Corticospinal neuroprostheses to restore locomotion after spinal cord injury

In this conceptual review, we highlight our strategy for, and progress in the development of corticospinal neuroprostheses for restoring locomotor functions and promoting neural repair after thoracic spinal cord injury in experimental animal models. We specifically focus on recent developments in recording and stimulating neural interfaces, decoding algorithms, extraction of real-time feedback information, and closed-loop control systems. Each of these complex neurotechnologies plays a significant role for the design of corticospinal neuroprostheses. Even more challenging is the coordinated integration of such multifaceted technologies into effective and practical neuroprosthetic systems to improve movement execution, and augment neural plasticity after injury. In this review we address our progress in rodent animal models to explore the viability of a technology-intensive strategy for recovery and repair of the damaged nervous system. The technical, practical, and regulatory hurdles that lie ahead along the path toward clinical applications are enormous - and their resolution is uncertain at this stage. However, it is imperative that the discoveries and technological developments being made across the field of neuroprosthetics do not stay in the lab, but instead reach clinical fruition at the fastest pace possible.. (C) 2013 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.

Neuroprosthetics to support impaired hand functions: A multidisciplinary approach combining brain-machine interfaces and wearable exoskeletons

Luca Randazzo

Neuroprosthetics, the discipline that aims at interfacing neural systems to artificially engineered devices, has witnessed in recent years important advancements towards the ultimate goal of augmenting and restoring human functions through technology and artificial systems. Research in this field covers a wide range of efforts, from advancing our basic understanding of the neural processes involved into human sensory, motor and cognitive functions, to developing artificial intelligence algorithms for their decoding, to the physical interfacing between artificial devices and the human nervous system and biomechanics. Ultimately, this discipline aims at fusing these systems in order to restore, replace and rehabilitate lost and impaired functions due to motor disabling conditions or traumatic accidents. In this thesis, I present a multidisciplinary approach that aimed at developing a neuroprosthesis for the assistance and restoration of hand functions impaired by neurological disorders or traumatic accidents, such as cerebrovascular accidents and spinal cord injuries. These efforts encompassed the conceptualization and development of a robotic hand exoskeleton and brain-machine interface (BMI) algorithms for its control. Specifically, this thesis focused on the design, development and testing of (i) a novel mechatronic hand exoskeleton to assist hand motions within domestic and clinical settings, (ii) non-invasive BMI approaches based on electroencephalography (EEG) to decode neural correlates of intended hand movements, and on (iii) the closed-loop integration of the proposed exoskeleton and BMI for the sake of providing continuous feedback about ongoing neural modulations through hand motions and to trigger sensorimotor rehabilitation within clinical scenarios. Results showed that the proposed mechatronic system can successfully control hand opening and closing within a fully wearable, portable and lightweight package. The system was tested with users who suffered from motor disabling impairments, showing that it could help them in performing several activities of daily living for the first time since their accidents. From a brain-machine interfacing perspective, this work shows how imagined hand movements can be decoded, through EEG, in parallel with exoskeleton-induced motions, with important implications for the development of more embodied human-machine interaction protocols. Finally, this work shows how the closed-loop control of exoskeleton motions by means of the decoded ongoing neural activity enhances the discriminability of sensorimotor neural patterns and improves the performance of the brain-machine control channel. Overall, the results presented here represent important advancements within the field of neuroprosthetics, with interesting implications for the development of assistive exoskeletal technologies and non-invasive brain-machine interfaces aimed at controlling such systems in clinical or domestic settings, for both assistive and neurorehabilitative purposes.

EPFL2018

Brain-controlled neuroprosthetic interventions to restore locomotion after contusion spinal cord injury in the rat

Marco Bonizzato

Spinal cord injury (SCI), second only to stroke, is the leading cause of paralysis. Therapies based on electrical stimulation of the spinal cord and other locomotor areas of the Nervous System improve motor control in people with neurotrauma. Neuromodulation of the sensorimotor systems can indeed reactivate circuitries that are left dormant after SCI and turn them into an active locomotor state. These results have been found in animal models and translated to clinical fruition. Recent medical research has demonstrated that the involvement of volition and motor intent is a decisive factor for success of rehabilitation therapies that involve functional electrical stimulation of spinal cord and muscles. A key brain area that encodes information related to the conscious processing and execution of movement is the primary sensory-motor cortex. In this thesis I present two novel neuroprosthetic systems for neuromodulation based on cortical population activity in rats with SCI. We tested the hypotheses that neurons in the motor cortex could provide a reliable input for closed-loop neuroprosthetic systems designed to electrically stimulate different locomotor areas of the nervous system in a locomotor-phase-specific manner and thus enhance the locomotor output. During the experiments, we connected cortical correlates of intended movements with patterns of stimulation delivered either at the midbrain or at the sublesional spinal cord. Our brain-controlled functional stimulation reduced locomotor deficits caused by spinal cord injury and restored voluntary control of foot movement. These findings and the control policies we developed could be applied to clinical trials to improve the results of neurorehabilitation, for the benefit of people living with SCI.

EPFL2017

Versatile robotic interface to evaluate, enable and train locomotion and balance after neuromotor disorders

Grégoire Courtine, Lucia Florinda Friedli Wittler, Pavel Musienko, Rubia van den Brand

Central nervous system (CNS) disorders distinctly impair locomotor pattern generation and balance, but technical limitations prevent independent assessment and rehabilitation of these subfunctions. Here we introduce a versatile robotic interface to evaluate, enable and train pattern generation and balance independently during natural walking behaviors in rats. In evaluation mode, the robotic interface affords detailed assessments of pattern generation and dynamic equilibrium after spinal cord injury (SCI) and stroke. In enabling mode, the robot acts as a propulsive or postural neuroprosthesis that instantly promotes unexpected locomotor capacities including overground walking after complete SCI, stair climbing following partial SCI and precise paw placement shortly after stroke. In training mode, robot-enabled rehabilitation, epidural electrical stimulation and monoamine agonists reestablish weight-supported locomotion, coordinated steering and balance in rats with a paralyzing SCI. This new robotic technology and associated concepts have broad implications for both assessing and restoring motor functions after CNS disorders, both in animals and in humans. © 2012 Nature America, Inc. All rights reserved.

Nature Publishing Group2012

Neuroprosthetics to support impaired hand functions: A multidisciplinary approach combining brain-machine interfaces and wearable exoskeletons

Luca Randazzo

EPFL2018