Abstract
Reaching and manipulating objects are crucial tasks that allow proactive interaction with our surroundings. However, these functions are lost after neurological disorders or traumatic events that cause hand paralysis. Neuroprosthetic technologies are medical devices that can substitute or restore a damaged motor or sensory modality. In this Review, we discuss how advanced technological modules can be used to restore hand functions in subjects with paralysis. First, we illustrate how the subject’s intended hand functions can be extracted by deciphering their cortical activity or residual body movements. Next, we describe how invasive and non-invasive electrical stimulation of neural or muscular structures can activate different hand muscles to restore functional movements. We then provide examples of ‘brain-to-body’ interfaces that can decode the hand motor intent from brain signals and activate muscles accordingly, allowing voluntary control of movements while bypassing the neurological issue. Finally, we discuss the future steps required for the clinical translation of these technologies.
Key points
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Neuroprostheses based on decoding and stimulation of the nervous system can be used to restore hand functions.
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Voluntary hand control can be restored by bypassing the lesion using ‘brain-to-body’ interfaces (BBIs).
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Various invasive and non-invasive solutions exist to develop the BBI components needed to restore hand function.
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BBIs could potentially provide long-term restoration of hand function.
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Acknowledgements
This Review was partly funded by the Swiss National Science Foundation through the National Centre of Competence in Research (NCCR) Robotics, the CHRONOS project, the Wyss Center for Bio and Neuroengineering and the Bertarelli Foundation.
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C.C. and M.M. wrote the sections on natural motor control and hand decoding. E.L., S.S. and S.M. wrote the sections on motor function restoration and brain-to-body interfaces. E.L., S.S. and S.M. also harmonized all the different sections, writing introductions and conclusions. All authors revised and approved the final version of the manuscript.
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S.M. holds shares in the companies IUVO, GTX and Sensars Neurotechnologies, which are all developing neurotechnologies to restore the sensorimotor functions of people with disabilities. All other authors declare no competing interests.
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Losanno, E., Mender, M., Chestek, C. et al. Neurotechnologies to restore hand functions. Nat Rev Bioeng 1, 390–407 (2023). https://doi.org/10.1038/s44222-023-00054-4
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DOI: https://doi.org/10.1038/s44222-023-00054-4
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