title: An osseointegrated human-machine gateway for long-term sensory feedback and motor control of artificial limbs.
abstract: A major challenge since the invention of implantable devices has been a reliable and long-term stable transcutaneous communication. In the case of prosthetic limbs, existing neuromuscular interfaces have been unable to address this challenge and provide direct and intuitive neural control. Although prosthetic hardware and decoding algorithms are readily available, there is still a lack of appropriate and stable physiological signals for controlling the devices. We developed a percutaneous osseointegrated (bone-anchored) interface that allows for permanent and unlimited bidirectional communication with the human body. With this interface, an artificial limb can be chronically driven by implanted electrodes in the peripheral nerves and muscles of an amputee, outside of controlled environments and during activities of daily living, thus reducing disability and improving quality of life. We demonstrate in one subject, for more than 1 year, that implanted electrodes provide a more precise and reliable control than surface electrodes, regardless of limb position and environmental conditions, and with less effort. Furthermore, long-term stable myoelectric pattern recognition and appropriate sensory feedback elicited via neurostimulation was demonstrated. The opportunity to chronically record and stimulate the neuromuscular system allows for the implementation of intuitive control and naturally perceived sensory feedback, as well as opportunities for the prediction of complex limb motions and better understanding of sensory perception. The permanent bidirectional interface presented here is a critical step toward more natural limb replacement, by combining stable attachment with permanent and reliable human-machine communication.
authors.affiliation: Division of Signal Processing and Biomedical Engineering, Department of Signals and Systems, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden. Center of Orthopaedic Osseointegration and Center of Advanced Reconstruction of Extremities, Department of Orthopaedics, Sahlgrenska University Hospital, University of Gothenburg, SE-431 80 Mölndal, Sweden. maxo@chalmers.se.
authors.forename: Max
authors.initials: M
authors.lastname: Ortiz-Catalan
authors.affiliation: Division of Signal Processing and Biomedical Engineering, Department of Signals and Systems, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Håkansson
authors.affiliation: Center of Orthopaedic Osseointegration and Center of Advanced Reconstruction of Extremities, Department of Orthopaedics, Sahlgrenska University Hospital, University of Gothenburg, SE-431 80 Mölndal, Sweden.
authors.forename: Rickard
authors.initials: R
authors.lastname: Brånemark
mesh_terms: D000203:Activities of Daily Living; D000674:Amputees / Q000534:rehabilitation; D001186:Artificial Limbs; D004567:Electrodes, Implanted; D004576:Electromyography; D056228:Feedback, Sensory; D006801:Humans; D016348:Osseointegration; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D055698:Touch Perception; D057170:Translational Research, Biomedical