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  • Review Article
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Neurotechnologies to restore hand functions

Nature Reviews Bioengineering volume 1, pages 390–407 (2023)Cite this article

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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

  • Neuroprostheses based on decoding and stimulation of the nervous system can be used to restore hand functions.

  • Voluntary hand control can be restored by bypassing the lesion using ‘brain-to-body’ interfaces (BBIs).

  • Various invasive and non-invasive solutions exist to develop the BBI components needed to restore hand function.

  • BBIs could potentially provide long-term restoration of hand function.

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Fig. 1: Evolution of neuroprostheses for voluntary hand control.
Fig. 2: Normal hand movements and their anatomical pathway.
Fig. 3: Interfaces and strategies to decode hand movements from brain activity.
Fig. 4: Neurotechnologies to restore hand functions.

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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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Authors and Affiliations

  1. The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy

    Elena Losanno & Silvestro Micera

  2. Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA

    Matthew Mender & Cynthia Chestek

  3. Robotics Institute, University of Michigan, Ann Arbor, MI, USA

    Cynthia Chestek

  4. Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland

    Solaiman Shokur & Silvestro Micera

Authors
  1. Elena Losanno
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  2. Matthew Mender
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  4. Solaiman Shokur
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  5. Silvestro Micera
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Contributions

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.

Corresponding author

Correspondence to Silvestro Micera.

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Competing interests

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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Nature Reviews Bioengineering thanks Hyunglae Lee and the other, anonymous, reviewers for their contribution to the peer review of this work.

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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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