Hand Control With Invasive Feedback Is Not Impaired by Increased Cognitive Load

Giacomo Valle, Edoardo D'Anna, Ivo Strauss, Francesco Clemente, Giuseppe Granata, Riccardo Di Iorio, Marco Controzzi, Thomas Stieglitz, Paolo M Rossini, Francesco M Petrini, Silvestro Micera, Giacomo Valle, Edoardo D'Anna, Ivo Strauss, Francesco Clemente, Giuseppe Granata, Riccardo Di Iorio, Marco Controzzi, Thomas Stieglitz, Paolo M Rossini, Francesco M Petrini, Silvestro Micera

Abstract

Recent experiments have shown that neural stimulation can successfully restore sensory feedback in upper-limb amputees improving their ability to control the prosthesis. However, the potential advantages of invasive sensory feedback with respect to non-invasive solutions have not been yet identified. Our hypothesis was that a difference would appear when the subject cannot focus all the attention to the use of the prosthesis, but some additional activities require his/her cognitive attention, which is a quite common situation in real-life conditions. To verify this hypothesis, we asked a trans-radial amputee, equipped with a bidirectional hand prosthesis, to perform motor tasks also in combination with a cognitive task. Sensory feedback was provided via intraneural (invasive) or electro-tactile (non-invasive) stimulation. We collected also data related to self-confidence. While both approaches were able to significantly improve the motor performance of the subject when no additional cognitive effort was asked, the manual accuracy was not affected by the cognitive task only when intraneural feedback was provided. The highest self-confidence was obtained when intraneural sensory feedback was provided. Our findings show that intraneural sensory feedback is more robust to dual tasks than non-invasive feedback. This is the first direct comparison between invasive and non-invasive approaches for restoring sensory feedback and it could suggest an advantage of using invasive solutions. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02848846.

Keywords: cognitive load; electrical stimulation; neural interfaces; neural sensory feedback; prosthesis; superficial sensory feedback; upper limb amputees.

Copyright © 2020 Valle, D’Anna, Strauss, Clemente, Granata, Di Iorio, Controzzi, Stieglitz, Rossini, Petrini and Micera.

Figures

FIGURE 1
FIGURE 1
Bidirectional hand prosthesis. During the tests, the patient used a robotic hand prosthesis controlled through surface EMG signals, and providing neural sensory feedback through a single channel of a TIME implanted in her ulnar nerve or electrotactile sensory feedback through a single skin-electrode placed on her residual arm. The subject performed a dual-task paradigm involving motor and memory skills simultaneously (VET + SDFT, respectively).
FIGURE 2
FIGURE 2
Sensory feedback. (A) Locations of the elicited sensation when Intraneural sensory Feedback (IF) and Superficial sensory Feedback were provided. Both encoding strategies exploited amplitude modulation. (B) Induced sensation and stimulation parameters were reported for intraneural stimulation (IF) and superficial electrotactile stimulation (SF).
FIGURE 3
FIGURE 3
Dual-task: motor control and short-term memory assessment. (A) Memory digit spans according to the different conditions are presented. Baseline was acquired as control value. (B) Performances are evaluated as manual accuracy (number of unbroken and transferred blocks over total transferred blocks) and manual dexterity (number of total transferred blocks). (C) Time to recall all the digits sequence was collected in each condition. All data are reported as mean values ± standard deviations. A span of 6 was reached only once in SF and once in IF (error bars without std). Friedman test, with Tukey-Kramer correction for multiple groups of data when requested, was performed. We performed 5 repetitions × 15 feedback conditions (Intraneural Feedback – IF, Superficial Feedback – SF and No Feedback – NF) × 2 cognitive conditions (with Cognitive task C-ON and without Cognitive task C-OFF).
FIGURE 4
FIGURE 4
Self-confidence. A score of self-confidence was asked after the subject performed the task in each stimulation condition. All data are reported as mean values ± standard deviations. Friedman test, with Tukey-Kramer correction for multiple groups of data was performed. We performed 15 repetitions × 3 feedback conditions (Intraneural Feedback - IF, Superficial Feedback – SF and No Feedback – NF) × 2 cognitive conditions (with Cognitive task C-ON and without Cognitive task C-OFF).

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