Bose, Rohit
(2024)
Restoring Sensory Feedback in People with Lower-limb Amputation Using Epidural Spinal Cord Stimulation.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Each year, approximately 150,000 individuals experience lower-limb amputation, and this figure is growing rapidly. Existing prosthetic limbs do not provide somatosensory feedback from the missing limb. Restoring somatosensory feedback in individuals with lower-limb amputations would reduce the risk of falls and alleviate phantom limb pain. Although research employing peripheral nerve stimulation has established a foundation for these devices, translating these approaches into clinical practice remains a challenge. Furthermore, while more intuitive sensations (as opposed to unnatural ones) appear to provide additional functional benefits, we currently do not have a quantifiable measure to assess the intuitiveness of the sensation, which hinders systematic advancement of sensory neuroprosthetics.
This dissertation examines the feasibility of spinal cord stimulation (SCS) to restore missing sensations in three individuals with transtibial amputation. We first demonstrate that SCS can evoke sensations from the missing foot, with control over their location and intensity, using commercially available electrodes used to treat chronic pain. Using evoked sensation as sensory feedback during functional tasks improved balance control and gait stability. Over the duration of the study, we measured a decrease in phantom limb pain. We also characterized the spinal reflexes evoked from SCS and evaluated any effect on voluntary muscle activity. We observed a broad activation of the residual muscles, but the reflex activity did not cause any unwanted muscle activation during gait. Finally, we tested a recently proposed measure based on the crossmodal congruency effect to quantify the intuitiveness of sensation in the lower-limb. We demonstrate that the proposed paradigm is not robust and highlight the challenges that need to be overcome for future studies to implement such a measure in sensory neuroprosthetics.
This dissertation marks a significant advancement in the clinical translation of somatosensory neuroprosthetics for people with lower-limb amputation. We demonstrate that SCS is a clinically viable approach to restore sensation and improve quality of life for people with transtibial amputation.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
27 April 2024 |
| Defense Date: |
8 May 2024 |
| Approval Date: |
6 September 2024 |
| Submission Date: |
22 May 2024 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
172 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
Swanson School of Engineering > Bioengineering |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Spinal Cord Stimulation, Lower-limb amputation, Neuroprostheses |
| Date Deposited: |
06 Sep 2024 19:54 |
| Last Modified: |
06 Sep 2024 19:54 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/46426 |
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