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Diagrams of testing regions on the chests of the targeted reinnervation amputees. (A) TR1, Male bilateral shoulder disarticulation amputee. (B) TR2, female unilateral short trans-humeral amputee (functional shoulder disarticulation). The dashed line surrounding the light grey area on the left chest of the amputees denotes the extent of sensation that is referred to the missing limb. Within the light grey area the amputees feel a mix of referred hand sensation and native chest sensation. The white area denotes where the targeted reinnervation amputees feel only referred hand sensation with no native chest sensation. The crossed arrows show the vertical and horizontal axes of the grating placements for the grating orientation task. The Y shaped lines denote the placement of the grids used for the point localization task.
Source publication
Targeted reinnervation is a new neural-machine interface that has been developed to help improve the function of new-generation prosthetic limbs. Targeted reinnervation is a surgical procedure that takes the nerves that once innervated a severed limb and redirects them to proximal muscle and skin sites. The sensory afferents of the redirected nerve...
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... to the left shoulder of each individual. These sockets were created following each amputee's targeted reinnervation surgery and used to create reference marks for sensory reinnervation experiments. Once the reference points were placed, a cross was drawn on the chest of each targeted reinnervation subject to guide placement of the dome gratings (Fig. 1). On TR2, all testing tools were applied to reinnervated skin within the bounds of the region deemed to be insensate following transection of the supraclavicular cutaneous nerve ( Kuiken et al., 2007b). Each side of both amputees' chests was tested three separate times. The control site on the right chest of TR1 was shifted to a ...Context 2
... skin of TR2's chest was completely denervated by cutting the supraclavicular cutaneous nerve; her chest skin went numb after the surgery. The sensation that is evident in this region was likely entirely a product of regeneration (Fig. 1). The dome gratings and point localization grid used to test the subjects had footprints that fell entirely within the previously denervated skin region. Therefore, it was unlikely that the native innervation of the chest played a significant role in determining the orientation of the grating and the point localization for this subject. ...Context 3
... skin region. Therefore, it was unlikely that the native innervation of the chest played a significant role in determining the orientation of the grating and the point localization for this subject. In contrast to TR2, subject TR1 had overlapping sensation from the native chest afferents and the reinnervated limb afferents ( Kuiken et al., 2007a) (Fig. 1). It can be argued that the native afferents that were left in his chest following removal of the subcutaneous tissue may have been responsible for mediating the ability to orient the gratings. However, it is also possible that the reinnervated limb afferents contributed to the ability to orient the gratings. In either case, it is ...Similar publications
We have developed three different versions of a multifunction haptic device that can display touch, pressure, vibration, shear force, and temperature to the skin of an upper extremity amputee, especially the one who has undergone targeted nerve reinnervation (TR) surgery. In TR patients, sensation from the reinnervated skin is projected to the miss...
Citations
... Different authors have published data on utilizing transcutaneous electrical nerve stimulation 24 or mechanical pressure and vibration 25 in patients who underwent targeted reinnervation surgery with promising results. As of now, cases reported in the literature comprise the reinnervation of non-glabrous skin by nerves physiologically providing sensation to glabrous skin 22,26 and evidence suggests that the quality of the regained sensitivity is similar to that of the native skin 27 . Considering that glabrous skin additionally possesses Meissner corpuscles and a greater innervation density when compared to non-glabrous skin 28 , targeted reinnervation of the former may lead to even greater restoration of sensation than previously possible. ...
Neuromuscular control of bionic arms has constantly improved over the past years, however, restoration of sensation remains elusive. Previous approaches to reestablish sensory feedback include tactile, electrical, and peripheral nerve stimulation, however, they cannot recreate natural, intuitive sensations. Here, we establish an experimental biological sensorimotor interface and demonstrate its potential use in neuroprosthetics. We transfer a mixed nerve to a skeletal muscle combined with glabrous dermal skin transplantation, thus forming a bi-directional communication unit in a rat model. Morphological analyses indicate reinnervation of the skin, mechanoreceptors, NMJs, and muscle spindles. Furthermore, sequential retrograde labeling reveals specific sensory reinnervation at the level of the dorsal root ganglia. Electrophysiological recordings show reproducible afferent signals upon tactile stimulation and tendon manipulation. The results demonstrate the possibility of surgically creating an interface for both decoding efferent motor control, as well as encoding afferent tactile and proprioceptive feedback, and may indicate the way forward regarding clinical translation of biological communication pathways for neuroprosthetic applications.
... In addition, anecdotal evidence suggests that chronic peripheral nerve stimulation reduces PLP 8,[13][14][15] . To date, most studies to restore somatosensory feedback from the missing limb have relied on complex surgical techniques to implant devices inside or around peripheral nerves or to reroute those nerves to other regions of the body 7,8,10,12,16,17 . While these approaches clearly showed the promise of electrical stimulation, their surgical complexity remains a barrier to widespread clinical adoption. ...
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.
... In this study, amputors underwent surgery to reimplant the nerves that once innervated the amputated limb into the remaining skin and muscle sites. When touching this newly innervated skin, these individuals experience tactile [59] sensations projected to the phantom limb. Two of the patients underwent an experiment in which the newly innervated skin was mechanically stimulated each time the corresponding "receptive field" on the prosthesis was touched. ...
Limb loss or paralysis due to spinal cord injury has a devastating impact on quality of life. One way to restore the sensory and motor abilities lost by amputees and quadriplegics is to provide them with implants that interface directly with the central nervous system. Such Brain-machine interfaces could enable patients to exert active control over the electrical contractions of prosthetic limbs or paralysed muscles. The parallel interface can transmit sensory information about these motor outcomes back to the patient. Recent developments in algorithms for decoding motor intention from neuronal activity, using biomimetic and adaptation-based approaches and methods for delivering sensory feedback through electrical stimulation of neurons have shown promise for invasive interfaces with sensorimotor cortex, although significant challenges remain.
... As a result, these gadgets provide intuitive control and a natural flow of experience from the artificial device to the user. Bionic hands were the first practical proof of concept [26][27][28][29][30][31][32]. 22 Depending on the implant utilized, the kind of tissue interfaced, and the bionic limb, three primary categories may be made: direct muscle, direct nerve, and nerve-transferred muscle interfacing (TMR) ( Figure 5) [25,[32][33][34][35][36][37][38]. Figure 5: Implants, nerve, and muscles transferring [25,[32][33][34][35][36][37][38] ...
From prehistoric people's subconscious bionic actions to significant bionic designs in modern engineering, bionic consciousness,
ideas, and practice have paved the way for the advancement of humanity, the growth of society, and the invention of science and
technology. The term "bionics" describes the fusion of technological innovations created by humans with natural structures and
functioning systems. Following the trauma or disease, bionics devices stimulate the nerves or muscles to give therapeutic intervention,
sensory feedback, or motor function; they may also record the electrical activity from the nerves or muscles to identify disease
states; they can enable the voluntary control of devices like prosthetic limbs; or they can provide closed-loop feedback to modify
neural prostheses. The kind of prosthetic limb a person can use depends on various factors, including the person, the reason for the
amputation or loss of the limb, and the location of the missing limb. Novel bio-inspired therapies have emerged recently that work
by rearranging the bodily parts already present in a person to improve physiology. Instead of substituting biological tissue in this
case, engineering concepts are used to reorganize and manipulate the natural tissue and organs to replace or enhance physiological
activities (auto-bionics). This research aims to investigate the history, summarize, and simplify the understanding of the application
of bionics in medical treatment.
... Such a sensory map of a phantom limb enables a person with an amputation to experience touch, force, vibration, temperature, and pain in a skin area that they associate with the missing limb [235]. Such long-lasting maps may evolve naturally [556] or through targeted sensory reinnervation surgery during amputation-or pain/neuroma-indicated post-amputation surgery where surgeons connect sensory nerve fibers to skin areas [557][558][559][560][561][562]. ...
Focal vibration therapy seeks to restore the physiological function of tissues and the nervous system. Recommendations for vibration settings, e.g., that could improve residual limb health and prosthesis acceptance in people with amputation, are pending. To establish a physiological connection between focal vibration settings, clinical outcomes, and molecular and neuronal mechanisms, we combined the literature on focal vibration therapy, vibrotactile feedback, mechanosensitive Piezo ion channels, touch, proprioception, neuromodulation, and the recovery of blood vessels and nerves. In summary, intermittent focal vibration increases endothelial shear stress when applied superficially to blood vessels and tissues and triggers Piezo1 signaling, supporting the repair and formation of blood vessels and nerves. Conversely, stimulating Piezo1 in peripheral axon growth cones could reduce the growth of painful neuromas. Vibrotactile feedback also creates sensory inputs to the motor cortex, predominantly through Piezo2-related channels, and modulates sensory signals in the dorsal horn and ascending arousal system. Thus, sensory feedback supports physiological recovery from maladaptations and can alleviate phantom pain and promote body awareness and physical activity. We recommend focal vibration of phantom limb maps with frequencies from ~60–120 Hz and amplitudes up to 1 mm to positively affect motor control, locomotion, pain, nerves, and blood vessels while avoiding adverse effects.
... In TSR, sensory end organs are created at the cost of eliminating native sensate areas. For example, chest sensation is sacrificed for prosthetic hand sensation 23 . Second, as reinnervation occurs alongside existing neural pathways, sensory specificity is lost and patients report a mix of native skin and prosthetic sensations at target stimulation areas 24 . ...
Amputation destroys sensory end organs and does not provide an anatomical interface for cutaneous neuroprosthetic feedback. Here, we report the design and a biomechanical and electrophysiological evaluation of the cutaneous mechanoneural interface consisting of an afferent neural system that comprises a muscle actuator coupled to a natively pedicled skin flap in a cuff-like architecture. Muscle is actuated through electrical stimulation to induce strains or oscillatory vibrations on the skin flap that are proportional to a desired contact duration or contact pressure. In rat hindlimbs, the mechanoneural interface elicited native dermal mechanotransducers to generate at least four levels of graded contact and eight distinct vibratory afferents that were not significantly different from analogous mechanical stimulation of intact skin. The application of different patterns of electrical stimulation independently engaged slowly adapting and rapidly adapting mechanotransducers, and recreated an array of cutaneous sensations. The cutaneous mechanoneural interface can be integrated with current prosthetic technologies for tactile feedback. A neuroprosthetic interface comprising a muscle actuator coupled to a natively pedicled skin flap in a cuff-like architecture elicits graded contact and vibratory afferent signals analogous to those elicited by mechanical stimulation of intact skin.
... New surgical approaches have increased the effictiveness of these technologies' interactions with a variety of muscle [83][84][85] and neurological tissues [86,87] in a more intimate manner [69]. These allow for a direct muscle approach through tiny implant injections, nerve rerouting for muscular reinnervation [82,88,89] and nerve interfacing around or within the fascicular structure [69]. By encoding sensory algorithms applied on a system controller, the impulses from tactile and position sensors included in the prosthesis are translated into electrical impulses to record the sensory information flow [69]. ...
Recent progress in microfabrication technique allowed the rapid development of neural implants. They are getting categorized as effective tools for clinical practice, especially to treat traumatic and neurodegenerative disorders. Microelectrode arrays already have been used in numerous neural interface devices. Basically, almost all neural implants have been developed based on BCI (Brain Computer Interface) system. When BCI system falls under invasive technique, it is referred as BMI or Brain Machine Interface. BMIs hold promises for neurorehabilitation of motor and sensory function, cognitive state evaluation and treatment of neurological chaos. A directed overview of the field of neural implants is discussed in this article. The aim of this review is to give a brief introduction of neural prosthetics as well as their exciting applications in treating neurological disorders and a deep discussion on their functionality are mentioned. BCI system and their different types, their functionality, their pros and cons, how other neural implants developed, and their present status have been covered. Different possibilities and possible future of deep brain stimulation (DBS), Neuralink, motor and sensory neural prosthetics are further discussed.
... Upon investigation of the included literature, neuroplasticity has been represented in all but one study. Six discussed both peripheral and central neuroplastic contributions, 19,21,25,26,28,30 while three only discussed central components, 22,23,29 and two only discussed peripheral components 20,24 in this population (Table 3). ...
... One reinnervation study exploring specificity found that a patient was able to orient gratings at thresholds similar to their contralateral normal side and controls and could even localize point stimuli more accurately on their reinnervated side compared to their contralateral normal side. 30 Another study found that after targeted reinnervation surgery, some patients showed vibration detection thresholds that were significantly higher than their contralateral chest, intact upper arm, forearm, and hand, and exceeded the 95% confidence intervals of healthy controls at certain stimulation frequencies. 28 ...
Background
Most of the current literature around amputation focuses on lower extremity amputation or engineering aspects of prosthetic devices. There is a need to more clearly understand neurobehavioral mechanisms related to upper extremity amputation and how such mechanisms might influence recovery and utilization of prostheses.
Objective
This scoping review aims to identify and summarize the current literature on adult traumatic upper limb amputation in regard to recovery and functional outcomes and how neuroplasticity might influence these findings.
Methods
We identified appropriate articles using Academic Search Complete EBSCO, OVID Medline, and Cochrane databases. The resulting articles were then exported, screened, and reviewed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines.
Results
Eleven (11) studies met the study criteria. Of these studies, 7 focused on sensory involvement, 3 focused on neuroplastic changes post-amputation related to functional impact, and 1 study focused on motor control and learning post-amputation. Overall, these studies revealed an incomplete understanding of the neural mechanisms involved in motor rehabilitation in the central and peripheral nervous systems, while also demonstrating the value of an individualized approach to neurorehabilitation in upper limb loss.
Conclusions
There is a gap in our understanding of the role of neurorehabilitation following amputation. Overall, focused rehabilitation parameters, demographic information, and clarity around central and peripheral neural mechanisms are needed in future research to address neurobehavioral mechanisms to promote functional recovery following traumatic upper extremity amputation.
... These approaches can provide different sensations with respect to the natural sensing pathways (sensory substitution). It is also possible to elicit natural phantom-limb sensations by targeting sites on the skin that have been surgically reinnervated (targeted sensory reinnervation) [188][189][190] . Furthermore, natural feedback can potentially be restored through electrical stimulation of surgically formed muscle-actuated skin flaps (cutaneous mechanoneural interface 191 ). ...
Most prosthetic limbs can autonomously move with dexterity, yet they are not perceived by the user as belonging to their own body. Robotic limbs can convey information about the environment with higher precision than biological limbs, but their actual performance is substantially limited by current technologies for the interfacing of the robotic devices with the body and for transferring motor and sensory information bidirectionally between the prosthesis and the user. In this Perspective, we argue that direct skeletal attachment of bionic devices via osseointegration, the amplification of neural signals by targeted muscle innervation, improved prosthesis control via implanted muscle sensors and advanced algorithms, and the provision of sensory feedback by means of electrodes implanted in peripheral nerves, should all be leveraged towards the creation of a new generation of high-performance bionic limbs. These technologies have been clinically tested in humans, and alongside mechanical redesigns and adequate rehabilitation training should facilitate the wider clinical use of bionic limbs. This Perspective argues that technologies for the neural interfacing of robotic devices with the body that have been clinically tested in humans should be leveraged toward the creation of a new generation of high-performance bionic limbs.
... Este tipo de prótesis implementa principalmente actuadores eléctricos, a veces controlados por servomotores, a pulsos o por interruptores, la desventaja más significativa en este tipo de prótesis es: su alto costo, exposición a ambientes hostiles, así como su peso. [8][5] [27] ...
Existe la necesidad de prótesis de bajo costo y hackeables, ya que las comerciales son muy caras y no pueden modificarse para adaptarse a las necesidades de cada individuo.
Las manos robóticas utilizadas en robots humanoides, manipuladores robóticos e investigación tienen un coste muy elevado, en muchos casos inasequible para startups, pequeñas universidades y centros de investigación.
En esta tesis explicamos el desarrollo y la implementación de una prótesis de brazo robótico controlada por sensores de electromiografía.
