The future of upper extremity rehabilitation robotics: research and practice

The loss of upper limb motor function can have a devastating effect on people’s lives. To restore upper limb control and functionality, researchers and clinicians have developed interfaces to interact directly with the human body’s motor system. In this invited review, we aim to provide details on the peripheral nerve interfaces and brain‐machine interfaces that have been developed in the past 30 years for upper extremity control, and we highlight the challenges that still remain to transition the technology into the clinical market. The findings show that peripheral nerve interfaces and brain‐machine interfaces have many similar characteristics that enable them to be concurrently developed. Decoding neural information from both interfaces may lead to novel physiological models that may one day fully restore upper limb motor function for a growing patient population.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155489/1/mus26860_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155489/2/mus26860.pd

Microwire regenerative peripheral nerve interfaces with wireless recording and stimulation capabilities

A scalable microwire peripheral nerve interface was developed, which interacted with regenerated peripheral nerves in microchannel scaffolds. Neural interface technologies are envisioned to facilitate direct connections between the nervous system and external technologies such as limb prosthetics or data acquisition systems for further processing. Presented here is an animal study using a handcrafted microwire regenerative peripheral nerve interface, a novel neural interface device for communicating with peripheral nerves. The neural interface studies using animal models are crucial in the evaluation of efficacy and safety of implantable medical devices before their use in clinical studies.16-electrode microwire microchannel scaffolds were developed for both peripheral nerve regeneration and peripheral nerve interfacing. The microchannels were used for nerve regeneration pathways as a scaffolding material and the embedded microwires were used as a recording electrode to capture neural signals from the regenerated peripheral nerves. Wireless stimulation and recording capabilities were also incorporated to the developed peripheral nerve interface which gave the freedom of the complex experimental setting of wired data acquisition systems and minimized the potential infection of the animals from the wire connections

Pilot feasibility study of a simple regenerative peripheral nerve interface designed to diminish cutaneous dysesthesia after supraclavicular operations

Supraclavicular operations can be associated with postoperative cutaneous dysesthesia and hypersensitivity. Regenerative peripheral nerve interfaces, created by attaching the proximal end of a divided peripheral nerve into a viable muscle target, can promote neurite regrowth and neuromuscular connections to help suppress painful nerve hyperactivity. During 40 consecutive operations for neurogenic thoracic outlet syndrome, we demonstrated that division of at least one of the superficial supraclavicular cutaneous sensory nerve branches was necessary in 98% of cases. We subsequently developed a novel regenerative peripheral nerve interface for supraclavicular operations using the adjacent omohyoid muscle and have described the technical steps involved in this procedure

Regenerative peripheral nerve interfaces for real-time, proportional control of a Neuroprosthetic hand

Abstract Introduction Regenerative peripheral nerve interfaces (RPNIs) are biological constructs which amplify neural signals and have shown long-term stability in rat models. Real-time control of a neuroprosthesis in rat models has not yet been demonstrated. The purpose of this study was to: a) design and validate a system for translating electromyography (EMG) signals from an RPNI in a rat model into real-time control of a neuroprosthetic hand, and; b) use the system to demonstrate RPNI proportional neuroprosthesis control. Methods Animals were randomly assigned to three experimental groups: (1) Control; (2) Denervated, and; (3) RPNI. In the RPNI group, the extensor digitorum longus (EDL) muscle was dissected free, denervated, transferred to the lateral thigh and neurotized with the residual end of the transected common peroneal nerve. Rats received tactile stimuli to the hind-limb via monofilaments, and electrodes were used to record EMG. Signals were filtered, rectified and integrated using a moving sample window. Processed EMG signals (iEMG) from RPNIs were validated against Control and Denervated group outputs. Results Voluntary reflexive rat movements produced signaling that activated the prosthesis in both the Control and RPNI groups, but produced no activation in the Denervated group. Signal-to-Noise ratio between hind-limb movement and resting iEMG was 3.55 for Controls and 3.81 for RPNIs. Both Control and RPNI groups exhibited a logarithmic iEMG increase with increased monofilament pressure, allowing graded prosthetic hand speed control (R2 = 0.758 and R2 = 0.802, respectively). Conclusion EMG signals were successfully acquired from RPNIs and translated into real-time neuroprosthetic control. Signal contamination from muscles adjacent to the RPNI was minimal. RPNI constructs provided reliable proportional prosthetic hand control.https://deepblue.lib.umich.edu/bitstream/2027.42/146521/1/12984_2018_Article_452.pd

Handcrafted Microwire Regenerative Peripheral Nerve Interfaces with Wireless Neural Recording and Stimulation Capabilities

A scalable microwire peripheral nerve interface was developed, which interacted with regenerated peripheral nerves in microchannel scaffolds. Neural interface technologies are envisioned to facilitate direct connections between the nervous system and external technologies such as limb prosthetics or data acquisition systems for further processing. Presented here is an animal study using a handcrafted microwire regenerative peripheral nerve interface, a novel neural interface device for communicating with peripheral nerves. The neural interface studies using animal models are crucial in the evaluation of efficacy and safety of implantable medical devices before their use in clinical studies. 16- electrode microwire microchannel scaffolds were developed for both peripheral nerve regeneration and peripheral nerve interfacing. The microchannels were used for nerve regeneration pathways as a scaffolding material and the embedded microwires were used as a recording electrode to capture neural signals from the regenerated peripheral nerves. Wireless stimulation and recording capabilities were also incorporated to the developed peripheral nerve interface which gave the freedom of the complex experimental setting of wired data acquisition systems and minimized the potential infection of the animals from the wire connections. A commercially available wireless recording system was efficiently adopted to the peripheral nerve interface. The 32-channel wireless recording system covered 16-electrode microwires in the peripheral nerve interface, two cuff electrodes, and two electromyography electrodes. The 2-channel wireless stimulation system was connected to a cuff electrode on the sciatic nerve branch and was used to make evoked signals which went through the regenerated peripheral nerves and were captured by the wireless recording system at a different location. The successful wireless communication was demonstrated in the result section and the future goals of a wireless neural interface for chronic implants and clinical trials were discussed together

Tutorial: A guide to techniques for analysing recordings from the peripheral nervous system

The nervous system, through a combination of conscious and automatic processes, enables the regulation of the body and its interactions with the environment. The peripheral nervous system is an excellent target for technologies that seek to modulate, restore or enhance these abilities as it carries sensory and motor information that most directly relates to a target organ or function. However, many applications require a combination of both an effective peripheral nerve interface and effective signal processing techniques to provide selective and stable recordings. While there are many reviews on the design of peripheral nerve interfaces, reviews of data analysis techniques and translational considerations are limited. Thus, this tutorial aims to support new and existing researchers in the understanding of the general guiding principles, and introduces a taxonomy for electrode configurations, techniques and translational models to consider

Analysis of Passive Charge Balancing for Safe Current-Mode Neural Stimulation

Charge balancing has been often considered as one of the most critical requirement for neural stimulation circuits. Over the years several solutions have been proposed to precisely balance the charge transferred to the tissue during anodic and cathodic phases. Elaborate dynamic current sources/sinks with improved matching, and feedback loops have been proposed with a penalty on circuit complexity, area or power consumption. Here we review the dominant assumptions in safe stimulation protocols, and derive mathematical models to determine the effectiveness of passive charge balancing in a typical application scenario

Enhancing selectivity of minimally invasive peripheral nerve interfaces using combined stimulation and high frequency block: from design to application

The discovery of the excitable property of nerves was a fundamental step forward in our knowledge of the nervous system and our ability to interact with it. As the injection of charge into tissue can drive its artificial activation, devices have been conceived that can serve healthcare by substituting the input or output of the peripheral nervous system when damage or disease has rendered it inaccessible or its action pathological. Applications are far-ranging and transformational as can be attested by the success of neuroprosthetics such as the cochlear implant. However, the body’s immune response to invasive implants have prevented the use of more selective interfaces, leading to therapy side-effects and off-target activation. The inherent tradeoff between the selectivity and invasiveness of neural interfaces, and the consequences thereof, is still a defining problem for the field. More recently, continued research into how nervous tissue responds to stimulation has led to the discovery of High Frequency Alternating Current (HFAC) block as a stimulation method with inhibitory effects for nerve conduction. While leveraging the structure of the peripheral nervous system, this neuromodulation technique could be a key component in efforts to improve the selectivity-invasiveness tradeoff and provide more effective neuroprosthetic therapy while retaining the safety and reliability of minimally invasive neural interfaces. This thesis describes work investigating the use of HFAC block to improve the selectivity of peripheral nerve interfaces, towards applications such as bladder control or vagus nerve stimulation where selective peripheral nerve interfaces cannot be used, and yet there is an unmet need for more selectivity from stimulation-based therapy. An overview of the underlying neuroanatomy and electrophysiology of the peripheral nervous system combined with a review of existing electrode interfaces and electrochemistry will serve to inform the problem space. Original contributions are the design of a custom multi-channel stimulator able to combine conventional and high frequency stimulation, establishing a suitable experimental platform for ex-vivo electrophysiology of the rat sciatic nerve model for HFAC block, and exploratory experiments to determine the feasibility of using HFAC block in combination with conventional stimulation to enhance the selectivity of minimally-invasive peripheral nerve interfaces.Open Acces

Doctor of Philosophy

dissertationHands are so central to the human experience, yet we often take for granted the capacity to maneuver objects, to form a gesture, or to caress a loved-one’s hand. The effects of hand amputation can be severe, including functional disabilities, chronic phantom pain, and a profound sense of loss which can lead to depression and anxiety. In previous studies, peripheral-nerve interfaces, such as the Utah Slanted Electrode Array (USEA), have shown potential for restoring a sense of touch and prosthesis movement control. This dissertation represents a substantial step forward in the use of the USEAs for clinical careâ€"ultimately providing human amputees with widespread hand sensation that is functionally useful and psychologically meaningful. In completion of this ultimate objective, we report on three major advances. First, we performed the first dual-USEA implantations in human amputees; placing one USEA in the residual median nerve and another USEA in the residual ulnar nerve. Chapter 2 of this dissertation shows that USEAs provided full-hand sensory coverage, and that movement of the implant site to the upper arm in the second subject, proximal to nerve branch-points to extrinsic hand muscles, enabled activation of both proprioceptive sensory percepts and cutaneous percepts. Second, in Chapter 3, we report on successful use of USEA-evoked sensory percepts for functional discrimination tasks. We provide a comprehensive report of functional discrimination among USEA-evoked sensory percepts from three human subjects, including discrimination among multiple proprioceptive or cutaneous sensory percepts with different hand locations, sensory qualities, and/or intensities. Finally, in Chapter 4, we report on the psychological value of multiple degree of freedom prosthesis control, multisensor prosthesis sensation, and closed-loop control. This chapter represents the first report of prosthesis embodiment during closed-loop and open-loop prosthesis control by an amputee, as well as the most sophisticated closed-loop prosthesis control reported in literature to-date, including 5-degree-of-freedom motor control and sensory feedback from 4 hand locations. Ultimately, we expect that USEA-evoked hand sensations may be used as part of a take-home prosthesis system which will provide users with both advanced functional capabilities and a meaningful sense of embodiment and limb restoration