High-density peripheral nerve cuffs restore natural sensation to individuals with lower-limb amputations
High-density peripheral nerve cuffs restore natural sensation to individuals with lower-limb amputations
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DOI：
10.1088/1741-2552/aac964
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发表时间：
2018-10-01
影响因子：
4
通讯作者：
Triolo, Ronald J.
中科院分区：
文献类型：
--
作者：
Charkhkar, Hamid;Shell, Courtney E.;Triolo, Ronald J.
客观的。下肢截肢者的感觉输入对于保持平衡、防止跌倒、通过不平坦的地形、应对意外扰动以及培养在陌生环境中进行社会参与和公共互动所需的信心至关重要。尽管下肢截肢者的机器人假肢取得了显着的进步，例如微处理器膝盖和电动脚踝，但来自失去肢体的自然体感反馈尚未纳入当前的假肢技术中。方法。在这项工作中，我们报告了通过长期植入的非穿透性神经袖带电极在两名小腿截肢者身上传递的神经刺激来引发躯体感觉。通过手术植入高密度、柔性、16 触点神经袖带电极，用于选择性激活膝盖上方大腿后部神经的感觉束。外部刺激器通过连接到袖带电极的经皮导线将安全水平的电脉冲传递到神经。主要结果。参与者将神经刺激视为源自缺失肢体的感觉。我们定量和定性地确定了感知感觉的强度、形态以及位置和稳定性。通过神经套内的单独接触进行刺激，可在投射到缺失的脚趾、脚和脚踝以及残肢的离散位置上引起各种形式的可重复感觉。此外，我们观察到远端袖带与近端袖带之间报告的位置存在高度重叠，这表明可以从神经上更近端的点引发相同的感觉反应。意义。基于这些发现，高密度袖带技术适用于恢复下肢截肢者的自然感觉，并可用于开发具有自然感觉反馈的神经假体。近端和远端袖带之间报告位置的重叠表明我们的方法可能适用于无法获得远端肌肉和坐骨神经分支的经股截肢者。
Objective. Sensory input in lower-limb amputees is critically important to maintaining balance, preventing falls, negotiating uneven terrain, responding to unexpected perturbations, and developing the confidence required for societal participation and public interactions in unfamiliar environments. Despite noteworthy advances in robotic prostheses for lower-limb amputees, such as microprocessor knees and powered ankles, natural somatosensory feedback from the lost limb has not yet been incorporated in current prosthetic technologies. Approach. In this work, we report eliciting somatic sensation with neural stimulation delivered by chronically-implanted, non-penetrating nerve cuff electrodes in two transtibial amputees. High-density, flexible, 16-contact nerve cuff electrodes were surgically implanted for the selective activation of sensory fascicles in the nerves of the posterior thigh above the knee. Electrical pulses at safe levels were delivered to the nerves by an external stimulator via percutaneous leads attached to the cuff electrodes. Main results. The neural stimulation was perceived by participants as sensation originating from the missing limb. We quantitatively and qualitatively ascertained the intensity, modality as well as the location and stability of the perceived sensations. Stimulation through individual contacts within the nerve cuffs evoked repeatable sensations of various modalities and at discrete locations projected to the missing toes, foot and ankle, as well as in the residual limb. In addition, we observed a high overlap in reported locations between distal versus proximal cuffs suggesting that the same sensory responses could be elicited from more proximal points on the nerve. Significance. Based on these findings, the high-density cuff technology is suitable for restoring natural sensation to lower-limb amputees and could be utilized in developing a neuroprosthesis with natural sensory feedback. The overlap in reported locations between proximal and distal cuffs indicates that our approach might be applicable to transfemoral amputees where distal muscles and branches of sciatic nerve are not available.