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Invasive Versus Non-Invasive Neuroprosthetics of the Upper Limb: Which Way to Go?

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Invasive Versus Non-Invasive Neuroprosthetics of the Upper Limb: Which Way to Go? Editorial Invasive versus Non-Invasive Neuroprosthetics of the Upper Limb: Which Way to Go? Andreas Otte Laboratory of NeuroScience, Division of Medical Engineering, Department of Electrical Engineering, Medical Engineering and Computer Science, Offenburg University, Badstr. 24, D-77652 Offenburg, Germany; andreas.otte@hs-offenburg.de Received: 24 August 2020; Accepted: 4 September 2020; Published: 5 September 2020 Abstract: In this editorial, a topic for general discussion in the field of neuroprosthetics of the upper limb is addressed: which way—invasive or non-invasive—is the right one for the future in the development of neuroprosthetic concepts. At present, two groups of research priorities (namely the invasive versus the non-invasive approach) seem to be emerging, without taking a closer look at the wishes but also the concerns of the patients. This piece is intended to stimulate the discussion on this. Keywords: neuroprosthetics; upper limb; invasive; non-invasive; augmented reality; 3D printing; finite element method; computer-aided design If we had a time machine and could travel to the year 2040, we would certainly be in a better position to decide which way — invasive or non-invasive — would have been more appropriate for developing intelligent neuroprosthetic approaches of the upper limb. The work of Ortiz-Catalan et al., for example, recently published in the New England Journal of Medicine, is undoubtedly very impressive [1]: In four patients, the authors presented an implant that was anchored to the humerus through osseointegration, allowing for bidirectional communication between a prosthetic hand and electrodes implanted in the nerves and muscles of the upper arm. Whether this method will in future be the method chosen by the majority of patients and, if at all, paid for by health insurance companies, is open to discussion [2,3]. Certainly, simpler, non-invasive approaches should be considered, such as electrode-free visual control of the prostheses with augmented reality (AR) glasses [4] and providing the user with sensory input in a different, non-invasive way: Marasco et al. [5], for instance, integrated kinesthetic feedback in three hand amputees by vibrating the muscles used for prosthetic control via a neural-machine interface, improving movement control within few minutes. Last but not least, today’s inexpensive multi-material 3D printing offers the possibility of producing personalized prostheses based on design data, 3D scans, or magnetic resonance imaging data. Physical models implemented by computer-aided design (CAD) using the finite element method (FEM) analysis also allow for developing improved mechanical components of existing or planned prostheses (Figure1). Already 20 years ago, there were many approaches to control prostheses with electrodes, mainly via electromyography or electroencephalography signals. Electrodeless control via AR glasses did not exist at that time, since the development of the AR glasses was still in its infancy, and 3D printing was also just in the beginning stages. Today, however, we can cost-effectively incorporate both 3D printing and AR glasses into our thinking about developing novel smart neuroprostheses. Prosthesis 2020, 2, 237–239; doi:10.3390/prosthesis2030020 www.mdpi.com/journal/prosthesis Prosthesis 2020, 1, FOR PEER REVIEW 2 Prosthesis 2020, 2 238 Figure 1. Finite element method (FEM) analysis of a part of the CAD-reconstructed historical first hand prosthesis of Götz of the Iron Hand (Götz von Berlichingen 1480–1562) [6–8]: The analysis shows increased forces mainly in the thumb lever; the maximum stress of this analysis is about 2.5 105 N × m2 (von Mises). MaybeFigure in 1. 20 Finite years, element we will method say that (FEM) it would analysis have of been a part good of tothe combine CAD-reconstructed both approaches, historical i.e., first ideas from thehand invasive prosthesis approach of Götz with of the ideas Iron fromHand the (Götz non-invasive von Berlichingen approach. 1480–1562) Parallel [6–8]: development The analysis of these, withoutshows increased looking forces at the mainly other idea, in the as thumb we currently lever; the deem maximum to observe, stress of is this probably analysis the is wrongabout 2 move..5 The degree10 of invasiveness(von Mises). is ultimately determined by the possibilities that the non-invasive approaches ∙ 5 2 will provide. The more convincing non-invasive approaches we develop, the better. The lynchpin shouldAlready ultimately 20 beyears the ago user,, there depending were many on various approaches factors to such control as age, prostheses health status, with financialelectrodes, status,mainly etc. via Akin electromyography the situation with or deep-brainelectroencephalography stimulation [9 ],signals. it would Electrodeless be the onus control that an via open AR dialogueglassesbetween did not exist engineers at that and time, physicians since the should development take place of the for theAR developmentglasses was still of neuroprosthetics in its infancy, and of3D the upperprinting limb. was also just in the beginning stages. Today, however, we can cost-effectively incorporate both 3D printing and AR glasses into our thinking about developing novel smart Funding:neuroprostheses.This research received no external funding. ConflictsMaybe of Interest: in 20 Theyears author, we declareswill say no that conflict it would of interest. have been good to combine both approaches, i.e., ideas from the invasive approach with ideas from the non-invasive approach. Parallel development Referencesof these, without looking at the other idea, as we currently deem to observe, is probably the wrong move. The degree of invasiveness is ultimately determined by the possibilities that the non-invasive 1. Ortiz-Catalan, M.; Mastinu, E.; Sassu, P.; Aszmann, O.; Brånemark, R. Self-contained neuromusculoskeletal approachesarm prostheses. will provide.N. Engl. J.The Med. more2020 convincing, 382, 1732–1738. non- [invasiveCrossRef][ approachesPubMed] we develop, the better. The 2. lynchpinOtte, A. should Smart neuroprosthetics ultimately be becomingthe user, smarter,depending but noton forvarious everyone? factorsEClinicalMedicine such as age,2018 health, 2, 11–12. status, financial[CrossRef status,][PubMed etc. Akin] the situation with deep-brain stimulation [9], it would be the onus that an 3. openHazubski, dialogue S.; Soekadar, between S.R.; engineers Hoppe, H.; and Otte, physicians A. Neuroprosthetics should 2.0.takeEBioMedicine place for2019 the, 48development, 22. [CrossRef ] of neuroprosthetics[PubMed] of the upper limb. 4. Hazubski, S.; Hoppe, H.; Otte, A. Non-contact visual control of personalized hand prostheses/exoskeletons Funding:by tracking This usingresearch augmented received realityno external glasses. funding.3D Print Med. 2020, 6, 6. [CrossRef][PubMed] 5. ConflictsMarasco, of P.D.;Interest: Hebert, The J.S.; author Sensinger, declare J.W.;s no Shell,conflict C.E.; of Schofield,interest. J.S.; Thumser, Z.C.; Nataraj, R.; Beckler, D.T.; Dawson, M.R.; Blustein, D.H. Illusory movement perception improves motor control for prosthetic hands. ReferencesSci. Transl. Med. 2018, 10, eaao6990. [CrossRef][PubMed] 6. Weinert, O.; Otte, A. 3-D CAD-Rekonstruktion der ersten "Eisernen Hand" des Reichsritters Gottfried von 1. Ortiz-Catalan, M.; Mastinu, E.; Sassu, P.; Aszmann, O.; Brånemark, R. Self-contained Berlichingen (1480–1562) [3D CAD reconstruction of the first "Iron Hand" of German knight Gottfried von neuromusculoskeletal arm prostheses. N. Engl. J. Med. 2020, 382, 1732–1738, doi:10.1056/NEJMoa1917537. Berlichingen (1480–1562)]. Arch. Kriminol. 2017, 240, 50–58. Prosthesis 2020, 2 239 7. Weinert, O.; Otte, A.; Junk, S. Götz von Berlichingens Eiserne Hand—neu geschaffen am 3-D-Drucker [A 3-D reprint of the prosthetic hand of Götz of the Iron Hand]. MMW Fortschr. Med. 2018, 160, 71–73. [CrossRef] [PubMed] 8. Brezo, K. 3-D-CAD-Konstruktion eines neuen Doppelgelenks für den Daumenhebel bei der rekonstruierten ersten “Eisernen Hand” des Götz von Berlichingen. Bachelor’s Thesis, Offenburg University, Offenburg, Germany, 30 August 2019. 9. Otte, A. Deep-brain stimulation for Parkinson’s disease. N. Engl. J. Med. 2013, 368, 483. [CrossRef][PubMed] © 2020 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)..
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