A regenerative peripheral nerve interface allows real-time control of an artificial hand in upper limb amputees.
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ABSTRACT:
SUBMITTER: Vu PP
PROVIDER: S-EPMC8082695 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The human brain contains multiple hand-selective areas, in both the sensorimotor and visual systems. Could our brain repurpose neural resources, originally developed for supporting hand function, to represent and control artificial limbs? We studied individuals with congenital or acquired hand-loss (hereafter one-handers) using functional MRI. We show that the more one-handers use an artificial limb (prosthesis) in their everyday life, the stronger visual hand-selective areas in the lateral occipitotemporal cortex respond to prosthesis images. This was found even when one-handers were presented with images of active prostheses that share the functionality of the hand but not necessarily its visual features (e.g. a 'hook' prosthesis). Further, we show that daily prosthesis usage determines large-scale inter-network communication across hand-selective areas. This was demonstrated by increased resting state functional connectivity between visual and sensorimotor hand-selective areas, proportional to the intensiveness of everyday prosthesis usage. Further analysis revealed a 3-fold coupling between prosthesis activity, visuomotor connectivity and usage, suggesting a possible role for the motor system in shaping use-dependent representation in visual hand-selective areas, and/or vice versa. Moreover, able-bodied control participants who routinely observe prosthesis usage (albeit less intensively than the prosthesis users) showed significantly weaker associations between degree of prosthesis observation and visual cortex activity or connectivity. Together, our findings suggest that altered daily motor behaviour facilitates prosthesis-related visual processing and shapes communication across hand-selective areas. This neurophysiological substrate for prosthesis embodiment may inspire rehabilitation approaches to improve usage of existing substitutionary devices and aid implementation of future assistive and augmentative technologies.
| S-EPMC5917779 | biostudies-literature
Project description:Individuals with upper limb loss lack sensation of the missing hand, which can negatively impact their daily function. Several groups have attempted to restore this sensation through electrical stimulation of residual nerves. The purpose of this study was to explore the utility of regenerative peripheral nerve interfaces (RPNIs) in eliciting referred sensation. In four participants with upper limb loss, we characterized the quality and location of sensation elicited through electrical stimulation of RPNIs over time. We also measured functional stimulation ranges (sensory perception and discomfort thresholds), sensitivity to changes in stimulation amplitude, and ability to differentiate objects of different stiffness and sizes. Over a period of up to 54 months, stimulation of RPNIs elicited sensations that were consistent in quality (e.g. tingling, kinesthesia) and were perceived in the missing hand and forearm. The location of elicited sensation was partially-stable to stable in 13 of 14 RPNIs. For 5 of 7 RPNIs tested, participants demonstrated a sensitivity to changes in stimulation amplitude, with an average just noticeable difference of 45 nC. In a case study, one participant was provided RPNI stimulation proportional to prosthetic grip force. She identified four objects of different sizes and stiffness with 56% accuracy with stimulation alone and 100% accuracy when stimulation was combined with visual feedback of hand position. Collectively, these experiments suggest that RPNIs have the potential to be used in future bi-directional prosthetic systems.
| S-EPMC10938368 | biostudies-literature
Project description:In the past years, especially with the advent of multi-fingered hand prostheses, the rehabilitation robotics community has tried to improve the use of human-machine interfaces to reliably control mechanical artifacts with many degrees of freedom. Ideally, the control schema should be intuitive and reliable, and the calibration (training) short and flexible. This work focuses on medical ultrasound imaging as such an interface. Medical ultrasound imaging is rich in information, fast, widespread, relatively cheap and provides high temporal/spatial resolution; moreover, it is harmless. We already showed that a linear relationship exists between ultrasound image features of the human forearm and the hand kinematic configuration; here we demonstrate that such a relationship also exists between similar features and fingertip forces. An experiment with 10 participants shows that a very fast data collection, namely of zero and maximum forces only and using no force sensors, suffices to train a system that predicts intermediate force values spanning a range of about 20 N per finger with average errors in the range 10-15%. This training approach, in which the ground truth is limited to an "on-off" visual stimulus, constitutes a realistic scenario and we claim that it could be equally used by intact subjects and amputees. The linearity of the relationship between images and forces is furthermore exploited to build an incremental learning system that works online and can be retrained on demand by the human subject. We expect this system to be able in principle to reconstruct an amputee's imaginary limb, and act as a sensible improvement of, e.g., mirror therapy, in the treatment of phantom-limb pain.
| S-EPMC3804922 | biostudies-literature
Project description: Not available
| S-EPMC9728628 | biostudies-literature
Project description:Recent advances in neuroprosthetics have enabled those living with extremity loss to reproduce many functions native to the absent extremity, and this is often accomplished through integration with the peripheral nervous system. Unfortunately, methods currently employed are often associated with significant tissue damage which prevents prolonged use. Additionally, these devices often lack any meaningful degree of sensory feedback as their complex construction dampens any vibrations or other sensations a user may have previously depended on when using more simple prosthetics. The composite regenerative peripheral nerve interface (C-RPNI) was developed as a stable, biologic construct with the ability to amplify efferent motor nerve signals while providing simultaneous afferent sensory feedback. The C-RPNI consists of a segment of free dermal and muscle graft secured around a target mixed sensorimotor nerve, with preferential motor nerve reinnervation of the muscle graft and sensory nerve reinnervation of the dermal graft. In rats, this construct has demonstrated the generation of compound muscle action potentials (CMAPs), amplifying the target nerve's signal from the micro- to milli-volt level, with signal to noise ratios averaging approximately 30-50. Stimulation of the dermal component of the construct generates compound sensory nerve action potentials (CSNAPs) at the proximal nerve. As such, this construct has promising future utility towards the realization of the ideal, intuitive prosthetic.
| S-EPMC7413224 | biostudies-literature
Project description:Unsuccessful rehabilitation therapy is a widespread issue amongst modern day amputees. Of the estimated 10 million amputees worldwide, 3 million of whom are upper limb amputees, a large majority are discontent and experience rejection with their current prosthesis during activities of daily living (ADL). Here we introduce Upbeat, an augmented reality (AR) dance game designed to improve rehabilitation therapies in upper limb amputees. In Upbeat, the patient is instructed to follow a virtual dance instructor, performing choreographed dance movements containing hand gestures involved in upper limb rehabilitation therapy. The patient's position is then tracked using a Microsoft Kinect sensor while the hand gestures are analyzed using EMG data collected from a Myo Armband. Additionally, a gamified score is calculated based on how many gestures and movements were correctly performed. Upon completion of the game, a diagnostic summary of the results is shown in the form of a graph summarizing the collected EMG data, as well as with a video displaying an augmented visualization of the patient's upper arm muscle activity during gameplay. By gamifying the rehabilitation process, Upbeat has the potential to improve therapy on upper limb amputees by enabling the start of rehabilitation immediately after trauma, providing personalized feedback which professionals can utilize to accurately assess patient's progress, and increasing patient excitement, therefore increasing patient willingness to complete rehabilitation. This paper is concerned with the description and evaluation of our prototypic implementation of Upbeat that will serve as the basis for conducting clinical studies to evaluate its impact on rehabilitation.
| S-EPMC6444250 | biostudies-literature
Project description:Amputation is a traumatic and life-changing event that can take years to adjust to. The present study (a) examines psychological adjustment in a specific trauma-exposed sample, (b) compares the phenomenology (e.g., vividness) of amputation-related memories to more recent memories, and (c) tests whether memory phenomenology is associated with psychological distress. A total of 24 upper-limb amputees recalled two autobiographical memories--an amputation-related memory and a recent memory--and rated the phenomenological qualities of each memory, including Vividness, Coherence, Emotional Intensity, Visual Perspective, and Distancing. Participants also completed self-rated measures of psychological distress and personality. The sample was generally well adjusted; participants showed no relevant symptoms of anxiety and depression, and personality scores were similar to the general population. There were no significant differences in phenomenology between the two types of memories recalled. Even though amputation-related memories were, on average, almost 20 years older than the recent memories, they retained their intense phenomenology. Despite the intensity of the memory, none of the phenomenological dimensions were associated with psychological distress. It is worth to further define which dimensions of phenomenology characterize memories of traumatic events, and their association with individuals' psychological reactions.
| S-EPMC4055696 | biostudies-other
Project description:Restoring somatosensory feedback to people with limb amputations is crucial to improve prosthetic control. Multiple studies have demonstrated that peripheral nerve stimulation and targeted reinnervation can provide somatotopically relevant sensory feedback. While effective, the surgical procedures required for these techniques remain a major barrier to translatability. Here, we demonstrate in four people with upper-limb amputation that epidural spinal cord stimulation (SCS), a common clinical technique to treat pain, evoked somatosensory percepts that were perceived as emanating from the missing arm and hand. Over up to 29 days, stimulation evoked sensory percepts in consistent locations in the missing hand regardless of time since amputation or level of amputation. Evoked sensations were occasionally described as naturalistic (e.g. touch or pressure), but were often paresthesias. Increasing stimulus amplitude increased the perceived intensity linearly, without increasing area of the sensations. These results demonstrate the potential of SCS as a tool to restore somatosensation after amputations.
| S-EPMC7373432 | biostudies-literature
Project description:Individuals with upper extremity (UE) amputation abandon prostheses due to challenges with significant device weight-particularly among myoelectric prostheses-and limited device dexterity, durability, and reliability among both myoelectric and body-powered prostheses. The Modular Prosthetic Limb (MPL) system couples an advanced UE prosthesis with a pattern recognition paradigm for intuitive, non-invasive prosthetic control. Pattern recognition accuracy and functional assessment-Box & Blocks (BB), Jebsen-Taylor Hand Function Test (JHFT), and Assessment of Capacity for Myoelectric Control (ACMC)-scores comprised the main outcomes. 10 participants were included in analyses, including seven individuals with traumatic amputation, two individuals with congenital limb absence, and one with amputation secondary to malignancy. The average (SD) time since limb loss, excluding congenital participants, was 85.9 (59.5) months. Participants controlled an average of eight motion classes compared to three with their conventional prostheses. All participants made continuous improvements in motion classifier accuracy, pathway completion efficiency, and MPL manipulation. BB and JHFT improvements were not statistically significant. ACMC performance improved for all participants, with mean (SD) scores of 162.6 (105.3), 213.4 (196.2), and 383.2 (154.3), p = 0.02 between the baseline, midpoint, and exit assessments, respectively. Feedback included lengthening the training period to further improve motion classifier accuracy and MPL control. The MPL has potential to restore functionality to individuals with acquired or congenital UE loss.
| S-EPMC7806748 | biostudies-literature
Project description:BACKGROUND:Peripheral nerve block is a single injection that inhibits the transmission of peripheral nerve impulses to the central nervous system. The inhibition of the nociceptive impulse may decrease the occurrence of muscle spasm following mobilization postoperatively. This mechanism may contribute to a better functional recovery following upper limb surgery. This systematic review will investigate the impact of peripheral nerve block on functional recovery after an upper limb surgery. METHODS:We will search studies comparing peripheral nerve block to general anesthesia for upper limb surgery in the following databases: CENTRAL, MEDLINE (Ovid), CINAHL, EMBASE, and Scopus. In duplicate, independent reviewers will assess eligibility, evaluate risk of bias, and abstract data on type of peripheral nerve block and functional outcome. Where possible, we will pool results using a random effects model. For each outcome, we will assess the quality of evidence using GRADE methodology. DISCUSSION:We aim to summarize the available evidence comparing functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery. These data will inform the design of a trial on the topic. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42018116298.
| S-EPMC6844046 | biostudies-literature