Robin Lienkämper

Intracortical microstimulation (ICMS) of somatosensory cortex can restore a sense of touch to people with spinal cord injury. In this early feasibility clinical trial (NCT01894802), we evaluated the safety, efficacy, and longevity of ICMS because there is a paucity of such long-term studies in humans. This information is crucial to the development of clinical neuromodulation devices, particularly for restoring touch, hearing, and vision. ICMS was delivered to five participants with spinal cord injury who were each implanted with two Blackrock NeuroPort microelectrode arrays in the hand representation of Brodmann's area 1. Across implant durations spanning 2 to 10 years, we measured single-electrode detection thresholds, projected fields, quality reports, and electrode health characteristics. ICMS-related adverse events were documented throughout. More than 168 million ICMS pulses were delivered across a combined implant duration of 27 years without any serious adverse events or direct negative effects on electrode health. ICMS consistently evoked sensations localized to the hand. Rarely, sensations persisted for brief periods after stimulation offset (3 to 25 events across participants). ICMS detection thresholds increased slowly over time (about 3.5 microamperes per year), but 64 ± 13% of the electrodes still reliably evoked tactile sensations (about 21% decrease in functional electrodes), including 60% of the electrodes after 10 years in one participant. The quality and projected field coverage of ICMS-evoked sensations were both consistent. Delivering ICMS to the somatosensory cortex was safe and effective, consistently evoking informative somatosensory percepts as long as 10 years, demonstrating the clinical promise of ICMS for sensory restoration.

Background: Intracortical microstimulation (ICMS) of somatosensory cortex can restore a sense of touch to people with spinal cord injury (SCI). In this early-feasibility clinical trial, we evaluate the safety, efficacy, and longevity of ICMS as there is a paucity of such long-term studies in humans. This information is crucial to the development of clinical neuromodulation devices, particularly for restoring touch, hearing, and vision. Methods: ICMS was delivered to five participants with SCI who were each implanted with two Blackrock NeuroPort microelectrode arrays in the hand representation of Brodmann’s Area 1. Across implant durations spanning two to ten years, we measured single-electrode detection thresholds, projected fields, quality reports, and electrode health characteristics. ICMS-related adverse events were documented throughout. Results: Over 168 million ICMS pulses were delivered across a combined implant duration of 24 years without any serious adverse events or direct negative effects on electrode health. ICMS consistently evoked sensations localized to the hand. Rarely, sensations persisted for brief periods after stimulation offset (3–25 events across participants). ICMS detection thresholds increased slowly over time (∼3.5 μA/year), but 62±15% of the electrodes still reliably evoke tactile sensations (∼25% decrease in functional electrodes), including 55% of the electrodes after 10 years in one participant. The quality and projected field coverage of ICMS-evoked sensations were both consistent. Conclusions: Delivering ICMS to somatosensory cortex was safe and reliable, consistently evoking informative somatosensory percepts as long as 10 years, demonstrating the clinical promise of ICMS for sensory restoration. (Funded by NIH; ClinicalTrials.gov: NCT01894802 ).

Intracortical microstimulation (ICMS) of somatosensory cortex evokes tactile sensations whose properties can be systematically manipulated by varying stimulation parameters. However, ICMS currently provides an imperfect sense of touch, limiting manual dexterity and tactile experience. Leveraging our understanding of how tactile features are encoded in the primary somatosensory cortex (S1), we sought to inform individuals with paralysis about local geometry and apparent motion of objects on their skin. We simultaneously delivered ICMS through electrodes with spatially patterned projected fields (PFs), evoking sensations of edges. We then created complex PFs that encode arbitrary tactile shapes and skin indentation patterns. By delivering spatiotemporally patterned ICMS, we evoked sensation of motion across the skin, the speed and direction of which could be controlled. Thus, we improved individuals’ tactile experience and use of brain-controlled bionic hands.

Intracortical microstimulation (ICMS) of somatosensory cortex evokes tactile sensations whose location and properties can be systematically manipulated by varying the electrode and stimulation parameters ^1–3 . This phenomenon can be used to convey feedback from a brain-controlled bionic hand about object interactions. However, ICMS currently provides an impoverished sense of touch, limiting dexterous object manipulation and conscious experience of neuroprosthetic systems. Leveraging our understanding of how these sensory features are encoded in S1 ^4,5 , we sought to expand the repertoire of ICMS-based artificial touch to provide information about the local geometry and motion of objects in individuals with paralysis. First, we simultaneously delivered ICMS through multiple, spatially patterned electrodes, adopting specific arrangements of aligned projected fields (PFs). Unprompted, the participants reported the sensation of an edge. Next, we created more complex PFs and found that participants could intuitively perceive arbitrary tactile shapes and skin indentation patterns. By delivering patterned ICMS sequentially through electrodes with spatially discontinuous PFs, we could even evoke sensations of motion across the skin, the direction and speed of which we were able to systematically manipulate. We conclude that appropriate spatiotemporal patterning of ICMS inspired by our understanding of tactile coding in S1 can evoke complex sensations. Our findings serve to push the boundaries of artificial touch, thereby enriching participants’ conscious sensory experience from simple artificial percepts to highly informative sensations that mimic natural touch.

Invasive brain–computer-interfaces (BCIs) aim to improve severely paralyzed patient’s (e.g. tetraplegics) quality of life by using decoded movement intentions to let them interact with robotic limbs. We argue that the performance in controlling an end-effector using a BCI depends on three major factors: decoding error, missing somatosensory feedback and alignment error caused by translation and/or rotation of the end-effector relative to the real or perceived body. Using a virtual reality (VR) model of an ideal BCI decoder with healthy participants, we found that a significant performance loss might be attributed solely to the alignment error. We used a shape-drawing task to investigate and quantify the effects of robot arm misalignment on motor performance independent from the other error sources. We found that a 90° rotation of the robot arm relative to the participant leads to the worst performance, while we did not find a significant difference between a 45° rotation and no rotation. Additionally, we compared a group of subjects with indirect haptic feedback with a group without indirect haptic feedback to investigate the feedback-error. In the group without feedback, we found a significant difference in performance only when no rotation was applied to the robot arm, supporting that a form of haptic feedback is another important factor to be considered in BCI control.