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
Chalmers, Electrical Engineering, Systems and control
Center for Bionics and Pain Research
Paolo Sassu
IRCCS Istituto Ortopedico Rizzoli, Bologna
Sahlgrenska University Hospital
Center for Bionics and Pain Research
Enzo Mastinu
Chalmers, Electrical Engineering, Systems and control
Center for Bionics and Pain Research
Sant'Anna School of Advanced Studies (SSSUP)
Eric Earley
Chalmers, Electrical Engineering, Systems and control
University of Colorado
Center for Bionics and Pain Research
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
Chalmers, Electrical Engineering, Systems and control
Bionics Institute
Center for Bionics and Pain Research
Science Translational Medicine
1946-6234 (ISSN) 1946-6242 (eISSN)
Vol. 15 704 eabq3665- eabq3665Subject Categories (SSIF 2011)
Orthopedics
DOI
10.1126/scitranslmed.abq3665
PubMed
37437016