Abstract

BackgroundLeg amputees suffer the lack of sensory feedback from a prosthesis, which is connected to their low confidence during walking, falls and low mobility. Electrical peripheral nerve stimulation (ePNS) of upper-limb amputee’s residual nerves has shown the ability to restore the sensations from the missing limb via intraneural (TIME) and epineural (FINE) neural interfaces. Physiologically plausible stimulation protocols targeting lower limb sciatic nerve hold promise to induce sensory feedback restoration that should facilitate close-to-natural sensorimotor integration and therefore walking corrections. The sciatic nerve, innervating the foot and lower leg, has very different dimensions in respect to upper-limb nerves. Therefore, there is a need to develop a computational model of its behavior in response to the ePNS.MethodsWe employed a hybrid FEM-NEURON model framework for the development of anatomically correct sciatic nerve model. Based on histological images of two distinct sciatic nerve cross-sections, we reconstructed accurate FEM models for testing neural interfaces. Two different electrode types (based on TIME and FINE) with multiple active sites configurations were tested and evaluated for efficiency (selective recruitment of fascicles). We also investigated different policies of stimulation (monopolar and bipolar), as well as the optimal number of implants. Additionally, we optimized the existing simulation framework significantly reducing the computational load.ResultsThe main findings achieved through our modelling study include electrode manufacturing and surgical placement indications, together with beneficial stimulation policy of use. It results that TIME electrodes with 20 active sites are optimal for lower limb and the same number has been obtained for FINE electrodes. To interface the huge sciatic nerve, model indicates that 3 TIMEs is the optimal number of surgically implanted electrodes. Through the bipolar policy of stimulation, all studied configurations were gaining in the efficiency. Also, an indication for the optimized computation is given, which decreased the computation time by 80%.ConclusionsThis computational model suggests the optimal interfaces to use in human subjects with lower limb amputation, their surgical placement and beneficial bipolar policy of stimulation. It will potentially enable the clinical translation of the sensory neuroprosthetics towards the lower limb applications.

Highlights

  • Leg amputees suffer the lack of sensory feedback from a prosthesis, which is connected to their low confidence during walking, falls and low mobility

  • The abovementioned electrodes are implanted and simulated into two different parts of the sciatic nerve: proximal and distal section. This choice was taken in order to consider the different levels of amputation that could occur in trans-femoral amputees and to exploit our model for two different nerve geometries

  • The results suggest that a highly selective stimulation of fascicles of the human sciatic nerve, which innervates the majority of sensations from the foot and lower leg, can be obtained by Transversal intraneural multichannel electrodes (TIMEs) and Flat interface nerve electrodes (FINEs), when using very penalizing selectivity indexes

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Summary

Introduction

Leg amputees suffer the lack of sensory feedback from a prosthesis, which is connected to their low confidence during walking, falls and low mobility. Resulting abnormal kinematics and postural asymmetries can, after long-term use of the prosthesis, lead to musculoskeletal diseases as knee and hip osteoarthritis, osteoporosis, and back pain [8, 9] Since they exert unnatural compensatory movements with prosthetic and healthy leg and body, they face an augmented metabolic cost, fatigue and occasionally hearth failures [10]. The provision of sensory feedback, has been shown to alleviate the PLP and metabolic cost in transfemoral amputees while walking [23], and help regarding the fall avoidance, stair mobility and embodiment boosting [24]. These are important rationales for the development of the models for a sensory neuroprosthesis, as the present one

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