Restoration of sensory feedback from the foot and reduction of phantom limb pain via closed-loop spinal cord stimulation

Ameya C Nanivadekar; Rohit Bose; Bailey A Petersen; Elizaveta V Okorokova; Devapratim Sarma; Tyler J Madonna; Beatrice Barra; Juhi Farooqui; Ashley N Dalrymple; Isaiah Levy; Eric R Helm; Vincent J Miele; Michael L Boninger; Marco Capogrosso; Sliman J Bensmaia; Douglas J Weber; Lee E Fisher

doi:10.1038/s41551-023-01153-8

Restoration of sensory feedback from the foot and reduction of phantom limb pain via closed-loop spinal cord stimulation

Nat Biomed Eng. 2023 Dec 14. doi: 10.1038/s41551-023-01153-8. Online ahead of print.

Authors

Ameya C Nanivadekar^#^{1

2

3}, Rohit Bose^#^{1

2

3}, Bailey A Petersen^#^{1

2

3}, Elizaveta V Okorokova⁴, Devapratim Sarma^{1

5}, Tyler J Madonna^{1

6}, Beatrice Barra^{1

7}, Juhi Farooqui^{1

3}, Ashley N Dalrymple^{1

5

8

9}, Isaiah Levy⁶, Eric R Helm⁶, Vincent J Miele¹⁰, Michael L Boninger^{1

2

3

6}, Marco Capogrosso^{1

2

3

10}, Sliman J Bensmaia⁴, Douglas J Weber^{1

5}, Lee E Fisher^{11

12

13

14}

Affiliations

¹ Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.
² Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
³ Center for the Neural Basis of Cognition, Pittsburgh, PA, USA.
⁴ Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA.
⁵ Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
⁶ Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.
⁷ Department of Neuroscience and Movement Science, University of Fribourg, Fribourg, Switzerland.
⁸ Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
⁹ Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
¹⁰ Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
¹¹ Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA. lef44@pitt.edu.
¹² Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA. lef44@pitt.edu.
¹³ Center for the Neural Basis of Cognition, Pittsburgh, PA, USA. lef44@pitt.edu.
¹⁴ Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA. lef44@pitt.edu.

^# Contributed equally.

PMID: 38097809
DOI: 10.1038/s41551-023-01153-8

Abstract

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.

Abstract

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