Section: Application Domains

Palliative solutions for movement deficiencies

Functional electrical stimulation is one possibility to restore or control motor functions in an evolutive and reversible way. Pacemaker, cochlear implants, deep brain stimulation (DBS) are successful examples. DEMAR focuses on movement disorder restoration in paraplegic and quadriplegic patients, enhancements in hemiplegic patients, and some other motor disorders such as bladder and bowel control. Nevertheless, since some advances in neuroprosthetic devices can be exploited for the next generation of cochlear implants, the team also contributes to technological and scientific improvements in this domain.

The possibility to interface the sensory motor system, both activating neural structure with implanted FES, and sensing through implanted neural signal recordings open a wide application area:

• Restoring motor function such as grasping for quadriplegic patient, standing and walking for paraplegic patient, compensating foot drop for hemiplegic patients. These applications can be firstly used in a clinical environment to provide physiotherapist with a new efficient FES based therapy (using mainly surface electrodes) in the rehabilitation process. Secondly, with a more sophisticated technology such as implanted neuroprostheses, systems can be used at home by the patient himself without a clinical staff.

• Modulating motor function such as tremors in Parkinsonian patient using DBS. Techniques are very similar but for the moment, modelling is not achieved because it implies the central nervous system modelling in which we are not implied.

• Sensing the afferent pathways, such as muscle's spindles, will be used to provide a closed loop control of FES through natural sensing and then a complete implanted solution. Sensing the neural system is a necessity in some complex motor controls such as the bladder control. Indeed, antagonist muscle's contractions, and sensory feedbacks interfere with FES when applied directly on the sacral root nerve concerned. Thus, enhanced activation waveforms and sensing feedback or feedforward signals are needed to perform a highly selective stimulation.

To achieve such objectives, experimentations on animals and humans are necessary. This research takes therefore a long time in order to go from theoretical results to real applications. This process is a key issue in biomedical research and is based on: i) design of complex experimental protocols and setups both for animals and humans, ii) ethical attitude both for humans and animals, with ethical committee approval for human experiments iii) volunteers and selected persons, both disabled and healthy, to perform experiments with the adequate medical staff.