Jacopo Rigosa
- Center for Neuroprosthetics, Ecole Polytechnique Federale de Lausanne, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Italy
| | - Federica Giambattistelli
- Institute of Neurology, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 200, 00128 Rome, Italy
| | - Giuseppe Granata
- IRCCS S.Raffale-Pisana, Via della Pisana 235, 00163 Rome, Italy
- Catholic University of the Sacred Heart, Largo Agostino Gemelli 1, 20123 Rome, Italy
| | - Beatrice Barra
- Center for Neuroprosthetics, Ecole Polytechnique Federale de Lausanne, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
- Bertarelli Foundation Chair in Translational NeuroEngineering, Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
- Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg, Switzerland
| | - Alessandra Pampaloni
- Center for Neuroprosthetics, Ecole Polytechnique Federale de Lausanne, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
- Bertarelli Foundation Chair in Translational NeuroEngineering, Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Eugenio Guglielmelli
- Laboratory of Biomedical Robotics & Biomicrosystems, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Loredana Zollo
- Laboratory of Biomedical Robotics & Biomicrosystems, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Marco Capogrosso
- Center for Neuroprosthetics, Ecole Polytechnique Federale de Lausanne, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
- Bertarelli Foundation Chair in Translational NeuroEngineering, Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
- Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg, Switzerland
| | - Silvestro Micera
- Center for Neuroprosthetics, Ecole Polytechnique Federale de Lausanne, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
- Bertarelli Foundation Chair in Translational NeuroEngineering, Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Italy
| | - Stanisa Raspopovic
- Neuroengineering Lab, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, TAN E 2, Tannenstrasse 1, 8092 Zurich, Switzerland
| |
Collapse
|
36
|
Formento E, Minassian K, Wagner F, Mignardot JB, Le Goff-Mignardot CG, Rowald A, Bloch J, Micera S, Capogrosso M, Courtine G. Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury. Nat Neurosci 2018; 21:1728-1741. [PMID: 30382196 PMCID: PMC6268129 DOI: 10.1038/s41593-018-0262-6] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/26/2018] [Indexed: 11/25/2022]
Abstract
Epidural electrical stimulation (EES) of the spinal cord restores locomotion in animal models of spinal cord injury but is less effective in humans. Here we hypothesized that this interspecies discrepancy is due to interference between EES and proprioceptive information in humans. Computational simulations and preclinical and clinical experiments reveal that EES blocks a significant amount of proprioceptive input in humans, but not in rats. This transient deafferentation prevents modulation of reciprocal inhibitory networks involved in locomotion and reduces or abolishes the conscious perception of leg position. Consequently, continuous EES can only facilitate locomotion within a narrow range of stimulation parameters and is unable to provide meaningful locomotor improvements in humans without rehabilitation. Simulations showed that burst stimulation and spatiotemporal stimulation profiles mitigate the cancellation of proprioceptive information, enabling robust control over motor neuron activity. This demonstrates the importance of stimulation protocols that preserve proprioceptive information to facilitate walking with EES.
Collapse
Affiliation(s)
- Emanuele Formento
- Bertarelli Foundation Chair in Translational NeuroEngineering, Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Karen Minassian
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Fabien Wagner
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Jean Baptiste Mignardot
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Camille G Le Goff-Mignardot
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Andreas Rowald
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
- Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg, Switzerland
| | - Jocelyne Bloch
- Department of Neurosurgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational NeuroEngineering, Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
- Neural Engineering Area, Institute of Biorobotics, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marco Capogrosso
- Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg, Switzerland
| | - Gregoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
- Department of Neurosurgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
| |
Collapse
|
37
|
Barra B, Roux C, Kaeser M, Schiavone G, Lacour SP, Bloch J, Courtine G, Rouiller EM, Schmidlin E, Capogrosso M. Selective Recruitment of Arm Motoneurons in Nonhuman Primates Using Epidural Electrical Stimulation of the Cervical Spinal Cord. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:1424-1427. [PMID: 30440659 DOI: 10.1109/embc.2018.8512554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recovery of reaching and grasping ability is the priority for people with cervical spinal cord injury (SCI). Epidural electrical stimulation (EES) has shown promising results in improving motor control after SCI in various animal models and in humans. Notably, the application of stimulation bursts with spatiotemporal sequences that reproduce the natural activation of motoneurons restored skilled leg movements in rodent and nonhuman primate models of SCI. Here, we studied whether this conceptual framework could be transferred to the design of cervical EES protocols for the recovery of reaching and grasping in nonhuman primates. We recorded muscle activity during a reaching and grasping task in a macaque monkey and found that this task involves a stereotypical spatiotemporal map of motoneuron activation. We then characterized the specificity of a spinal implant for the delivery of EES to cervical spinal segments in the same animal. Finally, we combined these results to design a simple stimulation protocol that may reproduce natural motoneuron activation and thus facilitate upper limb movements after injury.
Collapse
|
38
|
Séguin P, Wagner F, Mignardot J, Le Goff C, Komi S, Demaesmaker R, Capogrosso M, Maccracken L, Vat M, Minassian K, Bloch J, Courtine G. Spatiotemporal neuromodulation of the spinal cord in combination with a gravity-assist training to improve locomotor recovery in humans with spinal cord injury. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
39
|
Mignardot JB, Le Goff CG, van den Brand R, Capogrosso M, Fumeaux N, Vallery H, Anil S, Lanini J, Fodor I, Eberle G, Ijspeert A, Schurch B, Curt A, Carda S, Bloch J, von Zitzewitz J, Courtine G. A multidirectional gravity-assist algorithm that enhances locomotor control in patients with stroke or spinal cord injury. Sci Transl Med 2018; 9:9/399/eaah3621. [PMID: 28724575 DOI: 10.1126/scitranslmed.aah3621] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 01/26/2017] [Accepted: 06/29/2017] [Indexed: 12/18/2022]
Abstract
Gait recovery after neurological disorders requires remastering the interplay between body mechanics and gravitational forces. Despite the importance of gravity-dependent gait interactions and active participation for promoting this learning, these essential components of gait rehabilitation have received comparatively little attention. To address these issues, we developed an adaptive algorithm that personalizes multidirectional forces applied to the trunk based on patient-specific motor deficits. Implementation of this algorithm in a robotic interface reestablished gait dynamics during highly participative locomotion within a large and safe environment. This multidirectional gravity-assist enabled natural walking in nonambulatory individuals with spinal cord injury or stroke and enhanced skilled locomotor control in the less-impaired subjects. A 1-hour training session with multidirectional gravity-assist improved locomotor performance tested without robotic assistance immediately after training, whereas walking the same distance on a treadmill did not ameliorate gait. These results highlight the importance of precise trunk support to deliver gait rehabilitation protocols and establish a practical framework to apply these concepts in clinical routine.
Collapse
Affiliation(s)
- Jean-Baptiste Mignardot
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland.,Clinical Neuroscience, University Hospital of Vaud (CHUV), Lausanne, Switzerland
| | - Camille G Le Goff
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland.,Clinical Neuroscience, University Hospital of Vaud (CHUV), Lausanne, Switzerland
| | - Rubia van den Brand
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland.,Clinical Neuroscience, University Hospital of Vaud (CHUV), Lausanne, Switzerland
| | - Marco Capogrosso
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland.,Clinical Neuroscience, University Hospital of Vaud (CHUV), Lausanne, Switzerland
| | - Nicolas Fumeaux
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland
| | - Heike Vallery
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, Netherlands
| | - Selin Anil
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland
| | | | | | | | | | | | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefano Carda
- Clinical Neuroscience, University Hospital of Vaud (CHUV), Lausanne, Switzerland.,Neurorehabilitation, CHUV, Lausanne, Switzerland
| | - Jocelyne Bloch
- Clinical Neuroscience, University Hospital of Vaud (CHUV), Lausanne, Switzerland.,Neurosurgery, CHUV, Lausanne, Switzerland
| | - Joachim von Zitzewitz
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland. .,Neurosurgery, CHUV, Lausanne, Switzerland
| |
Collapse
|
40
|
Moraud EM, von Zitzewitz J, Miehlbradt J, Wurth S, Formento E, DiGiovanna J, Capogrosso M, Courtine G, Micera S. Closed-loop control of trunk posture improves locomotion through the regulation of leg proprioceptive feedback after spinal cord injury. Sci Rep 2018; 8:76. [PMID: 29311614 PMCID: PMC5758718 DOI: 10.1038/s41598-017-18293-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/05/2017] [Indexed: 01/09/2023] Open
Abstract
After spinal cord injury (SCI), sensory feedback circuits critically contribute to leg motor execution. Compelled by the importance to engage these circuits during gait rehabilitation, assistive robotics and training protocols have primarily focused on guiding leg movements to reinforce sensory feedback. Despite the importance of trunk postural dynamics on gait and balance, trunk assistance has comparatively received little attention. Typically, trunk movements are either constrained within bodyweight support systems, or manually adjusted by therapists. Here, we show that real-time control of trunk posture re-established dynamic balance amongst bilateral proprioceptive feedback circuits, and thereby restored left-right symmetry, loading and stepping consistency in rats with severe SCI. We developed a robotic system that adjusts mediolateral trunk posture during locomotion. This system uncovered robust relationships between trunk orientation and the modulation of bilateral leg kinematics and muscle activity. Computer simulations suggested that these modulations emerged from corrections in the balance between flexor- and extensor-related proprioceptive feedback. We leveraged this knowledge to engineer control policies that regulate trunk orientation and postural sway in real-time. This dynamical postural interface immediately improved stepping quality in all rats regardless of broad differences in deficits. These results emphasize the importance of trunk regulation to optimize performance during rehabilitation.
Collapse
Affiliation(s)
- Eduardo Martin Moraud
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland.
| | - Joachim von Zitzewitz
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland
| | - Jenifer Miehlbradt
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland
| | - Sophie Wurth
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland
| | - Emanuele Formento
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland
| | - Jack DiGiovanna
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland
| | | | - Grégoire Courtine
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland.
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Swiss Federal Institute of Technology (EPFL), CH-1202, Geneva, Switzerland.,The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
| |
Collapse
|
41
|
Wurth S, Capogrosso M, Raspopovic S, Gandar J, Federici G, Kinany N, Cutrone A, Piersigilli A, Pavlova N, Guiet R, Taverni G, Rigosa J, Shkorbatova P, Navarro X, Barraud Q, Courtine G, Micera S. Long-term usability and bio-integration of polyimide-based intra-neural stimulating electrodes. Biomaterials 2017; 122:114-129. [PMID: 28110171 DOI: 10.1016/j.biomaterials.2017.01.014] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/21/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
Abstract
Stimulation of peripheral nerves has transiently restored lost sensation and has the potential to alleviate motor deficits. However, incomplete characterization of the long-term usability and bio-integration of intra-neural implants has restricted their use for clinical applications. Here, we conducted a longitudinal assessment of the selectivity, stability, functionality, and biocompatibility of polyimide-based intra-neural implants that were inserted in the sciatic nerve of twenty-three healthy adult rats for up to six months. We found that the stimulation threshold and impedance of the electrodes increased moderately during the first four weeks after implantation, and then remained stable over the following five months. The time course of these adaptations correlated with the progressive development of a fibrotic capsule around the implants. The selectivity of the electrodes enabled the preferential recruitment of extensor and flexor muscles of the ankle. Despite the foreign body reaction, this selectivity remained stable over time. These functional properties supported the development of control algorithms that modulated the forces produced by ankle extensor and flexor muscles with high precision. The comprehensive characterization of the implant encapsulation revealed hyper-cellularity, increased microvascular density, Wallerian degeneration, and infiltration of macrophages within the endoneurial space early after implantation. Over time, the amount of macrophages markedly decreased, and a layer of multinucleated giant cells surrounded by a capsule of fibrotic tissue developed around the implant, causing an enlargement of the diameter of the nerve. However, the density of nerve fibers above and below the inserted implant remained unaffected. Upon removal of the implant, we did not detect alteration of skilled leg movements and only observed mild tissue reaction. Our study characterized the interplay between the development of foreign body responses and changes in the electrical properties of actively used intra-neural electrodes, highlighting functional stability of polyimide-based implants over more than six months. These results are essential for refining and validating these implants and open a realistic pathway for long-term clinical applications in humans.
Collapse
Affiliation(s)
- S Wurth
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - M Capogrosso
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - S Raspopovic
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - J Gandar
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - G Federici
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - N Kinany
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - A Cutrone
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - A Piersigilli
- Laboratory Animals Pathology Unit, Institute of Animal Pathology, University of Bern, Bern, Switzerland
| | - N Pavlova
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Pavlov Institute of Physiology, St Petersbourg, Russia
| | - R Guiet
- Bioimaging and Optics Platform, Faculty of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - G Taverni
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - J Rigosa
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; SAMBA Lab, International School for Advanced Studies, Trieste, Italy
| | - P Shkorbatova
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Pavlov Institute of Physiology, St Petersbourg, Russia
| | - X Navarro
- Institute of Neurosciences, Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma de Barcelona, and CIBERNED, Bellaterra, Spain
| | - Q Barraud
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - G Courtine
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - S Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
| |
Collapse
|
42
|
Capogrosso M, Milekovic T, Borton D, Wagner F, Moraud EM, Mignardot JB, Buse N, Gandar J, Barraud Q, Xing D, Rey E, Duis S, Jianzhong Y, Ko WKD, Li Q, Detemple P, Denison T, Micera S, Bezard E, Bloch J, Courtine G. A brain-spine interface alleviating gait deficits after spinal cord injury in primates. Nature 2016; 539:284-288. [PMID: 27830790 PMCID: PMC5108412 DOI: 10.1038/nature20118] [Citation(s) in RCA: 340] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022]
Abstract
Spinal cord injury disrupts the communication between the brain and the spinal circuits that orchestrate movement. To bypass the lesion, brain–computer interfaces1–3 have directly linked cortical activity to electrical stimulation of muscles, which have restored grasping abilities after hand paralysis1,4. Theoretically, this strategy could also restore control over leg muscle activity for walking5. However, replicating the complex sequence of individual muscle activation patterns underlying natural and adaptive locomotor movements poses formidable conceptual and technological challenges6,7. Recently, we showed in rats that epidural electrical stimulation of the lumbar spinal cord can reproduce the natural activation of synergistic muscle groups producing locomotion8–10. Here, we interfaced leg motor cortex activity with epidural electrical stimulation protocols to establish a brain–spinal interface that alleviated gait deficits after a spinal cord injury in nonhuman primates. Rhesus monkeys were implanted with an intracortical microelectrode array into the leg area of motor cortex; and a spinal cord stimulation system composed of a spatially selective epidural implant and a pulse generator with real-time triggering capabilities. We designed and implemented wireless control systems that linked online neural decoding of extension and flexion motor states with stimulation protocols promoting these movements. These systems allowed the monkeys to behave freely without any restrictions or constraining tethered electronics. After validation of the brain–spinal interface in intact monkeys, we performed a unilateral corticospinal tract lesion at the thoracic level. As early as six days post-injury and without prior training of the monkeys, the brain–spinal interface restored weight-bearing locomotion of the paralyzed leg on a treadmill and overground. The implantable components integrated in the brain–spinal interface have all been approved for investigational applications in similar human research, suggesting a practical translational pathway for proof-of-concept studies in people with spinal cord injury.
Collapse
Affiliation(s)
- Marco Capogrosso
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, EPFL, Lausanne, Switzerland
| | - Tomislav Milekovic
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - David Borton
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,School of Engineering, Brown University, Providence, Rhode Island, USA
| | - Fabien Wagner
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Eduardo Martin Moraud
- Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, EPFL, Lausanne, Switzerland
| | - Jean-Baptiste Mignardot
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | | | - Jerome Gandar
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Quentin Barraud
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - David Xing
- School of Engineering, Brown University, Providence, Rhode Island, USA
| | - Elodie Rey
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Simone Duis
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | | | | | - Qin Li
- Motac Neuroscience Ltd, Manchester, UK.,Institute of Lab Animal Sciences, China Academy of Medical Sciences, Beijing, China
| | - Peter Detemple
- Mainz Institute for Microtechnology, Fraunhofer Institute for Chemical Technology (ICT-IMM), Mainz, Germany
| | | | - Silvestro Micera
- Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, EPFL, Lausanne, Switzerland.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Erwan Bezard
- Motac Neuroscience Ltd, Manchester, UK.,Institute of Lab Animal Sciences, China Academy of Medical Sciences, Beijing, China.,Institut des Maladies Neurodégénératives, University of Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Jocelyne Bloch
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Grégoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| |
Collapse
|
43
|
Moraud EM, Capogrosso M, Formento E, Wenger N, DiGiovanna J, Courtine G, Micera S. Mechanisms Underlying the Neuromodulation of Spinal Circuits for Correcting Gait and Balance Deficits after Spinal Cord Injury. Neuron 2016; 89:814-28. [PMID: 26853304 DOI: 10.1016/j.neuron.2016.01.009] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/11/2015] [Accepted: 12/26/2015] [Indexed: 01/24/2023]
Abstract
Epidural electrical stimulation of lumbar segments facilitates standing and walking in animal models and humans with spinal cord injury. However, the mechanisms through which this neuromodulation therapy engages spinal circuits remain enigmatic. Using computer simulations and behavioral experiments, we provide evidence that epidural electrical stimulation interacts with muscle spindle feedback circuits to modulate muscle activity during locomotion. Hypothesis-driven strategies emerging from simulations steered the design of stimulation protocols that adjust bilateral hindlimb kinematics throughout gait execution. These stimulation strategies corrected subject-specific gait and balance deficits in rats with incomplete and complete spinal cord injury. The conservation of muscle spindle feedback circuits across mammals suggests that the same mechanisms may facilitate motor control in humans. These results provide a conceptual framework to improve stimulation protocols for clinical applications.
Collapse
Affiliation(s)
| | - Marco Capogrosso
- Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland; BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Emanuele Formento
- Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland
| | - Nikolaus Wenger
- Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland; Department of Neurology and Experimental Neurology, University of Berlin, 10098 Berlin, Germany
| | - Jack DiGiovanna
- Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland
| | - Grégoire Courtine
- Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland.
| | - Silvestro Micera
- Swiss Federal Institute of Technology (EPFL), 1015 Lausanne, Switzerland; BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
| |
Collapse
|
44
|
Wenger N, Moraud EM, Gandar J, Musienko P, Capogrosso M, Baud L, Le Goff CG, Barraud Q, Pavlova N, Dominici N, Minev IR, Asboth L, Hirsch A, Duis S, Kreider J, Mortera A, Haverbeck O, Kraus S, Schmitz F, DiGiovanna J, van den Brand R, Bloch J, Detemple P, Lacour SP, Bézard E, Micera S, Courtine G. Spatiotemporal neuromodulation therapies engaging muscle synergies improve motor control after spinal cord injury. Nat Med 2016; 22:138-45. [PMID: 26779815 PMCID: PMC5061079 DOI: 10.1038/nm.4025] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 12/08/2015] [Indexed: 12/17/2022]
Abstract
Electrical neuromodulation of lumbar segments improves motor control after spinal cord injury in animal models and humans. However, the physiological principles underlying the effect of this intervention remain poorly understood, which has limited this therapeutic approach to continuous stimulation applied to restricted spinal cord locations. Here, we developed novel stimulation protocols that reproduce the natural dynamics of motoneuron activation during locomotion. For this, we computed the spatiotemporal activation pattern of muscle synergies during locomotion in healthy rats. Computer simulations identified optimal electrode locations to target each synergy through the recruitment of proprioceptive feedback circuits. This framework steered the design of spatially selective spinal implants and real–time control software that modulate extensor versus flexor synergies with precise temporal resolution. Spatiotemporal neuromodulation therapies improved gait quality, weight–bearing capacities, endurance and skilled locomotion in multiple rodent models of spinal cord injury. These new concepts are directly translatable to strategies to improve motor control in humans.
Collapse
Affiliation(s)
- Nikolaus Wenger
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eduardo Martin Moraud
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, EPFL, Lausanne, Switzerland
| | - Jerome Gandar
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Pavel Musienko
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Motor Physiology Laboratory, Pavlov Institute of Physiology, St. Petersburg, Russia.,Laboratory of Neuroprosthetics, Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia.,Lab of Neurophysiology and Experimental Neurorehabilitation, Children's Surgery and Orthopedic Clinic, Department of Nonpulmonary Tuberculosis, Institute of Physiopulmonology, St. Petersburg, Russia
| | - Marco Capogrosso
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, EPFL, Lausanne, Switzerland.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Laetitia Baud
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Camille G Le Goff
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Quentin Barraud
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Natalia Pavlova
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Motor Physiology Laboratory, Pavlov Institute of Physiology, St. Petersburg, Russia
| | - Nadia Dominici
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,MOVE Research Institute Amsterdam, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands
| | - Ivan R Minev
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Center for Neuroprosthetics and Institute of Bioengineering, EPFL, Lausanne, Switzerland
| | - Leonie Asboth
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Arthur Hirsch
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Center for Neuroprosthetics and Institute of Bioengineering, EPFL, Lausanne, Switzerland
| | - Simone Duis
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Julie Kreider
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Andrea Mortera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, EPFL, Lausanne, Switzerland
| | | | | | - Felix Schmitz
- Fraunhofer Institute for Chemical Technology-Mainz Institute for Microtechnology (ICT-IMM), Mainz, Germany
| | - Jack DiGiovanna
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, EPFL, Lausanne, Switzerland
| | - Rubia van den Brand
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Jocelyne Bloch
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Peter Detemple
- Fraunhofer Institute for Chemical Technology-Mainz Institute for Microtechnology (ICT-IMM), Mainz, Germany
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Center for Neuroprosthetics and Institute of Bioengineering, EPFL, Lausanne, Switzerland
| | - Erwan Bézard
- Motac Neuroscience Inc., Beijing, China.,University of Bordeaux, Institut des Maladies Neurodégénératives, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, Bordeaux, France
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, EPFL, Lausanne, Switzerland.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Grégoire Courtine
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.,Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| |
Collapse
|
45
|
Mazzoni A, Petrini FM, Rigosa J, Capogrosso M, Raspopovic S, Micera S. How central inputs and force and velocity feedbacks determine motoneurons activity during voluntary hand movements. BMC Neurosci 2015. [PMCID: PMC4697634 DOI: 10.1186/1471-2202-16-s1-p163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
46
|
Marianelli P, Capogrosso M, Bassi Luciani L, Panarese A, Micera S. A Computational Framework for Electrical Stimulation of Vestibular Nerve. IEEE Trans Neural Syst Rehabil Eng 2015; 23:897-909. [DOI: 10.1109/tnsre.2015.2407861] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
47
|
van den Brand R, Mignardot JB, von Zitzewitz J, Le Goff C, Fumeaux N, Wagner F, Capogrosso M, Martin Moraud E, Micera S, Schurch B, Curt A, Carda S, Bloch J, Courtine G. Neuroprosthetic technologies to augment the impact of neurorehabilitation after spinal cord injury. Ann Phys Rehabil Med 2015; 58:232-237. [PMID: 26100230 DOI: 10.1016/j.rehab.2015.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/19/2015] [Indexed: 12/11/2022]
Abstract
Spinal cord injury leads to a range of disabilities, including limitations in locomotor activity, that seriously diminish the patients' autonomy and quality of life. Electrochemical neuromodulation therapies, robot-assisted rehabilitation and willpower-based training paradigms restored supraspinal control of locomotion in rodent models of severe spinal cord injury. This treatment promoted extensive and ubiquitous remodeling of spared circuits and residual neural pathways. In four chronic paraplegic individuals, electrical neuromodulation of the spinal cord resulted in the immediate recovery of voluntary leg movements, suggesting that the therapeutic concepts developed in rodent models may also apply to humans. Here, we briefly review previous work, summarize current developments, and highlight impediments to translate these interventions into medical practice to improve functional recovery of spinal-cord-injured individuals.
Collapse
Affiliation(s)
- Rubia van den Brand
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), SV BMI UPCOURTINE, Station 19, CH-1015 Lausanne, Switzerland.
| | - Jean-Baptiste Mignardot
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), SV BMI UPCOURTINE, Station 19, CH-1015 Lausanne, Switzerland
| | - Joachim von Zitzewitz
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), SV BMI UPCOURTINE, Station 19, CH-1015 Lausanne, Switzerland
| | - Camille Le Goff
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), SV BMI UPCOURTINE, Station 19, CH-1015 Lausanne, Switzerland
| | - Nicolas Fumeaux
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), SV BMI UPCOURTINE, Station 19, CH-1015 Lausanne, Switzerland
| | - Fabien Wagner
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), SV BMI UPCOURTINE, Station 19, CH-1015 Lausanne, Switzerland
| | - Marco Capogrosso
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Eduardo Martin Moraud
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Silvestro Micera
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Bioengineering, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Brigitte Schurch
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefano Carda
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jocelyne Bloch
- Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Grégoire Courtine
- International Paraplegic Foundation Chair in Spinal Cord Repair, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), SV BMI UPCOURTINE, Station 19, CH-1015 Lausanne, Switzerland
| |
Collapse
|
48
|
Minev IR, Musienko P, Hirsch A, Barraud Q, Wenger N, Moraud EM, Gandar J, Capogrosso M, Milekovic T, Asboth L, Torres RF, Vachicouras N, Liu Q, Pavlova N, Duis S, Larmagnac A, Vörös J, Micera S, Suo Z, Courtine G, Lacour SP. Biomaterials. Electronic dura mater for long-term multimodal neural interfaces. Science 2015; 347:159-63. [PMID: 25574019 DOI: 10.1126/science.1260318] [Citation(s) in RCA: 536] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The mechanical mismatch between soft neural tissues and stiff neural implants hinders the long-term performance of implantable neuroprostheses. Here, we designed and fabricated soft neural implants with the shape and elasticity of dura mater, the protective membrane of the brain and spinal cord. The electronic dura mater, which we call e-dura, embeds interconnects, electrodes, and chemotrodes that sustain millions of mechanical stretch cycles, electrical stimulation pulses, and chemical injections. These integrated modalities enable multiple neuroprosthetic applications. The soft implants extracted cortical states in freely behaving animals for brain-machine interface and delivered electrochemical spinal neuromodulation that restored locomotion after paralyzing spinal cord injury.
Collapse
Affiliation(s)
- Ivan R Minev
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Centre for Neuroprosthetics, Institute of Microengineering and Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Pavel Musienko
- International Paraplegic Foundation Chair in Spinal Cord Repair, Centre for Neuroprosthetics and Brain Mind Institute, EPFL, Switzerland. Pavlov Institute of Physiology, St. Petersburg, Russia
| | - Arthur Hirsch
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Centre for Neuroprosthetics, Institute of Microengineering and Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Quentin Barraud
- International Paraplegic Foundation Chair in Spinal Cord Repair, Centre for Neuroprosthetics and Brain Mind Institute, EPFL, Switzerland
| | - Nikolaus Wenger
- International Paraplegic Foundation Chair in Spinal Cord Repair, Centre for Neuroprosthetics and Brain Mind Institute, EPFL, Switzerland
| | - Eduardo Martin Moraud
- Translational Neural Engineering Laboratory, Center for Neuroprosthetics and Institute of Bioengineering, EPFL, Lausanne, Switzerland
| | - Jérôme Gandar
- International Paraplegic Foundation Chair in Spinal Cord Repair, Centre for Neuroprosthetics and Brain Mind Institute, EPFL, Switzerland
| | - Marco Capogrosso
- Translational Neural Engineering Laboratory, Center for Neuroprosthetics and Institute of Bioengineering, EPFL, Lausanne, Switzerland
| | - Tomislav Milekovic
- International Paraplegic Foundation Chair in Spinal Cord Repair, Centre for Neuroprosthetics and Brain Mind Institute, EPFL, Switzerland
| | - Léonie Asboth
- International Paraplegic Foundation Chair in Spinal Cord Repair, Centre for Neuroprosthetics and Brain Mind Institute, EPFL, Switzerland
| | - Rafael Fajardo Torres
- International Paraplegic Foundation Chair in Spinal Cord Repair, Centre for Neuroprosthetics and Brain Mind Institute, EPFL, Switzerland
| | - Nicolas Vachicouras
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Centre for Neuroprosthetics, Institute of Microengineering and Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland. International Paraplegic Foundation Chair in Spinal Cord Repair, Centre for Neuroprosthetics and Brain Mind Institute, EPFL, Switzerland
| | - Qihan Liu
- School of Engineering and Applied Sciences, Kavli Institute for Bionano Science and Technology, Harvard University, Cambridge, MA, USA
| | - Natalia Pavlova
- International Paraplegic Foundation Chair in Spinal Cord Repair, Centre for Neuroprosthetics and Brain Mind Institute, EPFL, Switzerland. Pavlov Institute of Physiology, St. Petersburg, Russia
| | - Simone Duis
- International Paraplegic Foundation Chair in Spinal Cord Repair, Centre for Neuroprosthetics and Brain Mind Institute, EPFL, Switzerland
| | - Alexandre Larmagnac
- Laboratory for Biosensors and Bioelectronics, Institute for Biomedical Engineering, University and ETH Zurich, Switzerland
| | - Janos Vörös
- Laboratory for Biosensors and Bioelectronics, Institute for Biomedical Engineering, University and ETH Zurich, Switzerland
| | - Silvestro Micera
- Translational Neural Engineering Laboratory, Center for Neuroprosthetics and Institute of Bioengineering, EPFL, Lausanne, Switzerland. The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa 56025, Italy
| | - Zhigang Suo
- School of Engineering and Applied Sciences, Kavli Institute for Bionano Science and Technology, Harvard University, Cambridge, MA, USA
| | - Grégoire Courtine
- International Paraplegic Foundation Chair in Spinal Cord Repair, Centre for Neuroprosthetics and Brain Mind Institute, EPFL, Switzerland.
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Centre for Neuroprosthetics, Institute of Microengineering and Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland.
| |
Collapse
|
49
|
Raspopovic S, Capogrosso M, Petrini FM, Bonizzato M, Rigosa J, Di Pino G, Carpaneto J, Controzzi M, Boretius T, Fernandez E, Granata G, Oddo CM, Citi L, Ciancio AL, Cipriani C, Carrozza MC, Jensen W, Guglielmelli E, Stieglitz T, Rossini PM, Micera S. Restoring natural sensory feedback in real-time bidirectional hand prostheses. Sci Transl Med 2014; 6:222ra19. [PMID: 24500407 DOI: 10.1126/scitranslmed.3006820] [Citation(s) in RCA: 513] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Hand loss is a highly disabling event that markedly affects the quality of life. To achieve a close to natural replacement for the lost hand, the user should be provided with the rich sensations that we naturally perceive when grasping or manipulating an object. Ideal bidirectional hand prostheses should involve both a reliable decoding of the user's intentions and the delivery of nearly "natural" sensory feedback through remnant afferent pathways, simultaneously and in real time. However, current hand prostheses fail to achieve these requirements, particularly because they lack any sensory feedback. We show that by stimulating the median and ulnar nerve fascicles using transversal multichannel intrafascicular electrodes, according to the information provided by the artificial sensors from a hand prosthesis, physiologically appropriate (near-natural) sensory information can be provided to an amputee during the real-time decoding of different grasping tasks to control a dexterous hand prosthesis. This feedback enabled the participant to effectively modulate the grasping force of the prosthesis with no visual or auditory feedback. Three different force levels were distinguished and consistently used by the subject. The results also demonstrate that a high complexity of perception can be obtained, allowing the subject to identify the stiffness and shape of three different objects by exploiting different characteristics of the elicited sensations. This approach could improve the efficacy and "life-like" quality of hand prostheses, resulting in a keystone strategy for the near-natural replacement of missing hands.
Collapse
Affiliation(s)
- Stanisa Raspopovic
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa 56025, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Micera S, Raspospovic S, Capogrosso M, Carpaneto J, Granata G, Oddo C, Cipriani C, Stieglitz T, Schuettler M, Navarro X, Raffo L, Barbaro M, Rossini P. P190: NEurocontrolled BIdirectional Artificial upper limb and hand prosthesiS (NEBIAS). Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|