Restoring upper limb movement sense to amputees; a move towards natural control o

描述(申请人提供)：近年来，在研究方面投入了大量资金，以创造灵活、多功能的假肢，以恢复截肢后的上肢功能。在许多方面，临床可操作的运动神经-机器接口的进步推动了对假肢发展的关注；例如靶向再支配，手术重定向被切断的神经以控制多功能肢体的运动，以及其他大脑和周围神经-机器接口在近期的水平。尽管这些运动接口为控制新型假肢提供了相当大的优势，这是现代工程的奇迹，但一个根本的问题仍然存在。如果没有自然和直观的感觉反馈，假肢仍然只是感觉迟钝的工具。本体感觉是一种基本的能力，不需要看就能感觉到你的手臂在空间中的位置。截肢者缺乏这种感觉反馈，这是实施先进假肢的根本挑战。截肢者需要视力确认才能使用假肢，从最基本的设备到最先进的设备。这是我们寻求通过我们的研究目标解决的关键问题。我们建议在3个目标上解决缺乏运动感觉反馈的假肢问题，重点是开发和实施利用截肢者肢体运动的认知错觉和有针对性的感觉再支配的方法。这项研究对美国国立卫生研究院的科学事业非常重要，因为它具有很高的转换性，其结果直接影响截肢者的护理。我们假设我们可以在靶向再支配截肢者的再神经组织中刺激适当的感觉受体来产生“运动错觉”，并为假肢提供生理上相关的肢体运动感。目的1)我们将使用振动和压力来选择性地激活错觉，并观察目标再神经截肢者如何感知这种动觉输入。目的2)我们将开发一种小型可穿戴机器人界面，以选择性地激活运动感受器，并将肢体运动的感觉分配给假肢。有了这一点，我们将看看受试者如何从一个中性连接但物理上没有连接的假体来解释关节角度。我们将通过与恒速运动相关的内部动态模型的心理物理检查来评估肢体功能。我们还将使用眼球跟踪和运动捕捉来评估功能，以跟踪假体使用期间的视觉负荷。目的3)假体承窝是假体与截肢者之间的物理连接点。这个结合点将需要发展，以反映机器人接口的实现限制。为了解决这一问题，我们将开发新的插座设计，以提供具有临床适用性的肢体运动反馈系统。 公共卫生相关性：这项研究与公共卫生相关，因为它具有很强的翻译性，其结果可能会直接影响截肢者的护理标准。截至2011年 在美国，有77万名创伤性上肢截肢者；这是一个年轻而活跃的群体，他们将从功能更强的人工手臂中受益匪浅，这种手臂是中性整合的，提供与生理相关的肢体运动感。此外，我们对感觉反馈的神经接口和认知机制的研究可以为许多不同领域的感觉整合问题带来的挑战提供深远的科学见解。

DESCRIPTION (provided by applicant): In recent years there has been a substantial investment in research to create dexterous, multi- functional, prosthetic limbs for restoration of upper limb function following amputation. The focus on prosthetic limb development has, has in many ways, been fueled by advances in clinically operational motor neural- machine-interfaces; such as Targeted Reinnervation, the surgical redirection of amputated nerves for motor control of multifunction limbs, and other brain and peripheral neural-machine-interfaces on the near horizon. Although these motor interfaces provide considerable advantage to the control of the new prosthetic limbs, which are wonders of modern engineering, a fundamental problem still remains. Without natural and intuitive sensory feedback artificial limbs are still just insensate tools. Proprioception is the basic ability to sense where your arm is in space without looking. Amputees lack this sensory feedback, and this is the fundamental challenge in the implementation of advanced prosthetic limbs. Vision confirmation is needed for an amputee to use a prosthesis; from the most basic device to the most advanced. This is the key issue that we seek to address with our research objectives. We propose to attack the problem of prosthetic limbs that lack kinesthetic feedback in 3 Aims focused on developing and implementing approaches to harness and utilize a cognitive illusion of limb movement in human amputees with targeted sensory reinnervation. This research is important to the NIH scientific enterprise because it is highly translational and results directly impact amputee care. We hypothesize that we can stimulate the appropriate sensory receptors in the reinnervated tissue of targeted reinnervation amputees to generate the "kinesthetic illusion" and provide a sense of physiologically relevant limb movement for prosthetic limbs. Aim 1) We will use vibration and pressure to selectively activate the illusion and look at how targeted reinnervation amputees perceive this kinesthetic input. Aim 2) We will develop a small wearable robotic interface to selectively activate the kinesthetic receptors and assign sensations of limb movement to a prosthesis. With this we will look at how the subject interprets joint angle from a neutrally connected but physically unattached prosthesis. We will evaluate limb function with psychophysical examination of internal dynamic models related to constant velocity movements. We will also evaluate function using eye tracking and motion capture to track visual loading during prosthesis use. Aim 3) The prosthetic socket is the physical junction between the prosthesis and the amputee. This junction will need to evolve to reflect implementation restraints of the robot interface. To address this we will develop new socket designs to provide a limb movement feedback system with clinical applicability. PUBLIC HEALTH RELEVANCE: This research is relevant to public health because it is highly translational and the results will likely directly impact standard of care for amputees. As of 2011 there were 770,000 traumatic upper limb amputees in the US; a population that is young and active and will benefit substantially from more functional artificial arms that are neutrally integrated and provide a physiologically relevant sense of limb movement. Furthermore, our lines of investigation into neural interfaces and cognitive mechanisms of sensory feedback could provide far reaching scientific insight into challenges arising from sensory integration issues in many different fields.