Nghiem Bao Tram, Sando Ian C, Gillespie R Brent, McLaughlin Bryan L, Gerling Gregory J, Langhals Nicholas B, Urbanchek Melanie G, Cederna Paul S
Ann Arbor, Mich.; Cambridge, Mass.; and Charlottesville, Va. From the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Health System; the Department of Mechanical Engineering, University of Michigan; the Charles Stark Draper Laboratory; and the Department of Systems and Information Engineering, University of Virginia.
Plast Reconstr Surg. 2015 Jun;135(6):1652-1663. doi: 10.1097/PRS.0000000000001289.
Each year, approximately 185,000 Americans suffer the devastating loss of a limb. The effects of upper limb amputations are profound because a person's hands are tools for everyday functioning, expressive communication, and other uniquely human attributes. Despite the advancements in prosthetic technology, current upper limb prostheses are still limited in terms of complex motor control and sensory feedback. Sensory feedback is critical to restoring full functionality to amputated patients because it would relieve the cognitive burden of relying solely on visual input to monitor motor commands and provide tremendous psychological benefits. This article reviews the latest innovations in sensory feedback and argues in favor of peripheral nerve interfaces. First, the authors examine the structure of the peripheral nerve and its importance in the development of a sensory interface. Second, the authors discuss advancements in targeted muscle reinnervation and direct neural stimulation by means of intraneural electrodes. The authors then explore the future of prosthetic sensory feedback using innovative technologies for neural signaling, specifically, the sensory regenerative peripheral nerve interface and optogenetics. These breakthroughs pave the way for the development of a prosthetic limb with the ability to feel.
每年,约有18.5万美国人遭受肢体缺失带来的毁灭性打击。上肢截肢的影响极为深远,因为人的双手是日常活动、表达交流以及其他人类独特属性的工具。尽管假肢技术取得了进步,但目前的上肢假肢在复杂运动控制和感官反馈方面仍存在局限。感官反馈对于恢复截肢患者的全部功能至关重要,因为它能减轻仅依靠视觉输入来监测运动指令的认知负担,并带来巨大的心理益处。本文回顾了感官反馈方面的最新创新,并支持外周神经接口。首先,作者研究了外周神经的结构及其在感官接口开发中的重要性。其次,作者讨论了通过神经内电极进行靶向肌肉再支配和直接神经刺激方面的进展。作者接着利用神经信号创新技术探索假肢感官反馈的未来,特别是感官再生外周神经接口和光遗传学。这些突破为开发具有感知能力的假肢铺平了道路。