Neural Interface and Control Design to Restore Sensation in Amputees

用于恢复截肢者感觉的神经接口和控制设计

• 批准号: 8278363
• 负责人: MATTHEW Anthony SCHIEFER
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8278363
• 关键词: Afferent Neurons; Amputees; Articular Range of Motion; Back; Biological Neural Networks; Computer software; Contralateral; Data; Electric Stimulation; Electrodes; Ensure; Environment; Esthesia; Fiber; Foundations; Frequencies; Future; Goals; Hand; Implant; Lead; Life; Limb structure; Location; Manuscripts; Maps; Medicine; Modality; Motor; Muscle; Myoelectric prosthesis; Nerve; Nervous system structure; Neural Pathways; Pain; Pattern; Perception; Peripheral Nerve Stimulation; Peripheral Nerves; Phase; Planning Techniques; Population; Positioning Attribute; Proprioception; Prosthesis; Quality of life; Radial; Ramp; Research; Research Project Grants; Residual state; Rubber; Sensory; Sensory Receptors; Series; Shoulder; Stimulus; Stretching; System; Technology; Temperature; Testing; Time; Touch sensation; Upper Extremity; afferent nerve; arm; base; combat; design; flexibility; grasp; improved; new technology; novel; pressure; relating to nervous system; research study; response; sensor; sensory feedback; success; theories; vibration; visual feedback

DESCRIPTION Rationale: The standard upper extremity prosthesis has been a cable-based system in which cables attached to the prosthesis wrap around the back to the contralateral shoulder. By manipulating the contralateral shoulder, the user controls the function of the prosthesis, such as gripping or releasing an object, as well as the force that is applied by the prosthesis. While not natural, the user does receive a form of sensory feedback from the amount of tension developed in the cables. In more recent years, myoelectric prostheses have become available. These newer prostheses rely on voluntary contraction of the residual muscles of the amputated limb to control the function of the prosthesis. While myoelectric prostheses are more cosmetically pleasing and provide a greater range of motion than the traditional cable-based system, they lack sensory feedback. Because the hands are key for manipulating the external environment, sensory feedback is critical in the upper extremities. The ideal artificial sensory feedback mechanism would be one that produces the exact same perception as the non-amputated limb. Although the sensory receptors are missing in the amputated limb, the neural pathways that once carried sensory information remain intact and can be excited with electrical stimulation, thus affording an opportunity for providing sensory feedback to the amputee. Objective: The objective of this study is to prove that electrical stimulation applied to the residal nerves in an amputee in a controlled manner can provide sensory feedback that can be modulated and is reproducible. Further, this study aims to demonstrate that the sensations induced by electrical stimulation are stable over time and that their locations can be artificially manipulated without altering stimulus parameters. Numerous hypotheses will be tested through a series of experiments that span a 10 week time period. Research Plan and Methodology: Five subjects will be implanted with nerve cuff electrodes around residual nerves in their arm: the median, radial, ulnar, and musculocutaenous nerves. Stimulus space will be searched in a gross, rapid manner over the first four weeks of the study. The most promising stimulus parameters and the space surrounding them will be tested in more detail during the next 6 weeks. Subjects will be queried for their perceptions to stimulation and how those perceptions change with time or with changes in stimulus parameters. Sensations that the limb has changed position will be studied by having the subject mirror the position with the contralateral, intact limb. Limb positions will be recorded with a Vicon system. In addition to creating a stimulus-to-percept map, which may vary over time, a percept will be singled out for the purpose of artificial relocation. This will be accomplished by stimulating the nerve and inducing a percept that is in disagreement with what the subject sees. Specifically, pressure will be applied to the fingertip of the subject's prosthesis at the same time that the subject's nerve is stimulated with a set of stimulus parameters known to induce a sensation somewhere else. The visual feedback should allow the subject to "adjust" the location of the perception to the fingertip. Successful relocatio of a sensation may allow a perfect mapping from where a clinician wants a stimulus to be perceived and where the subject actually perceives it. In addition to the data gathered during the study, which will lead to two manuscripts, a software package will exist that allows fast, efficien, and meaningful stimulus optimization at the conclusion of the study. This software will be useful in future studies that incorporate additional stimulus channels or locations. The data obtained in this study will guide a future phase in which a prosthesis is designed to control sensory feedback and the subject's ability to perform tasks of daily living with the sensory feedback is evaluated. PUBLIC HEALTH RELEVANCE: The amputee population continues to grow due to improvements in combat armor and medicine. While the amputee can be fitted with a prosthesis that allows objects to be manipulated, the amputee is unable to feel the object. Lack of perception of how the prosthesis interacts with the environment decreases ease of use and contributes to a sense of disassociation between the user and the prosthesis. It is believed that sensory feedback is critical for efficient prosthesis use and will improve the user's quality of life. This research ais to improve the quality of life of amputees by laying a foundation upon which novel technologies can be used to restore sensation. Flexible cuffs will be implanted around sensory nerves in the arm of amputees. Low-level electrical nerve stimulation will restore sensation of the amputated arm. The goal is for the amputee to feel where the prosthesis is in space as well as pressure that the prosthesis exerts on objects that the user manipulates.

描述 理由：标准的上肢假体是一个基于电缆的系统，在该系统中，电缆附在背面的假体包裹到对侧的肩膀上。通过操纵对侧肩膀，用户可以控制假体的功能，例如抓地或释放对象，以及假体施加的力。虽然不自然，但用户确实会从电缆中产生的张力量获得一种感觉反馈形式。近年来，肌电假体已获得。这些较新的假体依赖于截肢肢体残留肌肉的自愿收缩来控制假体的功能。虽然肌电假肢在化妆上更令人愉悦，并且比传统的基于电缆的系统更具运动范围，但它们缺乏感官反馈。因为手是操纵外部环境的关键，所以感觉反馈在上肢至关重要。理想的人工感觉反馈机制将是一种与非吸引人的肢体完全相同的感知。尽管在截肢的肢体中缺少感觉受体，但曾经携带的感觉信息的神经途径仍然完好无损，并且可以对电刺激感到兴奋，从而为向截肢者提供感觉反馈提供了机会。目的：这项研究的目的是证明以受控方式将电刺激应用于截肢者的残留神经可以提供可以调节且可重现的感觉反馈。此外，这项研究旨在证明电刺激引起的感觉会随着时间的流逝而稳定，并且它们的位置可以人为地。 操纵而无需改变刺激参数。将通过一系列跨越10周的实验来检验许多假设。研究计划和方法论：五个受试者将在其手臂中残留神经周围植入神经袖口电极：中间，radial，尺和肌肉神经。在研究的前四个星期中，将以总体的快速方式搜索刺激空间。在接下来的6周内，最有希望的刺激参数及其周围空间将进行更详细的测试。受试者的看法对刺激以及这些感知如何随着时间的变化或刺激参数的变化而受到查询。通过让主体用对侧，完整的肢体镜像位置，将研究肢体变化的感觉。肢体位置将使用Vicon系统记录。除了创建一个可能随着时间的流逝而变化的刺激对感知图外，还将出于人工迁移的目的而挑出感知。这将通过刺激神经并引起与受试者所见的意识来实现。具体而言，将向指尖施加压力 受试者的假体同时，受试者的神经是通过已知在其他地方引起感觉的一组刺激参数刺激的。视觉反馈应允许受试者“调整”感知到指尖的位置。成功的重新启动可以从临床医生希望被感知的刺激以及受试者实际感知到的地方进行完美的映射。除了研究期间收集的数据（这将导致两个手稿）外，还将存在一个软件包，可以在研究结束时快速，效率和有意义的刺激优化。该软件将在包含其他刺激通道或位置的未来研究中很有用。在本研究中获得的数据将指导未来的阶段，在该阶段中，评估了假体旨在控制感觉反馈和受试者通过感觉反馈执行日常生活任务的能力。 公共卫生相关性： 由于战斗装甲和药物的改善，截肢者人口不断增长。尽管截肢者可以安装允许对象操纵对象的假体，但截肢者无法感觉到对象。缺乏对假体如何与环境相互作用的看法会降低使用的易用性，并有助于用户与假体之间的分离感。人们认为，感官反馈对于有效的假体使用至关重要，并将改善用户的生活质量。这项研究通过为新技术恢复感觉的基础来改善截肢者的生活质量。柔性袖口将围绕截肢者的臂中的感觉神经植入。低级电神经刺激将恢复截肢臂的感觉。目的是让截肢者感觉到假体在太空中的位置以及假体对用户操纵对象施加的压力。