DARPA Improving Robustness of Neural Interfaces

Targeted M scle Reinnervation: Muscle Reinner ation: Progress and Challenges

Todd A. Kuiken, MD, PhD and MANY smart collaborators!

Neural Engineering Center for Artificial Limbs Rehabilitation Institute of Chicago Department of PM&R, BME and Surgery, Northwestern University
May 2010

Targeted Muscle Reinnervation

TECHNIQUE Residual nerves transferred to spare muscle and skin. Muscle acts as a biological amplifier of the motor command ADVANTAGES Additional control signals for simultaneous control of more degrees-of-freedom Control signals are physiologically appropriate More natural feel Easier, more intuitive operation Shoulder still available for controlling other functions No implanted hardware required Can use existing myoelectric prosthetic technology DISADVANTAGE Requires additional surgery
unless it is done at time of amputation

Bilateral Shoulder Disarticulation p Amputee

Original Prosthesis
(Used more than 20 months)

Nerve Transfer Prosthesis

(Used about 2 months)

Motion During Contractions

Sensory Reinnervation Studies

Jesse Sullivan Sensory Map

Paul Marasco

Targeted Sensory Reinnervation

TECHNIQUE Denervate residual limb skin to allow the hand afferents to reinnervate this skin Stimuli detected by sensors in prosthetic hand can be applied to reinnervated skin Creates a portal to sensory pathways POTENTIAL ADVANTAGES Provides physiologically appropriate sensory feedback Provides anatomically appropriate sensory feedback

CONTROLLER TOUCH SENSORS TACTOR

Targeted Reinnervation Functional Outcomes

Functional Outcomes of 1st six F i lO f t i patients
2.5-7 times faster on Block and Box test 50% faster on Clothes Pin test Improvement in speed on all Wolf Motor Functions tests Significant improvement in AMPs testing g

University of Alberta TMR subject

Transfer sensation in 6+ patients One Unsuccessful Transhumeral Surgery

In OR, radial nerve atrophy discovered Likely brachial plexopathy

~50 patients worldwide

Vienna University of Washington Walter Reed Army Medical Center Brook Army Medical Center Edmonton, Canada

96% Surgical success rate in producing usable EMG signals

Two prosthetic arms systems commercially available Liberating TechnologyBoston Elbow Otto BockTMR Dynamic Arm

Advanced Signal Processing Techniques

Pattern Recognition Results Linear Discriminant Analysis (LDA) with time domain feature sets and a combination of autoregressive features and the root mean square (AR+RMS) feature sets were used.

Bipolar Electrodes
Subject
thumb abduction wrist supination elbow flexion

Time Domain 98.40.7 90.32.9 97.1 98.3

AR+RMS 97.81.1 87.62.9 95.5 99.2

BSD* STH** LTH1

thumb dd ti th b adduction wrist pronation rist elbow extension lb t i
mV V
75 70 65 60 55 50 45 40 35 30 25

LTH2

Average

96.03.9 95.05.2

* average of 3 experiments and 3 different bipolar electrode configurations ** average of 2 experiments and 3 different bipolar Kevin Englehart electrode configurations UNB, BME

How Many Electrodes Do We Need?

Electrode Channel Reduction Analysis
curacy (%) Classification Acc
100 90 80 70 60 50 40 30 20 10 0

P1 P2 P3 P4

1 2 3 4 5 6 7 8 9 10 11 12 >300

Number of Bipolar Electrodes

16 classes 2 elbow 4 wrist 10 hand

Courtesy of JHU-APL and RIC

Richness of Neural Interface

We want as much motor control data as possible
Need lots to control more degrees of freedom Need separable data to control multiple DOFs simultaneously

Back to source separation problem Closer to the source, generally the better the signal separation i

Challenges in Neural Interfacing

Signal Stability g y
Surface EMG signals are problematic Location different each time prosthesis is donned Electrodes shift with prosthetic use Potential solutions Developing new surface EMG interfaces Implantable EMG system

Challenges in Neural Interfacing

Smart Decoding and Control Algorithms

Need to decode of signals robustly
Extract as much info as possible N d to l Need learn the patient and the h i d h task

Constant tension between smart devices and human control

Example: slip sensors

Potential solutions
Better information fusion Consider time-history systems Adaptive algorithms

Challenges in Neural Interfacing

Physical Robustness of Neural Interface

Amputees are very active
Implanted system needs to withstand repetitive deformation All sub-system needs to withstand high force impacts The flying kid test

Considerations
External devices are easier Replaceable Can incase in sockets Internal (implanted) devices: Need to be small and tough And/Or they need to be compliant like tissues Weak point will be where compliance changes

Challenges in Neural Interfacing

Need device compatibility for clinical flexibility

We need STANDARDS Next generation of prostheses will likely have electronic bus systems Advocate using an CAN bus with common interface protocol
UNB, RIC, Vanderbilt and others have developed one that is open to all.

Advocate a common mechanical Ad t h i l connector for device interchangeability

connector

Myoelectric Controls Conference Several universities collaborating to (Best Upper Limb Prosthetics Meeting) develep a new STANDARD August 14 - 19, 2011

Challenges in Neural Interfacing

Need Multidimensional Sensation Feedback

TR can provide some cutaneous feedback Very useful for goal confirmation, force regulation, etc regulation etc Not enough room for electrodes and tactors Cant control reinnervation process well Proprioception necessary for complex limb system TR cant provide proprioception--yet Proprioception poorly understood Sensory substitution does not work adequately Need physiologically and anatomically p y g y y appropriate feedback Cant rely on neural plasticity too much

Mechatronics Challenges
Need lighter devices for amputees This is what patients complain about! Need more robust devices They breakdown way too often Need more dexterous devices As we develop the ability to control more p y DOFs, we need more dexterous devices Functionally, multi-degree-of freedom wrists are particular important

Need better suspension/attachment

Need better attachment systems Stability of control and y mechatronics depends on mechanical fixation P Powered orthotics are d th ti equally (or more) challenging Potential Solutions oe So u o s Percutaneous Skeletal Attachment (osseointegration) is i very promising for ii f prosthetics
From http://www.branemark.se/osseointegration.htm

Collaborators and Support

NECAL Team Todd Kuiken, MD, PhD Aimee Schultz, MS Bl i Lock, MS Blair L k Bob Parks, MBA Dat Tran, BS Kathy Stubblefield, OTR Laura Miller, CP, PhD Levi Hargrove, PhD Robert Lipschutz, CP Jon Sensinger, PhD Northwestern University Gregory Dumanian, MD Richard Weir, PhD Jules Dewald, PhD , Previous Post Docs Nikolay Stoykov, PhD Madeleine Lowery, PhD Ping Zhou PhD Zhou, Helen Huang, PhD Paul Marasco, PhD Collaborating Institution University of New Brunswick Liberating Technologies Inc Otto Bock, Inc. Deka Research, Inc J h H ki A li d Johns Hopkins Applied Physics Lab Kinea Design This work supported by: The National Institutes of Health Grant #1K08HD01224-01A1 Grant # R01 HD043137 01 HD043137-01 Grant # R01 HD044798-01 Grant # NO1-HD-5-3402 Defense Advanced Research Projects Agency The National Institute of Disability and Rehabilitation Research US Army Generous Philanthropic Support

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