Hand loss is a highly disabling event that markedly affects the quality of life. To achieve a close to natural replacement for the lost hand, the user should be provided with the rich sensations that we naturally perceive when grasping or manipulating an object. Ideal bidirectional hand prostheses should involve both a reliable decoding of the user's intentions and the delivery of nearly "natural" sensory feedback through remnant afferent pathways, simultaneously and in real time. However, current hand prostheses fail to achieve these requirements, particularly because they lack any sensory feedback. We show that by stimulating the median and ulnar nerve fascicles using transversal multichannel intrafascicular electrodes, according to the information provided by the artificial sensors from a hand prosthesis, physiologically appropriate (near-natural) sensory information can be provided to an amputee during the real-time decoding of different grasping tasks to control a dexterous hand prosthesis. This feedback enabled the participant to effectively modulate the grasping force of the prosthesis with no visual or auditory feedback. Three different force levels were distinguished and consistently used by the subject. The results also demonstrate that a high complexity of perception can be obtained, allowing the subject to identify the stiffness and shape of three different objects by exploiting different characteristics of the elicited sensations. This approach could improve the efficacy and "life-like" quality of hand prostheses, resulting in a keystone strategy for the near-natural replacement of missing hands.

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Several efforts have been carried out to enhance dexterous hand prosthesis control by impaired individuals. Choosing which voluntary signal to use for control purposes is a critical element to achieve this goal. This review presents and discusses the recent results achieved by using electromyographic signals, recorded either with surface (sEMG) or intramuscular (iEMG) electrodes, and electroneurographic (ENG) signals. The potential benefits and shortcomings of the different approaches are described with a particular attention to the definition of all the steps required to achieve an effective hand prosthesis control in the different cases. Finally, a possible roadmap in the field is also presented.

Objective: Hand amputation is a highly disabling event, which significantly affects quality of life. An effective hand replacement can be achieved if the user, in addition to motor functions, is provided with the sensations that are naturally perceived while grasping and moving. Intraneural peripheral electrodes have shown promising results toward the restoration of the sense of touch. However, the long-term usability and clinical relevance of intraneural sensory feedback have not yet been clearly demonstrated. Methods: To this aim, we performed a six months clinical study with three trans-radial amputees who received implants of transverse intrafascicular multichannel electrodes (TIMEs) in their median and ulnar nerves. After calibration, electrical stimulation was delivered through the TIMEs connected to artificial sensors in the digits of a prosthesis to generate sensory feedback, which was then used by the subjects while performing different grasping tasks. Results: All the subjects, notwithstanding their important clinical differences, reported stimulationinduced sensations from the phantom hand for the whole duration of the trial. They also successfully integrated the sensory feedback into their motor control strategies while performing experimental tests simulating tasks of real life (with and without the support of vision). Finally, they reported a decrement of their phantom limb pain and a general improvement in mood state. Interpretation: The promising results achieved with all subjects show the feasibility of the use of intraneural stimulation in clinical settings.

Among the possible interfaces with the peripheral nervous system (PNS), intraneural electrodes represent an interesting solution for their potential advantages such as the possibility of extracting spikes from electroneurographic (ENG) signals. Their use could increase the precision and the amount of information which can be detected with respect to other processing methods.In this study, in order to verify this assumption, thin-film longitudinal intrafascicular electrodes (tfLIFE) were implanted in the sciatic nerve of rabbits. Various sensory stimuli were applied to the hind limb of the animal and the elicited ENG signals were recorded using the tfLIFEs. These signals were processed to determine whether the different types of information can be decoded. Signals were wavelet denoised and spike sorted. Support vector machines were trained to use the spike waveforms found to infer the stimulus applied to the rabbit. This approach was also compared with previously used ENG processing methods.The results indicate that the combination of wavelet denoising and spike sorting techniques can increase the amount of information extractable from ENG signals recorded with intraneural electrodes. This strategy could allow the development of more effective closed-loop neuroprostheses and hybrid bionic systems connecting the human nervous system with artificial devices.