nature biomedical engineering

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

Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA


Somatosensory feedback, lower-limb amputation, phantom limb pain, spinal cord stimulation, pressure-sensitive shoe insole, balance control, gait stability, neuroprostheses


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. traumatic an

Moticon's Summary

In this research work, the plantar pressure information of Moticon's OpenGo Sensor Insoles was used to create somatosensory feedback for individuals with lower-limb amputations. The OpenGo sensors are wireless pressure-sensitive shoe insoles which can be used in almost any shoe, in this case under the prosthetic foot. A closed sensory feedback loop was realized using Moticon OpenGo's Software Development Kit to interface the raw data stream of the sensor insoles in real time. Therefore, the plantar pressure information of the OpenGo Sensor Insoles was linked to a spinal cord stimulation with commercially available electrodes. The intensity of the stimulation was modulated in real time, based on the amplitude and quality of the planatar pressure distribution. Important improvements related to a better quality of life, such as increased balance control and gait stability, as well as a meaningful decrease in phantom limb pain, were found in the patient group.

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