Restoring the volitional control of a paralyzed limb using patient-controlled spinal cord stimulation

瘫痪是一种毁灭性的缺陷，通过轮椅等物理辅助工具来维持独立性。在许多情况下，瘫痪的肌肉仍然具有功能，但与大脑断开了联系。因此，从理论上讲，用“读心”系统来控制瘫痪的肢体并将预期的运动指令传递给脊髓是可能的。两个小组（NeuraLink和Brain Gate）目前正在领导脑机接口的开发，但这些系统的植入和支持都很复杂，而且目前提供的慢性读数不可靠。此外，没有脊髓刺激器可以根据使用这些系统检测到的命令产生运动收缩。该项目的目标是开发一种脊髓刺激器，产生精确的运动收缩，由患者使用触觉手套界面直接控制。这种手套将把手指的运动映射成由刺激器产生的特定腿部运动，并根据本体感觉信号振动，从而绕过复杂的脑机接口，彻底改变目前的模式。该系统将由一个包括神经外科医生（Iorio-Morin）、神经生理学家（Frigon）、电子工程师（Fontaine）、机器人工程师（Michaud）和伦理学家（Marchildon）在内的团队创建，他们的目标如下：1)适应现有的视网膜刺激器（doi: 10.1002/adbi）。202000055)用于植入脊髓的多阵列电极，并增加双向通信的支持（Fontaine, Michaud, Iorio-Morin, Frigon）2)开发一种带有所需软件的触觉手套，以短延迟控制刺激器，并通过感觉替代提供本体感受反馈。（Michaud, Fontaine, Iorio-Morin, Frigon）3)设计植入程序，指定最佳电极位置和配置，并在脊柱解剖的猫模型中测试系统（doi: 10.1152/jn.00747.2019） （Iorio-Morin, Frigon）4)制定指导未来植入物在人类中的使用的伦理流程（Marchildon, Iorio-Morin）该项目将在5年内支持培养至少2名硕士和3名博士和1名博士后在生理学，工程学和伦理学方面。学生将加入强大的现有团队，在多学科环境中工作（3IT-U）。路易斯塔里夫CRCHUS)。他们将在学科双周会议和多学科月度会议上介绍他们的进展，从而创造一个丰富的培训环境。

Paralysis is a devastating deficit where independence is maintained through physical adjuncts such as wheelchairs. In many cases, paralyzed muscles remain functional, but are disconnected from the brain. Thus, in theory, it is possible to control a paralyzed limb with a system to "read the mind" and transfer the intended motor command to the spinal cord. Two groups (NeuraLink and Brain Gate) are currently leading the development of brain-computer interfaces, but these systems are complex to implant and support, and currently provide unreliable chronic readings. Furthermore, no spinal cord stimulator exists to generate motor contractions from commands detected using any of these systems.The goal of this project is to develop a spinal cord stimulator generating precise motor contractions directly controlled by the patient using a haptic glove interface. The glove will remap finger motion into specific leg movements generated by the stimulator and vibrate in response to proprioceptive signals, bypassing the need for complex brain-computer interfaces and completely changing the current paradigm. The system will be created by a team involving a neurosurgeon (Iorio-Morin), neurophysiologist (Frigon), electrical engineer (Fontaine), robotic engineer (Michaud) and ethicist (Marchildon) working on the following objectives:1) Adapt an existing retinal stimulator (doi: 10.1002/adbi.202000055) for use with multi-array electrodes implanted in the spinal cord and add support for bidirectional communication (Fontaine, Michaud, Iorio-Morin, Frigon)2) Develop a haptic glove with required software to control the stimulator with short-latency and provide proprioceptive feedback through sensory substitution. (Michaud, Fontaine, Iorio-Morin, Frigon)3) Design the implantation procedure, specify the optimal electrode location and configuration, and test the system in a spinal-transected cat model (doi: 10.1152/jn.00747.2019) (Iorio-Morin, Frigon)4) Develop the ethics processes guiding the future use of the implant in humans (Marchildon, Iorio-Morin)The project will support the training of at least 2 MSc and 3 PhD and 1 post-doctoral fellow in physiology, engineering and ethics over 5 years. Students will join strong existing teams working in multidisciplinary environments (3IT-U. Sherbrooke, CRCHUS). They will present their progress in disciplinary biweekly meetings and in multidisciplinary monthly meetings thus creating a rich training environment.