Improved control of a prosthetic limb by surgically creating electro-neuromuscular constructs with implanted electrodes
Journal article, 2023

Remnant muscles in the residual limb after amputation are the most common source of control signals for prosthetic hands, because myoelectric signals can be generated by the user at will. However, for individuals with amputation higher up the arm, such as an above-elbow (transhumeral) amputation, insufficient muscles remain to generate myoelectric signals to enable control of the lost arm and hand joints, thus making intuitive control of wrist and finger prosthetic joints unattainable. We show that severed nerves can be divided along their fascicles and redistributed to concurrently innervate different types of muscle targets, particularly native denervated muscles and nonvascularized free muscle grafts. We engineered these neuromuscular constructs with implanted electrodes that were accessible via a permanent osseointegrated interface, allowing for bidirectional communication with the prosthesis while also providing direct skeletal attachment. We found that the transferred nerves effectively innervated their new targets as shown by a gradual increase in myoelectric signal strength. This allowed for individual flexion and extension of all five fingers of a prosthetic hand by a patient with a transhumeral amputation. Improved prosthetic function in tasks representative of daily life was also observed. This proof-of-concept study indicates that motor neural commands can be increased by creating electro-neuromuscular constructs using distributed nerve transfers to different muscle targets with implanted electrodes, enabling improved control of a limb prosthesis.

Author

Jan Zbinden

Center for Bionics and Pain Research

Chalmers, Electrical Engineering, Systems and control

Paolo Sassu

Sahlgrenska University Hospital

IRCCS Istituto Ortopedico Rizzoli, Bologna

Center for Bionics and Pain Research

Enzo Mastinu

Center for Bionics and Pain Research

Sant'Anna School of Advanced Studies (SSSUP)

Chalmers, Electrical Engineering, Systems and control

Eric Earley

Center for Bionics and Pain Research

University of Colorado Anschutz Medical Campus

Chalmers, Electrical Engineering, Systems and control

Maria Munoz-Novoa

Sahlgrenska University Hospital

Center for Bionics and Pain Research

Rickard Brånemark

Massachusetts Institute of Technology (MIT)

University of Gothenburg

Max Jair Ortiz Catalan

Bionics Institute

Center for Bionics and Pain Research

Chalmers, Electrical Engineering, Systems and control

Science Translational Medicine

1946-6234 (ISSN) 1946-6242 (eISSN)

Vol. 15 704 eabq3665- eabq3665

Subject Categories

Orthopedics

DOI

10.1126/scitranslmed.abq3665

PubMed

37437016

More information

Latest update

7/20/2023