Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
Nat Biomed Eng. 2024 Aug;8(8):992-1003. doi: 10.1038/s41551-023-01153-8. Epub 2023 Dec 14.
Restoring somatosensory feedback in individuals with lower-limb amputations would reduce the risk of falls and alleviate phantom limb pain. Here we show, in three individuals with transtibial amputation (one traumatic and two owing to diabetic peripheral neuropathy), that sensations from the missing foot, with control over their location and intensity, can be evoked via lateral lumbosacral spinal cord stimulation with commercially available electrodes and by modulating the intensity of stimulation in real time on the basis of signals from a wireless pressure-sensitive shoe insole. The restored somatosensation via closed-loop stimulation improved balance control (with a 19-point improvement in the composite score of the Sensory Organization Test in one individual) and gait stability (with a 5-point improvement in the Functional Gait Assessment in one individual). And over the implantation period of the stimulation leads, the three individuals experienced a clinically meaningful decrease in phantom limb pain (with an average reduction of nearly 70% on a visual analogue scale). Our findings support the further clinical assessment of lower-limb neuroprostheses providing somatosensory feedback.
恢复下肢截肢患者的躯体感觉反馈，可以降低跌倒风险并减轻幻肢痛。在这里，我们在三名胫部截肢患者（一名创伤性截肢，两名因糖尿病外周神经病变导致截肢）中展示了，通过使用市售电极对侧腰骶脊髓进行刺激，并根据无线压力感应鞋垫的信号实时调节刺激强度，可以诱发缺失脚的感觉，同时可以控制其位置和强度。通过闭环刺激恢复的躯体感觉改善了平衡控制（一名患者的感觉组织测试综合评分提高了 19 分）和步态稳定性（一名患者的功能性步态评估提高了 5 分）。在刺激导线植入期间，这三名患者的幻肢痛有了明显的临床改善（视觉模拟评分平均降低近 70%）。我们的研究结果支持进一步评估提供躯体感觉反馈的下肢神经假体。
