Regenerative Peripheral Nerve Interfaces for Prevention and Management of Neuromas

Santosa, Katherine B.; Oliver, Jeremie D.; Cederna, Paul S.; Kung, Theodore A.

doi:10.1016/j.cps.2020.01.004

Cited by 62 publications

(62 citation statements)

References 62 publications

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“…These procedures not only provide alternative methods of prosthetic control, but can also prevent and treat painful postamputation neuromas (Santosa et al, 2020 ). After transection, a peripheral nerve works to regenerate until it finds an end organ to innervate.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…RPNI is based on the same neurobiological foundations as TMR in that it uses a transected peripheral nerve or fascicle and implants it into an autologous muscle graft ( Figure 2 ) to serve as a biological amplifier of efferent signals (Santosa et al, 2020 ). The novel aspects of the RPNI are that it utilizes free muscle grafts that contain integrated electrodes to improve specificity and reduce crosstalk, thereby producing high quality, isolated EMG signals (Urbanchek et al, 2012 , 2016 ; Kung et al, 2014 ; Woo et al, 2014 ; Irwin et al, 2016 ; Ursu et al, 2016 ).…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…The substantial progress that has been made in the field of neuroprosthetics and the formation of silos is reflected in the robust body of literature published on these topics. Many of the reviews focus on a specific area of the field such as electrodes (Rijnbeek et al, 2018 ; Russell et al, 2019 ; Raspopovic et al, 2020 ); interface design (Larson and Meng, 2020 ), or surgical techniques like Targeted Muscle Reinnervation (TMR) (Mioton and Dumanian, 2018 ; Oh and Carlsen, 2019 ; Peters et al, 2020 ); and Regenerative Peripheral Nerve Interface (RPNI) (Santosa et al, 2020 ). Others explore algorithmic control systems (Wolf et al, 2020 ); prosthetic device designs (Naufel et al, 2020 ); and specific outcomes such as sensation or myoelectric control (Tyler, 2015 ; Geethanjali, 2016 ; Ghafoor et al, 2017 ; Sensinger and Dosen, 2020 ; Raspopovic et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements

2021

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Over the last few decades there has been a push to enhance the use of advanced prosthetics within the fields of biomedical engineering, neuroscience, and surgery. Through the development of peripheral neural interfaces and invasive electrodes, an individual's own nervous system can be used to control a prosthesis. With novel improvements in neural recording and signal decoding, this intimate communication has paved the way for bidirectional and intuitive control of prostheses. While various collaborations between engineers and surgeons have led to considerable success with motor control and pain management, it has been significantly more challenging to restore sensation. Many of the existing peripheral neural interfaces have demonstrated success in one of these modalities; however, none are currently able to fully restore limb function. Though this is in part due to the complexity of the human somatosensory system and stability of bioelectronics, the fragmentary and as-yet uncoordinated nature of the neuroprosthetic industry further complicates this advancement. In this review, we provide a comprehensive overview of the current field of neuroprosthetics and explore potential strategies to address its unique challenges. These include exploration of electrodes, surgical techniques, control methods, and prosthetic technology. Additionally, we propose a new approach to optimizing prosthetic limb function and facilitating clinical application by capitalizing on available resources. It is incumbent upon academia and industry to encourage collaboration and utilization of different peripheral neural interfaces in combination with each other to create versatile limbs that not only improve function but quality of life. Despite the rapidly evolving technology, if the field continues to work in divided “silos,” we will delay achieving the critical, valuable outcome: creating a prosthetic limb that is right for the patient and positively affects their life.

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Section: Surgical Techniquesmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements

2021

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“…RPNIs have been shown to effectively prevent and treat neuroma pain and phantom pain ( 33, 34 ). Most importantly, RPNIs serve as a stable biological amplifier for efferent motor signals, retaining anatomical consistency between the host nerve and RPNI functions ( 35 – 37 ). In a clinical trial, high resolution control signals recorded from electrodes implanted into RPNIs remained stable for up to 300 days (the duration of observation)( 38 ).…”

Section: Introductionmentioning

confidence: 99%

Surgically Implanted Electrodes Enable Real-Time Finger and Grasp Pattern Recognition for Prosthetic Hands

Vaskov

North

et al. 2020

Preprint

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Currently available prosthetic hands are capable of actuating anywhere from five to 30 degrees of freedom (DOF). However, grasp control of these devices remains unintuitive and cumbersome. To address this issue, we propose directly extracting finger commands from the neuromuscular system via electrodes implanted in residual innervated muscles and regenerative peripheral nerve interfaces (RPNIs). Two persons with transradial amputations had RPNIs created by suturing autologous free muscle grafts to their transected median, ulnar, and dorsal radial sensory nerves. Bipolar electrodes were surgically implanted into their ulnar and median RPNIs and into their residual innervated muscles. The implanted electrodes recorded local electromyography (EMG) with Signal-to-Noise Ratios ranging from 23 to 350 measured across various movements. In a series of single-day experiments, participants used a high speed pattern recognition system to control a virtual prosthetic hand in real-time. Both participants were able to transition between 10 pseudo-randomly cued individual finger and wrist postures in the virtual environment with an average online accuracy of 86.5% and latency of 255 ms. When the set was reduced to five grasp postures, average metrics improved to 97.9% online accuracy and 135 ms latency. Virtual task performance remained stable across untrained static arm positions while supporting the weight of the prosthesis. Participants also used the high speed classifier to switch between robotic prosthetic grips and complete a functional performance assessment. These results demonstrate that pattern recognition systems can use the high-quality EMG afforded by intramuscular electrodes and RPNIs to provide users with fast and accurate grasp control.

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“…It allowed obtaining a tubular-shaped hydrogel structure, which was applied in peripheral nerve tissue engineering [8]. Peripheral nerves can regenerate spontaneously by themselves, but without proper guidance the healing process may be hindered, causing illnesses and dysfunctions (e.g., neuroma) [9,10]. The golden standard in reconstruction of disrupted peripheral nerve tissue is nerve grafts taken from autologous tissue (e.g., sural nerve, medial antebrachial cutaneous nerve and posterior interosseous nerves).…”

Section: Introductionmentioning

confidence: 99%

Investigation of Parameters Influencing Tubular-Shaped Chitosan-Hydroxyapatite Layer Electrodeposition

2020

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Tubular-shaped layer electrodeposition from chitosan-hydroxyapatite colloidal solutions has found application in the field of regeneration or replacement of cylindrical tissues and organs, especially peripheral nerve tissue regeneration. Nevertheless, the quantitative and qualitative characterisation of this phenomenon has not been described. In this work, the colloidal systems are subjected to the action of an electric current initiated at different voltages. Parameters of the electrodeposition process (i.e., total charge exchanged, gas volume, and deposit thickness) are monitored over time. Deposit structures are investigated by scanning electron microscopy (SEM) and Fourier-transform infrared spectroscopy (FTIR). The value of voltage influences structural characteristics but not thickness of deposit for the process lasting at least 20 min. The calculated number of exchanged electrons for studied conditions suggests that the mechanism of deposit formation is governed not only by water electrolysis but also interactions between formed hydroxide ions and calcium ions coordinated by chitosan chains.

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Regenerative Peripheral Nerve Interfaces for Prevention and Management of Neuromas

Cited by 62 publications

References 62 publications

The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements

The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements

Surgically Implanted Electrodes Enable Real-Time Finger and Grasp Pattern Recognition for Prosthetic Hands

Investigation of Parameters Influencing Tubular-Shaped Chitosan-Hydroxyapatite Layer Electrodeposition

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