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

Abstract

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.

Management of symptomatic neuromas: a narrative review of the most common surgical treatment modalities in amputees

“…Although these treatment modalities may be less invasive, surgical intervention of symptomatic neuromas has shown to provide superior pain management. A meta-analysis comparing surgical interventions for symptomatic neuroma treatment found that 77% of patients undergoing neuroma resection had significant improvement in patient-reported pain, depression, and quality of life shortly after surgery regardless of the surgical technique used [17] . However, even with this seemingly high initial success rate, 20%-30% of symptomatic neuromas remain refractory to surgery, and reoperation rates for all symptomatic neuromas have been observed to be as high as 65% [17] .…”

“…A meta-analysis comparing surgical interventions for symptomatic neuroma treatment found that 77% of patients undergoing neuroma resection had significant improvement in patient-reported pain, depression, and quality of life shortly after surgery regardless of the surgical technique used [17] . However, even with this seemingly high initial success rate, 20%-30% of symptomatic neuromas remain refractory to surgery, and reoperation rates for all symptomatic neuromas have been observed to be as high as 65% [17] . Although traditional surgical approaches provide initial symptomatic relief, pathologic pain returns all too often.…”

“…The simple neuroma excision with nerve retraction or manual burial into muscle relies on creating a safe and privileged environment to shield the inevitable future neuroma from external stimuli. Although this approach is used as standard therapy to reduce the risk of symptomatic neuroma formation, it does not address the pathologic formation of a neuroma which is likely why the reoperation rates with this technique remain as high as 65% [17] .…”

Clinical Basis for Creating an Osseointegrated Neural Interface

“…Additionally, they are problematic from a mechanical and infectious standpoint with the use of surface electrodes in TMR and percutaneous wiring in RPNI ( Schofield et al, 2020 ; Vu et al, 2020b ). The clinical applications of these surgical techniques ( Vu et al, 2020a ; Herr et al, 2021 ; Karczewski et al, 2021 ) and electrode technology ( Ghafoor et al, 2017 ; Rijnbeek et al, 2018 ; Larson and Meng, 2020 ; Raspopovic et al, 2020 ) has been reviewed in substantial detail in previous studies.…”

Editorial: Getting Neuroprosthetics Out of the Lab: Improving the Human-Machine Interactions to Restore Sensory-Motor Functions

“…A key theme presented throughout this Research Topic has been multidisciplinary collaboration, a theme strongly supported by the editors ( Shokur et al, 2021 ; Karczewski et al, 1102 ). As technologies move from the bench to the bedside, there is an increased need for collaboration between academic researchers and clinicians, as well as industry and government partners and, of course, the patients.…”