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Restoring Sensation in Human Upper Extremity Amputees Using Chronic Peripheral Nerve Interfaces

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Restoring Sensation in Human Upper Extremity Amputees Using Chronic Peripheral Nerve Interfaces RESTORING SENSATION IN HUMAN UPPER EXTREMITY AMPUTEES USING CHRONIC PERIPHERAL NERVE INTERFACES by DANIEL WANEI TAN Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Dissertation Advisor: Dr. Dustin J. Tyler Department of Biomedical Engineering CASE WESTERN RESERVE UNIVERSITY August, 2014 1 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of DANIEL WANWEI TAN candidate for the degree of Doctor of Philosophy*. Committee Chair Dustin J. Tyler, Ph.D. Biomedical Engineering, Associate Professor Committee Member Kenneth J. Gustafson, Ph.D. Biomedical Engineering, Associate Professor Committee Member Robert Kirsch, Ph.D. Biomedical Engineering, Department Chair Committee Member Grover C. Gilmore, Ph.D. Dean of Mandel School of Applied Social Sciences Date of Defense 7/1/2014 *We also certify that written approval has been obtained for any proprietary material contained therein. 2 Copyright © 2014 by Daniel Wanwei Tan All rights reserved 3 Table of Contents Contents Table of Contents ............................................................................................................................................ 4 Table of Figures ............................................................................................................................................... 7 Table of Equations ........................................................................................................................................... 9 Table of Tables .............................................................................................................................................. 10 Acknowledgements ....................................................................................................................................... 11 Abstract ......................................................................................................................................................... 12 Chapter 1 : INTRODUCTION........................................................................................................................... 14 Significance ............................................................................................................................................... 14 Past Research in Sensory Feedback for amputees via nerve stimulation ................................................. 17 Intraneural microstimulation in man of 1980’s ........................................................................................ 18 Current Research in Sensory Feedback via Direct Afferent Nerve Stimulation ........................................ 19 Alternate methods of sensory feedback: .................................................................................................. 21 Sensory substitution ............................................................................................................................. 21 Targeted Sensory Reinnervation .......................................................................................................... 22 Sensory feedback via CNS stimulation. ................................................................................................. 23 Chapter 2 : SPECIFIC AIMS ............................................................................................................................. 25 Innovation ................................................................................................................................................. 25 Specific Approach...................................................................................................................................... 26 Specific Aims ............................................................................................................................................. 28 Aim I. Characterize sensory perception from chronically‐implanted, peripheral nerve cuff electrode stimulation. ........................................................................................................................................... 28 Aim II: Demonstrate functional improvement of a sensory feedback‐enabled prosthetic .................. 31 Risks .......................................................................................................................................................... 33 Paper Chapter Description ........................................................................................................................ 35 Chapter 3 : Neural interface provides stable, natural, touch perception to prosthetic hand users for more than one year ................................................................................................................................................ 37 Abstract ..................................................................................................................................................... 37 One Sentence Summary: ...................................................................................................................... 38 Introduction .............................................................................................................................................. 39 Results ....................................................................................................................................................... 41 Cuff Electrode Peripheral Interface is Selective and Stable .................................................................. 41 4 Stimulating with Constant Stimulation Intensity Produces Paresthesia .............................................. 43 Stimulation Intensity Modulation with a Time‐Variant Pulse Width Results in “Natural” Pressure Perception ............................................................................................................................................ 45 Sensory Feedback Improves Functional Performance and User Confidence ....................................... 53 Subjects Report That Sensory Feedback Eliminates Pain in the Phantom Hand .................................. 55 Discussion ................................................................................................................................................. 56 Conclusion: ................................................................................................................................................ 60 Materials and Methods: ............................................................................................................................ 60 Study Design ......................................................................................................................................... 60 Methods ............................................................................................................................................... 61 Experimental Setup .............................................................................................................................. 62 Generic Framework of Electrical Stimulation ....................................................................................... 63 Stimulating With Time Invariant Parameters ....................................................................................... 64 Stimulating With a Time‐Variant Pulse Width, PW(i,t) ....................................................................... 64 Threshold Detection Method ............................................................................................................... 65 Contralateral Pressure Matching .......................................................................................................... 65 Functional Testing ................................................................................................................................ 65 Statistical Analysis ................................................................................................................................ 66 Supplementary Materials .......................................................................................................................... 67 Chapter 4 Stability and selectivity of a chronic, multi‐contact cuff electrode for sensory stimulation in a human amputee ............................................................................................................................................ 71 INTRODUCTION ......................................................................................................................................... 71 METHODS .................................................................................................................................................. 73 A. Surgical Implantation ............................................................................................................................ 73 B. Nerve Stimulation ............................................................................................................................ 75 RESULTS .................................................................................................................................................... 77 A. Sensory Locations & Modalities ....................................................................................................... 77 B. Sensory Thresholds .........................................................................................................................
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