Posts tagged amputation
Articles and news from the latest research reports.
To understand the meaning of “proprioception,” try a simple experiment. Close your eyes and lift your right arm above your head. Then, move it down so that it’s parallel to the ground. Make a fist and release it. Move it forward, and then swing it around behind you like you’re stretching. Finally, freeze in place, open your eyes, and look. Is your arm positioned where you thought it would be?
For most people, the answer will be, “Yes.” That’s because your brain and nervous system worked together to move your body according to your intent and processed the sensory feedback to know where your arm was in space despite not being able to visually track it.
For many upper-limb amputees using prosthetic devices, the answer would be, “No.” They wouldn’t have confidence that their device would be where they think it is because current prostheses lack provisions for providing complex tactile and proprioceptive feedback to the user. Without this feedback, even the most advanced prosthetic limbs will remain numb to the user and manipulation functions will be impaired.
DARPA’s new Hand Proprioception and Touch Interfaces (HAPTIX) program seeks to deliver those kinds of naturalistic sensations to amputees, and in the process, enable intuitive, dexterous control of advanced prosthetic devices that substitute for amputated limbs, provide the psychological benefit of improving prosthesis “embodiment,” and reduce phantom limb pain. The program builds on neural-interface technologies advanced during DARPA’s Revolutionizing Prosthetics and Reliable Neural-Interface Technology (RE-NET) programs that made major steps forward in providing a direct and powerful link between user intent and prosthesis control.
HAPTIX aims to achieve its goals by developing interface systems that measure and decode motor signals recorded in peripheral nerves and/or muscles. The program will adapt one of the advanced prosthetic limb systems developed under Revolutionizing Prosthetics to incorporate sensors that provide tactile and proprioceptive feedback to the user, delivered through patterned stimulation of sensory pathways in the peripheral nerve. One of the key challenges will be to identify stimulation patterning strategies that elicit naturalistic sensations of touch and movement. The ultimate goal is to create a fully-implantable device that is safe, reliable, effective, and approved for human use.
“Peripheral nerves are information-rich and readily accessible targets for interfacing with the human nervous system. Research performed under DARPA’s RE-NET program and elsewhere showed that these nerves maintain motor and sensory fibers that previously innervated the amputated limb, and that these fibers remain functional for decades after limb loss,” said Doug Weber, the DARPA program manager. “HAPTIX will try to tap in to these biological communication pathways so that users can control and sense the prosthesis via the same neural signaling pathways used for intact hands and arms.”
In addition to the improved motor performance that restored touch and proprioception would convey to the user, mounting evidence suggests that sensory stimulation in amputees may provide important psychological benefits such as improving prosthesis “embodiment” and reducing the phantom limb pain that is suffered by approximately 80 percent of amputees. For this reason, DARPA seeks the inclusion of psychologists in the multi-disciplinary teams of scientists, engineers, and clinicians proposing to develop the electrodes, algorithms, and electronics technology components for the HAPTIX system. Teams will need to consider how the use of HAPTIX system may impact the user in several important domains including motor and sensory function, psychology, pain, and quality of life.
“We have the opportunity to not only significantly improve an amputee’s ability to control a prosthetic limb, but to make a profound, positive psychological impact,” Weber said. “Amputees view existing prostheses as if they were tools, like a wrench, used only to perform a specific job, so many people abandon their prostheses unless absolutely needed. We believe that HAPTIX will create a sensory experience so rich and vibrant that the user will want to wear his or her prosthesis full-time and accept it as a natural extension of the body. If we can achieve that, DARPA is even closer to fulfilling its commitment to help restore full and natural functionality to wounded service members.”
The program plan culminates with a 12-month, take-home trial of the complete HAPTIX prosthesis system. To aid performers in the completion of the steps necessary to achieve regulatory approvals for human trials, DARPA consulted with the U.S Food and Drug Administration to incorporate regulatory timelines into the program process.
“Once development of the HAPTIX system is complete, we want people to benefit immediately and be able to use their limb all day, every day, and in every aspect of their lives,” Weber said. “The experience needs to be comfortable and easy. Take-home trials are the first step in making that vision a reality.”
If it is successful, the HAPTIX program will create fully-implantable, modular, and reconfigurable neural-interface microsystems that communicate wirelessly with external modules, such as the prosthesis interface link. Because such technology would have broad application and could fuel future medical devices, HAPTIX also plans to fund teams to pursue the science and technology that would support next-generation HAPTIX capabilities.
Full details of the HAPTIX opportunity are available on the Federal Business Opportunities website at: http://go.usa.gov/kyjJ.
Phantom limb pain relieved when amputated arm is put back to work
Max Ortiz Catalan has developed a new method for the treatment of phantom limb pain (PLP) after an amputation. The method is based on a unique combination of several technologies, and has been initially tested on a patient who has suffered from severe phantom limb pain for 48 years. A case study shows a drastic reduction of pain.
People who lose an arm or a leg often experience phantom sensations, as if the missing limb were still there. Seventy per cent of amputees experience pain in the amputated limb despite that it no longer exists. Phantom limb pain can be a serious chronic and deteriorating condition that reduces the quality of the person´s life considerably. The exact cause of phantom limb pain and other phantom sensations is yet unknown.
Phantom limb pain is currently treated with several different methods. Examples include mirror therapy, different types of medication, acupuncture and hypnosis. In many cases, however, nothing helps. This was the case for the patient that Chalmers researcher Max Ortiz Catalan selected for a case study of the new treatment method he has envisaged as a potential solution.
The patient lost his arm 48 years ago, and had since that time suffered from phantom pain varying from moderate to unbearable. He was never entirely free of pain.
The patient´s pain was drastically reduced after a period of treatment with the new method. He now has periods where he is entirely free of pain, and he is no longer awakened by intense periods of pain at night like he was previously.
The new method uses muscle signals from the patient´s arm stump to drive a system known as augmented reality. The electrical signals in the muscles are sensed by electrodes on the skin. The signals are then translated into arm movements by complex algorithms. The patient can see himself on a screen with a superimposed virtual arm, which is controlled using his own neural command in real time.
”There are several features of this system which combined might be the cause of pain relief” says Max Ortiz Catalan. “The motor areas in the brain needed for movement of the amputated arm are reactivated, and the patient obtains visual feedback that tricks the brain into believing there is an arm executing such motor commands. He experiences himself as a whole, with the amputated arm back in place.”
Modern therapies that use conventional mirrors or virtual reality are based on visual feedback via the opposite arm or leg. For this reason, people who have lost both arms or both legs cannot be helped using these methods.
”Our method differs from previous treatment because the control signals are retrieved from the arm stump, and thus the affected arm is in charge” says Max Ortiz Catalan. ”The promotion of motor execution and the vivid sensation of completion provided by augmented reality may be the reason for the patient improvement, while mirror therapy and medicaments did not help previously.”
A clinical study will now be conducted of the new treatment, which has been developed in a collaboration between Chalmers University of Technology, Sahlgrenska University Hospital, the University of Gothenburg and Integrum. Three Swedish hospitals and other European clinics will cooperate during the study which will target patients with conditions resembling the one in the case study – that is, people who suffer from phantom pain and who have not responded to other currently available treatments.
The research group has also developed a system that can be used at home. Patients will be able to apply this therapy on their own, once it has been approved. An extension of the treatment is that it can be used by other patient groups that need to rehabilitate their mobility, such as stroke victims or some patients with spinal cord injuries.
The secrets of a tadpole’s tail and the implications for human healing
Scientists at The University of Manchester have made a surprising finding after studying how tadpoles re-grow their tails which could have big implications for research into human healing and regeneration.
It is generally appreciated that frogs and salamanders have remarkable regenerative capacities, in contrast to mammals, including humans. For example, if a tadpole loses its tail a new one will regenerate within a week. For several years Professor Enrique Amaya and his team at The Healing Foundation Centre in the Faculty of Life Sciences have been trying to better understand the regeneration process, in the hope of eventually using this information to find new therapies that will improve the ability of humans to heal and regenerate better.
In an earlier study, Professor Amaya’s group identified which genes were activated during tail regeneration. Unexpectedly, that study showed that several genes that are involved in metabolism are activated, in particular those that are linked to the production of reactive oxygen species (ROS) - chemically reactive molecules containing oxygen. What was unusual about those findings is that ROS are commonly believed to be harmful to cells.
Professor Amaya and his group decided to follow up on this unexpected result and their new findings will be published in the next issue of Nature Cell Biology.
Thought-controlled prosthesis is changing the lives of amputees
The world’s first implantable robotic arm controlled by thoughts is being developed by Chalmers researcher Max Ortiz Catalan. The first operations on patients will take place this winter.
“Our technology helps amputees to control an artificial limb, in much the same way as their own biological hand or arm, via the person’s own nerves and remaining muscles. This is a huge benefit for both the individual and to society”, says Max Ortiz Catalan, industrial doctoral student at Chalmers University of Technology in Sweden.
Ever since the 1960s, amputees have been able to use prostheses controlled by electrical impulses in the muscles. Unfortunately, however, the technology for controlling these prostheses has not evolved to any great extent since then. For example, very advanced electric hand prostheses are available, but their functionality is limited because they are difficult to control.
“All movements must by pre-programmed”, says Max Ortiz Catalan. “It’s like having a Ferrari without a steering wheel. Therefore, we have developed a new bidirectional interface with the human body, together with a natural and intuitive control system.”
Today’s standard socket prostheses, which are attached to the body using a socket tightly fitted on the amputated stump, are so uncomfortable and limiting that only 50 percent of arm amputees are willing to use one at all.
This research project is using the world-famous Brånemark titanium implant instead (OPRA Implant System), which anchors the prosthesis directly to the skeleton through what is known as osseointegration.“Osseointegration is vital to our success. We are now using the technology to gain permanent access to the electrodes that we will attach directly to nerves and muscles”, says Max Ortiz Catalan.
Please amputate this leg: it’s not mine
This wasn’t the first time that David had tried to amputate his leg. When he was just out of college, he’d tried to do it using a tourniquet fashioned out of an old sock and strong baling twine. David (not his real name) locked himself in his bedroom at his parents’ house, his bound leg propped up against the wall to prevent blood from flowing into it. After two hours the pain was unbearable, and fear sapped his will.
Undoing a tourniquet that has starved a limb of blood can be fatal: injured muscles downstream of the blockage flood the body with toxins, causing the kidneys to fail. Even so, David released the tourniquet himself; it was just as well that he hadn’t mastered the art of tying one.
Failure did not lessen David’s desire to be rid of the leg. It began to consume him, to dominate his awareness. The leg was always there as a foreign body, an impostor, an intrusion.
He spent every waking moment imagining freedom from the leg. He’d stand on his “good” leg, trying not to put any weight on the bad one. At home, he’d hop around. While sitting, he’d often push the leg to one side. The leg just wasn’t his. He began to blame it for keeping him single; but living alone in a small suburban townhouse, afraid to socialise and struggling to form relationships, David was unwilling to let anyone know of his singular fixation.
New metric to track prosthetic arm progress
A new validated and reliable measure of how well an adult amputee is able to perform everyday tasks with a prosthetic arm will help physical and occupational therapists, prosthetists, and doctors assess the progress that patients make during training with their new limb.
Amputees with a new prosthetic arm must learn how to use their device to perform everyday tasks that were once second nature. Taking off a shirt becomes a conscious, multistep effort: grasp the shirt, lift the shirt over the head, pull arms through the sleeves, place the shirt on the table, let go of the shirt.
In the best cases of treatment, patients work with teams of doctors, prosthetists, and therapists to learn how their new limbs can help them regain function and quality of life. But clinicians have had few tools to assess whether that crucial teaching/learning process is going well, because of a lack of standardized measurements to use with adults with upper limb amputations. To change that, a research team has unveiled a new index that clinicians can use to assess their patients’ progress. They describe the Activities Measure for Upper Limb Amputees (the AM-ULA) in an article published online Oct. 19 in the Archives of Physical Medicine and Rehabilitation.
Amputation disrupts not only the peripheral nervous system but also central structures of the brain. While the brain is able to adapt and compensate for injury in certain conditions, in amputees the traumatic event prevents adaptive cortical changes. A group of scientists reports adaptive plastic changes in an amputee’s brain following implantation of multielectrode arrays inside peripheral nerves.
"We found that a neurally-interfaced hand prosthesis re-established communication between the central and peripheral nervous systems, not only restructuring the areas directly responsible for motor control but also their functional balance within the bi-hemispheric system necessary for motor control," says lead investigator Camillo Porcaro, PhD, of the Institute of Neuroscience, Newcastle University, Medical School, Newcastle upon Tyne, UK and the Institute of Cognitive Sciences and Technologies (ISTC) — National Research Council (CNR).