Restoring Upper Limb Movement Sense to Amputees; a Move Towards Natural Control o

描述（由申请人提供）：近年来，在研究创造灵活，多功能的假肢方面投入了大量资金，用于截肢后上肢功能的恢复。在许多方面，对假肢发展的关注是由临床操作运动神经-机器接口的进步推动的；比如靶向神经再生，通过外科手术重定向截肢神经来控制多功能肢体的运动，以及其他即将出现的大脑和周围神经-机器接口。尽管这些马达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，但一个基本问题仍然存在。没有自然和直观的感官反馈，假肢仍然只是没有感觉的工具。本体感觉是一种不用看就能感知手臂在空间中的位置的基本能力。截肢者缺乏这种感觉反馈，这是实施高级假肢的根本挑战。截肢者需要视力确认才能使用义肢；从最基本的设备到最先进的。这是我们在研究目标中寻求解决的关键问题。我们建议在3个目标中解决假肢缺乏运动反馈的问题，重点是开发和实施方法，利用有针对性的感觉神经再生来控制和利用截肢者肢体运动的认知错觉。这项研究对美国国立卫生研究院的科学事业很重要，因为它具有高度的转译性，其结果直接影响到截肢者的护理。我们假设我们可以刺激目标再神经截肢者的再神经组织中适当的感觉受体，产生“动觉错觉”，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，并观察定向再神经截肢者如何感知这种动觉输入。目标2)我们将开发一个小型的可穿戴机器人界面，以选择性地激活动觉受体，并将肢体运动的感觉分配给假肢。有了这个，我们将看看主题如何解释关节角度从一个中立连接，但物理上独立的假体。我们将评估肢体功能与心理物理检查内部动态模型有关的匀速运动。我们还将评估使用眼动追踪和动作捕捉来跟踪假体使用过程中的视觉负荷的功能。目的3)义肢窝是义肢与被截肢者之间的物理连接。这种连接需要不断发展，以反映机器人接口的实现限制。为了解决这个问题，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。

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.