WHY THIS MATTERS IN BRIEF

The ability to use your mind to control prosthetic limbs is a game changer for millions of people around the world who’ve lost limbs.

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Over the past number of years there have been several significant advances in the field of neuro-prosthetics, technology that lets amputees, and even quadriplegics, for example, regain their sense of touch, as well as use nothing that their brains to control everything from exosuits to prosthetic arms.

Now researchers in the US have found a way to enable even greater fine-grained finger control of a prosthetic arm and hand using only a patient’s brain signals after they found a way to tap into faint, latent signals from a patients arm nerves and amplify them. Furthermore, and even more impressively because of the algorithms the researchers developed the patients using the new hand don’t have to undergo any training whatsoever – another major milestone.

To achieve this, the researchers developed a way to tame temperamental nerve endings, separate thick nerve bundles into smaller fibers that enable more precise control, and amplify the signals coming through those nerves. The approach involves tiny muscle grafts and machine learning algorithms borrowed from the brain-machine interface field.

“This is the biggest advance in motor control for people with amputations in many years,” says Paul Cederna, professor of plastic surgery at the University of Michigan and a professor of biomedical engineering.

“We have developed a technique to provide individual finger control of prosthetic devices using the nerves in a patient’s residual limb. With it, we have been able to provide some of the most advanced prosthetic control that the world has seen.”

“You can make a prosthetic hand do a lot of things, but that doesn’t mean that the person is intuitively controlling it. The difference is when it works on the first try just by thinking about it, and that’s what our approach offers,” says Cindy Chestek, associate professor of biomedical engineering in the College of Engineering.

“This worked the very first time we tried it. There’s no learning for the participants. All of the learning happens in our algorithms. That’s different from other approaches.”

The researchers report their results with four study participants using the Mobius Bionics LUKE arm in Science Translational Medicine.

While study participants aren’t yet allowed to take the arm home, in the lab, they were able to pick up blocks with a pincer grasp; move their thumb in a continuous motion, rather than have to choose from two positions; lift spherically shaped objects; and even play a version of Rock, Paper, Scissors called Rock, Paper, Pliers.

“It’s like you have a hand again,” says study participant Joe Hamilton, who lost his arm in a fireworks accident in 2013. “You can pretty much do anything you can do with a real hand with that hand. It brings you back to a sense of normalcy.”

One of the biggest hurdles in mind-controlled prosthetics is tapping into a strong and stable nerve signal to feed the bionic limb. Some research groups, those working in the Brain Machine Interface (BMI) field, go all the way to the primary source, the brain. This is necessary when working with people who are paralysed. But it’s invasive and high-risk.

For people with amputations, peripheral nerves – the network that fans out from the brain and spinal cord – have been interesting, but they hadn’t yet led to a long-term solution for a couple of reasons, in short, the nerve signals they carry are small. And other approaches to picking up those signals involved probes that eavesdropped by force. These “nails in nerves,” as researchers sometimes refer to them, lead to scar tissue, which muddles that already faint signal over time.

The team came up with a better way. They wrapped tiny muscle grafts around the nerve endings in the participants’ arms. These “regenerative peripheral nerve interfaces,” or RPNIs, offer severed nerves new tissue to latch on to. This prevents the growth of nerve masses called neuromas that lead to phantom limb pain.

It also gives the nerves a megaphone. The muscle grafts amplify the nerve signals. Two patients had electrodes implanted in their muscle grafts, and the electrodes were able to record these nerve signals and pass them on to a prosthetic hand in real time.

“To my knowledge, we’ve seen the largest voltage recorded from a nerve compared to all previous results,” Chestek says. “In previous approaches, you might get 5 microvolts or 50 microvolts, very, very small signals. We’ve seen the first ever millivolt signals.

“So now we can access the signals associated with individual thumb movement, multi-degree of freedom thumb movement, individual fingers. This opens up a whole new world for people who are upper limb prosthesis users.” And their interface has already lasted years. Others degrade within months due to scar tissue.

The findings also open up new possibilities for the field, says Chestek, whose expertise is on real-time machine learning algorithms to translate neural signals into movement intent.

“What we found is now the nerve signals are good enough to apply the whole world of things we learned in brain control algorithms to nerve control,” she says.

The approach generates signals for finer movements than what today’s prosthetic hands are capable of.

“Other research groups have contributed to this as well, but we’ve leapfrogged the capabilities of the prosthetic hands that are currently available. I think this is strong motivation for further developments from prosthetic hand companies,” says Philip Vu, a research fellow in biomedical engineering and first author of the paper.

A clinical trial is ongoing and the team is looking for participants.

“So many times, the things we do in a research lab add to the knowledge in the field, but you never actually get a chance to see how that impacts a person,” Cederna says. “When you can sit and watch one person with a prosthetic device do something that was unthinkable 10 years ago, it is so gratifying. I’m so happy for our participants, and even more happy for all the people in the future that this will help.”

“It’s going to be a ways from here, but we’re not going to stop working on this until we can completely restore able-bodied hand movements. That’s the dream of neuroprosthetics,” says Chestek.

DARPA and the National Institutes of Health funded the work.

Source: University of Michigan