RUI: Treating Phantom Limb Pain with Electrically Induced Somatosensation

幻肢痛发生在大多数截肢者中，包括超过一半的上肢患者，例如，手臂或手，截肢。这种疼痛是由于失去了可理解的肢体输入，这可能会导致神经通路的沿着变化。目前，经历这种疼痛的个体使用药理学（药物）治疗，取得了不同的成功，有时会产生显著的副作用。临床上没有治疗方案可以尝试直接解决神经变化以尝试治疗疼痛感觉。本研究将评估敲击感觉的无创电刺激作为减少幻肢疼痛的方法。此外，还将分析大脑中的电活动模式，以评估神经通路的变化。考虑到目前的阿片类药物危机，开发不需要药物的治疗方案对于未来患有幻肢痛的人以及其他可能患有神经系统疾病的人来说将是一个重大进步。 该项目还将有助于培养一批多样化的本科生，他们将获得宝贵的研究经验，并有助于开展外联活动，吸引和激发大学预科生对生物医学工程的兴趣。 这项研究的长期目标是开发电刺激作为一种促进神经可塑性的方法，用于神经损伤或疾病后的恢复。本项目的目的是分析在非侵入性表面电刺激周围神经的皮层活动，以评估是否可以诱导皮层可塑性。最初的目标人群将是截肢的人，对他们来说，诱导神经可塑性可能会减轻幻肢疼痛。这种方法的核心假设是，躯体感觉皮层的神经可塑性可以通过有针对性的、非侵入性的感觉激活与视觉输入逻辑配对来促进，并且这种神经可塑性将减少或消除幻肢痛。进行这项工作的基本原理是基于这样的期望，即中枢神经系统如何对电刺激做出反应的知识将有助于开发针对幻肢疼痛和其他神经系统疾病的定制疗法。该项目小组已经开发出一种非侵入性刺激方法，用于唤起截肢者幻肢的感觉。在本项目的下一阶段工作中，将描述对物理和电诱导的躯体感觉做出反应的皮层活动。预期感觉的外周神经激活将引起类似于物理触摸的皮层激活。在身体健全受试者的初步探索性试验的基础上，截肢受试者将接受治疗，包括同时电激活敲击感觉和敲击假体的视觉反馈。治疗将在12周内每周进行多次，并将评价这种长期激活对皮层活动和幻肢疼痛严重程度的影响。此外，还将开发一种多通道刺激系统，该系统可以轻松校准，从而为所有人产生真实的感觉，从而减少家庭治疗的障碍。该奖项反映了NSF的法定使命，并通过使用基金会的智力价值和更广泛的影响审查标准进行评估，被认为值得支持。

Phantom limb pain occurs in a majority of people with amputated limbs, including over half of people with upper extremity, e.g., arm or hand, amputations. This pain results from the loss of understandable input from the missing limb, which presumably causes changes along the neural pathway. Currently, individuals experiencing this pain use pharmacological (drug) treatments with varying success and sometimes significant negative side effects. There are no treatment options clinically available that attempt to directly address the neural changes in an attempt to treat the painful sensations. This study will evaluate non-invasive electrical stimulation of a tapping sensation as a method to reduce phantom limb pain. In addition, the patterns of electrical activity in the brain will be analyzed to assess changes to the neural pathway. Given the current opioid crisis, the development of treatment options that do not require drugs would be a momentous advance for people suffering from phantom limb pain and potentially others with neurological disorders in the future. This project will also contribute to the training of a diverse group of undergraduate students who will obtain valuable research experiences and to the development of outreach activities that will engage and excite pre-college students about biomedical engineering. The long-term goal of this research is to develop electrical stimulation as a method to promote neuroplasticity for recovery after neurological injury or illness. The objective of this project is to analyze cortical activity during non-invasive surface electrical stimulation of the peripheral nerve in order to assess whether cortical plasticity can be induced. The initial target population will be people with an amputated limb for whom inducing neuroplasticity may alleviate phantom limb pain. The central hypothesis of this approach is that neuroplasticity in the somatosensory cortex can be facilitated using targeted, non-invasive activation of sensation logically paired with visual input and that this neuroplasticity will reduce or eliminate phantom limb pain. The rationale for performing this work is based on the expectation that knowledge of how the central nervous system responds to electrical stimulation will help develop customized therapies for phantom limb pain and other neurological disorders. A non-invasive stimulation method to evoke sensation in the phantom limb of people with amputations has already been developed by the project team. In the next phase of work conducted during this project, the cortical activity in response to physical and electrically induced somatosensation will be characterized. It is expected that peripheral nerve activation of sensation will evoke cortical activation similar to physical touch. Building on an initial exploratory trial in able-bodied subjects, subjects with amputations will be given a therapy consisting of simultaneous electrical activation of a tapping sensation and visual feedback of that tapping on their prostheses. The therapy will occur multiple times per week over twelve weeks and the effects of this long-term activation on cortical activity and severity of phantom limb pain will be evaluated. In addition, a multichannel stimulation system that can be easily calibrated to generate realistic sensation across all individuals will be developed to reduce the barriers to a home-based therapy.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.