Abstract
Restoring somatosensory feedback to people with limb amputations is crucial to improve prosthetic control. Multiple studies have demonstrated that peripheral nerve stimulation and targeted reinnervation can provide somatotopically relevant sensory feedback. While effective, the surgical procedures required for these techniques remain a major barrier to translatability. Here, we demonstrate in four people with upper-limb amputation that epidural spinal cord stimulation (SCS), a common clinical technique to treat pain, evoked somatosensory percepts that were perceived as emanating from the missing arm and hand. Over up to 29 days, stimulation evoked sensory percepts in consistent locations in the missing hand regardless of time since amputation or level of amputation. Evoked sensations were occasionally described as naturalistic (e.g. touch or pressure), but were often paresthesias. Increasing stimulus amplitude increased the perceived intensity linearly, without increasing area of the sensations. These results demonstrate the potential of SCS as a tool to restore somatosensation after amputations.
Highlights
Individuals with amputations consistently state that the lack of somatosensory feedback from their prosthetic device is a significant problem that limits its utility (Cordella et al, 2016) and is often a primary cause of prosthesis abandonment (Biddiss and Chau, 2007; Wijk and Carlsson, 2015)
In Subjects 1 and 2, only multipolar stimulation evoked sensory percepts that were localized to focal regions of the missing hand and fingers (Figure 1—figure supplement 1)
We evaluated the goodness-of-fit using the probability of transformed likelihood ratio, which spans 0–1 with a higher value signifying a better fit and values below 0.05 signifying an unacceptable fit
Summary
Individuals with amputations consistently state that the lack of somatosensory feedback from their prosthetic device is a significant problem that limits its utility (Cordella et al, 2016) and is often a primary cause of prosthesis abandonment (Biddiss and Chau, 2007; Wijk and Carlsson, 2015). Body-powered devices are often preferred because of the feedback they provide through their harness and cable system (Huang et al, 2001; Stark and LeBlanc, 2004; Uellendahl, 2000; Williams, 2011). Addressing this limitation, advanced robotic prosthetic arms have been designed with embedded sensors that could be harnessed to provide somatosensory signals to a neural interface (Cipriani et al, 2011; Perry et al, 2018; Saudabayev and Varol, 2015).
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