Sensory feedback restoration in leg amputees improves walking speed, metabolic cost and phantom pain

Conventional leg prostheses do not convey sensory information about motion or interaction with the ground to aboveknee amputees, thereby reducing confidence and walking speed in the users that is associated with high mental and physical fatigue(1-4). The lack of physiological feedback from the remaining extremity to the brain also contributes to the generation of phantom limb pain from the missing legs(5,)(6). To determine whether neural sensory feedback restoration addresses these issues, we conducted a study with two transfemoral amputees, implanted with four intraneural stimulation electrodes' in the remaining tibial nerve (ClinicalTrials. gov identifier NCT03350061). Participants were evaluated while using a neuroprosthetic device consisting of a prosthetic leg equipped with foot and knee sensors. These sensors drive neural stimulation, which elicits sensations of knee motion and the sole of the foot touching the ground. We found that walking speed and self-reported confidence increased while mental and physical fatigue decreased for both participants during neural sensory feedback compared to the no stimulation trials. Furthermore, participants exhibited reduced phantom limb pain with neural sensory feedback. The results from these proof-of-concept cases provide the rationale for larger population studies investigating the clinical utility of neuroprostheses that restore sensory feedback.

Wearable multimodal tactile interfaces for augmenting haptic perception

Simon Gallo

Haptic feedback has been used to faithfully restitute the haptic sense lacking during telemanipulation, but also for providing auxiliary information via the haptic channel to restore functional perception of missing or damaged senses, e.g. sensory substitution for the visually impaired. Yet, despite the growing number of applications that would benefit from haptic feedback, its penetration rate remains low. We have identified three under-researched features of haptic feedback that we believe are necessary to break the bottleneck: multimodality, thermal feedback and wearability. Indeed, while haptic perception results from the integration of multiple somatosensory inputs, the interactions between haptic modalities have rarely been investigated. Thermal feedback is an ideal candidate to explore these interactions as skin temperature is known to modulate the sensitivity of skin receptors. Finally, although haptic perception is distributed over the entire body, most multimodal haptic devices are still bulky and rigid, thus limiting their usage to specific body parts and applications. As the integration of multiple feedback modalities into a flexible display is complex, the benefits of these three features need to be demonstrated. This motivated the developments presented in this thesis. First, we miniaturized and integrated thermal feedback in multisensory platforms to investigate its role in conveying non-sensory information and modulating tactile perception. The first study showed that users are able to distinguish the temperature difference between two adjacent thermal stimuli presented under the fingertip by a high-density thermal display, highlighting the potential of miniaturized displays to deliver thermally-encoded information through small skin areas. A second study showed that modifying the skin temperature yielded changes in the precision of stiffness judgments up to 22.3%, suggesting that thermal feedback can be used to modulate the perception of complex haptic percepts. Moving towards complete wearability, we introduced a wearable multimodal display that matches the skin curvature to deliver thermo-tactile cues optimally, as supported by the high usersâ identification rates of simulated materials. Subsequently, we developed a portable hydraulic actuation that generates multimodal tactile feedback in remote 3D-printed flexible displays, paving the way to truly versatile wearable multimodal displays. Finally, a tactile suit remapping tactile and proprioceptive sensations from the virtual legs of an avatar onto the upper limbs of paraplegic patients is developed. We show that the patients were able to perceive the position of the virtual legs based on tactile feedback alone, that the use of tactile feedback in synchrony with the avatarâs walk changed the perception of the boundaries of their body, and that the modulation of the tactile stimulation induced a robust sensation of walking on different floors. These results demonstrate the potential of wearable tactile displays to create perceptual orthoses. In this work, we have developed the tools to deliver a multimodal tactile stimulation using wearable thermo-tactile displays and have shown how their unique features can impact fields such as surgical and rehabilitation robotics. These findings encourage the future development of wearable multimodal tactile displays taking advantage of the synergies between haptic modalities to improve teleoperation and sensory rehabilitation.

EPFL2016

Framework for the Development of Neuroprostheses: From Basic Understanding by Sciatic and Median Nerves Models to Bionic Legs and Hands

Francesco Maria Petrini, Stanisa Raspopovic, Giacomo Valle, Marek Zelechowski

Neuroprostheses based on electrical stimulation are becoming a therapeutic reality, dramatically improving the life of disabled people. They are based on neural interfaces that are designed to create an intimate contact with neural cells. These devices speak the language of electron currents, while the human nervous system uses ionic currents to communicate. A deep understanding of the complex interplay between these currents, during the electrical stimulation, is essential for the development of optimized neuroprostheses. Neural electrodes can have different geometries, placement within the nervous system, and the stimulation protocols (paradigms of use). This high-dimensional problem is not tractable by an empiric, brute-force approach and should be tackled by exact computational models, making use of our accumulated knowledge. In pursuit of this goal, a hybrid finite element method-NEURON modeling-is used for a solution of electrical field generated by stimulation, within the different neural structures having anisotropic conductivity, and a corresponding neural response computation. In this work, an important correction of perineurium electrical conductivity is computed. Models of median and sciatic nerves, innervating the hand and foot areas, relevant to the development of bionic hands and legs with sensory feedback, are implemented. The obtained results have the potential to optimize the design of neural interfaces, in terms of shape and number of stimulating contacts. Guidelines for the neurosurgical planning are proposed, by indicating the optimal number of implants for a specific nerve to obtain the best efficacy with the lowest invasiveness. The interpretation is proposed for one of the basic problems of neural interfaces, consisting in the change of the stimulation threshold due to fibrotic reaction of tissue. We show that it is possible to use human microstimulation as an experimental setup for testing of afferent stimulation paradigms, which can be translated to further chronic implants. In the future, models will have a key role in the decision of the most appropriate design of customized neuroprostheses, their optimal modality of use, understanding the effects that occur during their use, and minimizing animal and human experimentation.

Ieee-Inst Electrical Electronics Engineers Inc2017

Intraneural sensory feedback restores grip force control and motor coordination while using a prosthetic hand

Francesco Iberite, Silvestro Micera, Francesco Maria Petrini, Ivo Strauss, Giacomo Valle

Objective. Tactile afferents in the human hand provide fundamental information about hand-environment interactions, which is used by the brain to adapt the motor output to the physical properties of the object being manipulated. A hand amputation disrupts both afferent and efferent pathways from/to the hand, completely invalidating the individual's motor repertoire. Although motor functions may be partially recovered by using a myoelectric prosthesis, providing functionally effective sensory feedback to users of prosthetics is a largely unsolved challenge. While past studies using invasive stimulation suggested that sensory feedback may help in handling fragile objects, none explored the underpinning, relearned, motor coordination during grasping. In this study, we aimed at showing for the first time that intraneural sensory feedback of the grip force (GF) improves the sensorimotor control of a transradial amputee controlling a myoelectric prosthesis. Approach. We performed a longitudinal study testing a single subject (clinical trial registration number NCT02848846). A stacking cups test (CUP) performed over two weeks aimed at measuring the subject's ability to finely regulate the GF applied with the prosthesis. A pick and lift test (PLT), performed at the end of the study, measured the level of motor coordination, and whether the subject transferred the motor skills learned in the CUP to an alien task. Main results. The results show that intraneural sensory feedback increases the subject's ability in regulating the GF and allows for improved performance over time. Additionally, the PLT demonstrated that the subject was able to generalize and transfer her manipulation skills to an unknown task and to improve her motor coordination. Significance. Our findings suggest that intraneural sensory feedback holds the potential of restoring functionally effective tactile feedback. This opens up new possibilities to improve the quality of life of amputees using a neural prosthesis.

2019