Proprioceptive Sensorimotor Integration with Neural Interfaces for Hand Prostheses

本体感觉感觉运动与手假肢神经接口的集成

• 批准号: 10728873
• 负责人: Emily L Graczyk
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-11-01 至 2025-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10728873
• 关键词: Agonist; Amputation; Amputees; Anesthesia procedures; Articulation; Chronic; Contralateral; Development; Devices; Electrodes; Electromyography; Esthesia; Feedback; Forearm; Freedom; Frequencies; Funding; Goals; Growth; Hand; Health Care Costs; Implant; Implanted Electrodes; Individual; Injections; Intramuscular; Intuition; Knowledge; Laboratories; Lidocaine; Limb Prosthesis; Limb structure; Motion; Motor; Movement; Muscle; Musculoskeletal Equilibrium; Myoelectric prosthesis; Nerve; Nerve Block; Neuromuscular Diseases; Neurosciences; Operative Surgical Procedures; Output; Ownership; Participant; Pattern; Perception; Performance; Peripheral Nerve Stimulation; Phantom Limb Pain; Physiologic pulse; Play; Population; Positioning Attribute; Posture; Process; Proprioception; Prosthesis; Psychometrics; Quality of life; Radial; Regression Analysis; Research; Residual state; Role; Scheme; Sensory; Signal Transduction; Spinal cord injury; Stimulus; Stroke; Structure of radial nerve; Structure of ulnar nerve; Surveys; System; Technology; Testing; Time; Touch sensation; Upper Extremity; Upper arm; Veterans; Work; antagonist; arm; coping; experimental study; finger movement; grasp; improved; kinematics; limb loss; median nerve; motor control; muscle reinnervation; neural; neural implant; neural stimulation; neurological rehabilitation; neurophysiology; prosthesis control; prosthesis wearer; prosthetic hand; psychosocial; recruit; rehabilitation strategy; reinnervation; sensorimotor system; sensory input; somatosensory; standard of care; virtual; virtual reality; visual feedback

Current prosthetic options do not meet the needs of all Veterans with upper extremity limb loss. Chronically- implanted neural interfaces have shown promise for providing intuitive control and somatosensory feedback to prosthesis users. However, restoring proprioception, which is the sense of limb position and movement, via neural stimulation remains largely unexplored. Proprioception is critical for informing and modulating motor control in able-bodied individuals, and without it, prosthesis users must rely on visual feedback. The goal of this study is to understand the perception of proprioception from peripheral nerve stimulation (PNS) and its integration with prosthesis control. The central hypothesis is that sensorimotor integration will be best when both the proprioceptive inputs and the prosthesis control scheme match the underlying neural representations of sensorimotor processes in the extant body schema. Providing natural proprioception to Veterans with upper limb loss is the next critical step in the advancement of upper limb prosthetics toward having a hand again. Six participants with unilateral trans-radial or trans-humeral limb loss will be implanted with chronic neural and muscular interfaces. Composite Flat Interface Nerve Electrodes (C-FINEs) will be implanted around the residual median, ulnar, and radial nerves in the upper arm. Three trans-radial participants will be implanted with bipolar intramuscular electromyography (EMG) electrodes (IMs) in residual muscles in the forearm. Three trans-humeral amputees will receive Targeted Muscle Reinnervation (TMR) surgery at the time of implant and IMs will be placed in re-innervated muscles. Participants will attend laboratory testing sessions every 45 days for two years to complete experiments for the three specific aims of the study. In Aim 1, proprioceptive percepts elicited by peripheral nerve stimulation will be characterized. PNS-elicited perceived hand movements will be tracked through contralateral posture matching. Regression analyses will be performed to determine the contribution of various stimulation parameters on the resulting perceived hand kinematics. This information will be used to build a stimulation encoder to provide time-varying proprioceptive information. Paired agonist-antagonist PNS strategies will also be developed. The discriminability of agonist- only and paired agonist-antagonist strategies will be compared with psychometric tests. In Aim 2, the role of direct muscle activation from PNS on stimulation-elicited proprioceptive percepts will be examined. A nerve block using lidocaine injection will be performed on trans-radial participants to temporarily anesthetize the forearm muscles. Perceived movements and EMG activity will be compared before and after motor block for various PNS stimuli. For trans-humeral participants who will receive TMR, muscle re- innervation takes ~3 months. Proprioceptive percepts and EMG activity will be compared before and after re- innervation is complete. All participants will perform psychometric experiments assessing PNS stimuli, and discriminability will be compared for pulse frequencies above and below tetanic contraction frequency. In Aim 3, the integration of artificial proprioception with motor control will be assessed. In a virtual posture matching task, participants will control a virtual hand to achieve target postures using EMG signals recorded from the IMs. Two control paradigms will be compared: 1) position-based control, which aims to mimic natural hand posture control in able-bodied individuals, and 2) velocity-based control, which is typical for commercially-available prostheses. Performance will be compared with and without stimulation-evoked proprioceptive feedback. In a psychometric dissimilarity rating task, participants will rate the subjective dissimilarity of pairs of stimulation-evoked percepts. Some pairs will also contain voluntary hand motions along with the stimulation. Ratings will be compared between passive and active proprioceptive conditions to determine the effect of voluntary control on stimulation-evoked percepts. Surveys to assess embodiment and agency will also be compared before and after each research session.

目前的假肢选择不能满足所有上肢丧失的退伍军人的需求。长期地—— 植入的神经接口已显示出为人们提供直观控制和体感反馈的前景 假肢使用者。然而，通过恢复本体感觉，即肢体位置和运动的感觉， 神经刺激在很大程度上仍未被探索。本体感觉对于通知和调节运动至关重要 身体健全的人有控制能力，如果没有它，假肢使用者就必须依赖视觉反馈。此举的目标 研究的目的是了解周围神经刺激（PNS）对本体感觉的感知及其影响 与假肢控制集成。中心假设是感觉运动整合在以下情况下效果最好： 本体感受输入和假肢控制方案都与底层神经表征相匹配 现有身体图式中的感觉运动过程。为退伍军人提供自然的本体感觉 肢体丧失是上肢假肢发展到再次拥有一只手的关键一步。 六名单侧经桡动脉或经肱骨肢体丧失的参与者将被植入慢性神经 和肌肉界面。复合平面接口神经电极（C-FINE）将被植入周围 上臂残留的正中神经、尺神经和桡神经。将植入三个经桡动脉的参与者 在前臂的残余肌肉中使用双极肌内肌电图 (EMG) 电极 (IM)。三 经肱骨截肢者将在植入时接受靶向肌肉神经再支配 (TMR) 手术 IM 将被放置在重新受神经支配的肌肉中。参与者将每 45 天参加一次实验室测试会议 两年的时间来完成该研究的三个具体目标的实验。 在目标 1 中，将表征由周围神经刺激引起的本体感觉。 PNS诱发 感知到的手部动作将通过对侧姿势匹配来跟踪。回归分析将 执行以确定各种刺激参数对所得到的感知手的贡献 运动学。该信息将用于构建刺激编码器，以提供时变本体感觉 信息。还将开发配对的激动剂-拮抗剂 PNS 策略。激动剂的可区分性 单独和配对的激动剂-拮抗剂策略将与心理测试进行比较。 在目标 2 中，PNS 直接肌肉激活对刺激引起的本体感觉的作用将 被检查。将对经桡动脉的参与者进行使用利多卡因注射的神经阻滞，以 暂时麻醉前臂肌肉。之前将比较感知到的运动和肌电图活动 以及各种 PNS 刺激的运动阻滞后。对于将接受 TMR 的经肱骨参与者，肌肉重新 神经支配需要〜3个月。将比较重新训练前后的本体感觉和肌电图活动。 神经支配完成。所有参与者将进行评估 PNS 刺激的心理测量实验，以及 将比较高于和低于强直性收缩频率的脉冲频率的可辨别性。 在目标 3 中，将评估人工本体感觉与运动控制的整合。虚拟姿势 匹配任务时，参与者将利用记录的肌电信号控制虚拟手达到目标姿势 来自即时消息。将比较两种控制范式：1）基于位置的控制，旨在模仿自然 身体健全的人的手部姿势控制，以及 2）基于速度的控制，这是典型的 市售假肢。将比较有和没有刺激诱发的表现 本体感受反馈。在心理测量相异性评级任务中，参与者将对主观差异进行评级 刺激诱发的感知对的差异。有些配对还包含自愿的手部动作 随着刺激。将比较被动和主动本体感受条件之间的评级，以 确定自愿控制对刺激诱发的感知的影响。评估实施例的调查和 机构还将在每次研究会议之前和之后进行比较。