Smart Prosthetics and Body Repair

John Farserotu, CSEM WiseSkin

Heinrich Hofmann, EPFL MagnetoTheranostics
Stphanie Lacour, EPFL SpineRepair
Bert Mller, UniBas SmartSphincter
Stefan Weber, UniBE HearRestore
Chair: Christofer Hierold, ETHZ
John Farserotu, CSEM

WiseSkin
WiseSkin Artificial Skin for Tactile Prosthetics

Presented by J. Farserotu
Nano-tera Annual meeting 2014
EPFL , 20 May 2014
The problem
Amputation of a hand or limb is a catastrophic event resulting in significant
disability with major consequences for daily activities and quality of life.
Although functional myoelectric prostheses are available today (e.g. hand),
their use remains limited due to a lack of sensory function in the prostheses.
As the worlds population grows and ages, so does the number of people
living with disabilities including lost limbs (e.g. trauma, diabetes or cancer).
A sense of tactility is needed for providing feedback for control of prosthetic
limbs and to perceive the prosthesis as a real part of the body thus inducing a
sense of body ownership and a natural sensation of touch.
Copyright 2014 CSEM | Wireless | J. Farserotu | Page 4
Modern electric hands. A: bebionic (RSLSteeper). B: i-Limb
Ultra (touchbionics). C: Michelangelo (Otto Bock)
Today, there is no solution for restoration of a natural sense
of touch for persons using prosthetic limbs
Copyright 2013 CSEM | WiseSkin | Christian Antfolk | Page 5
The WiseSkin solution
Transduce the artificial skin outputs into appropriate tactile
signals to be applied on the phantom map of amputees.

Phantom mapping
Non-invasive!
Copyright 2013 CSEM | Title | Author | Page 6
Technical challenges
Reliable sensors / sensing (e.g. pressure and shear) to feel objects, grip and
rapidly adjust (moving hand).
Ease of use, freedom of movement, natural look and feel of the prosthetic
demand highly miniaturized sensors placed almost anywhere
Minimum impact on autonomy of the myoelectric prosthesis.
Scalability / modularity are critical (e.g. communication, processing); potentially
many sensors (100-150 mechanoreceptors/cm
2
at fingertip of human hand).
Real-time response and low latency are needed to react to slipping or falling, use
of the prosthesis without actually watching
Sensory feedback / actuation is essential and the Humanelectronics interface is
key (e.g. electrodes, vibration).
Advanced material engineering for sensing: piezoelectric AlN on elastomers,
metallized PDMS waveguide, stretchable sensors
source: www.sciencedaily.com
WiseSkin pushes the forefront of technology in miniature, ULP sensor and
communication devices, materials and sensory feedback systems.
Key innovations / benefits
Wireless and sensor technology
Reliable, miniature, soft-MEMS sensors (e.g. pressure)
Scalable routing, adaptable MAC, robust, event driven, HD-WSN
Conformal power distribution system
Stretchable power distribution and signal transmission layers (e.g. gold, liquid metal)
Electro-mechanical sensor integration, interconnects and flexible miniature antenna
Tactile sensory perception and human-electronics interface (HEI)
Study and test of a non-invasive HEI on real patients
Multi-sensory perception, MRI brain imaging analysis (e.g. phantom finger somatotopy)
WiseSkin system and technology integration
A flexible, stretchable artificial skin / smart material that is relatively easy to manufacture
Restore a natural sensation of touch, ease of sensor placement, coverage of large areas
Copyright 2012 CSEM | Wireless | J. Farserotu | Page 7
WiseSkin provides a natural sense of touch!
Copyright 2013 CSEM | Title | Author | Page 8
Haptic applications of WiseSkin
Health and Medical
Tactile prosthetics (non-invasive as well as invasive)
Braille display for the blind, rehabilitation, surgical simulators
Robots
Health: Surgical robotics (maybe soon),
Service robots : e.g. Assisted Living
Industrial: Factories, harsh environments e.g. undersea/space
Commercial
Touch screens (haptic feedback), computer games
Safety and security
Smart gloves (e.g. firefighters, screening, haptic interface)
And more!
Thank you for your attention!
Heinrich Hofmann, EPFL

MagnetoTheranostics
Particle composition
Characterisation
Tox screening
Functionalisation
of particles
with antibodies
Nanocomposite
formulation
IN VITRO
Specific absorption
in metastases
IN VIVO
Biodistribution
MRI detection
IN VITRO
Heating capacity
IN VIVO
Induced tumor in mice
Clinical study in dogs
Development of temperature simulation tool
Improvement of magnetic generator
Theranostics
in human
clinical trail
http://howtogetridofallthings.com
http://beforeitsnews.com/health/2012/04/targeted-nanoparticles-show-success-in- clinical-trials-
1990861.html
http://j ochenebmeier.wordpress.com
http://www. ways2gogreenblog.com/2013/05/30/best-
practices-for-going-green-wi th- your-heati ng-and-
cooling/
h t t p : / /d e . w i k i p e d i a . o r g/w i k i/ H u m a n i s m u s



,

Documentation
with Electronic
Sample Book
(ESB)
Project Layout
MagnetoTheranostics
RTD 2013
From superparamagnetic nanoparticles to cancer detection and treatment
S. Barbieri, J. Bastiaansen,D. BovinS. Ehrenberger , H. Richter,
G. Borchart, M. Clapstick, H. Hofmann, O. Jordan, N.Kuster, P.Kircher, B.von Rechenberg,
M.Stuber, H.Thoeny

Determination of the optimal size of
superparamagnetic nanoparticles
0.0
0.5
1.0
1.5
2.0
2.5
3.0
5 10 15 20 25 30
S
L
P

(
W
/
g
F
e
)

Mean crystalline diameter (nm)
Physics
Magnetisation
Anisotropy constant
Relaxation time
Relaxation mechanism
Biology
Coating
Biocompatibility
Antibody
Residence time
Cellular up take
Protein corona
Clinics
Frequency
Mag field strengths
Iron Metabolism
Biodistribution
Specific adsorption
Clearing mechanism

The big barriers
Accepted methods for biocompatibility tests of
(inorganic) nanoparticles
Regulations for the use of inorganic nanoparticles
for diagnostic and therapeutic applications
Good manufacturing practice at academic level
Reproducibility (at batch to batch and research
level)
Acceptance of nanotechnology


Openings for a solution
Highly interdisciplinary research including all aspects from basic science
up to clinical research and development of manufacturing and test
methods
Several up and downstream research projects in parallel to the core
project preparing the ground for translation of results to big pharmacy and
clinics
Education at all levels
Contact with of regulatory bodies (SMA, EMA, FDA) from beginning
Use only materials which is approved by the regulatory bodies

Magnetic field generator
ESM, KTI, Nano-Tera
Nanoparticle coating and
functionalisation
EU, SNF, KTI,
Feasibility tests and
preclinical toxicity
EU-FP 7
Active participation in
methods developemnt for
biocompatibility tests ,
nanoregulation, CCMX
Magnetotheranostic
Nano-Tera
1998 2018
Stphanie Lacour, EPFL

SpineRepair
nano-tera annual review meeting S.P. Lacour 20 May 2014
Spinal Cord Stimulation for Locomotor Disorders
Stphanie P. Lacour

Nano-tera annual review meeting

20 May 2014
nano-tera annual review meeting S.P. Lacour 20 May 2014
Image: Nitin N. Bhatia, Am. Assoc. of Orthopedic Surgeons
2.5M people with Spinal Cord
Injury (SCI) worldwide

half never recover walking
Context
Rob Summers standing during electrical
stimulation of the spinal cord
Dan Dry/University of Louisville
Mission
develop and optimize enabling technologies
to implement spinal cord neuroprosthesis
nano-tera annual review meeting S.P. Lacour 20 May 2014
An integrated Spinal Neuroprosthesis
Development of animal models of
SCI, a test-bed for human trials

Development of improved
implantable technology

Gaining understanding of the
physiology of the spinal cord as
movement generator

Our aims:
Treadmill or ladder
Kinematic analysis platform
To be tested
stimulation patterns
ephys.
chip
Stretchable
MEA
Stretchable
interconnects
Implanted
electronics
Brainstem
Spinal cord
Vertebra
is
y
c
o
m

Compliant
digital cable
Subcutaneous
electronics
Implantable platform
nano-tera annual review meeting S.P. Lacour 20 May 2014
Technological advances biology, nanomaterials, engineering
where and how to
stimulate
1 mm
500m
Electrodes
Spinal cord
biologically transparent
implants
low-power, real-time
control electronics
Implantable telemetry
Implantable stimulator
nano-tera annual review meeting S.P. Lacour 20 May 2014
Project impact

In the neural prosthetic community


improve patients quality of life

significant impact on the prosthetic market

further applications beyond spinal cord injury reaching an even wider industrial
as well as patient community.
nano-tera annual review meeting S.P. Lacour 20 May 2014
Grgoire Courtine
Jrme Gandar, David Borton, Jean Laurens, Nikolaus Wenger, Natalia
Pavlova, Pavel Musienko, Simone Duis

Silvestro Micera
Marco Capogrosso, Eduardo Martin Moraud, Stanisa Raspopovic

Stphanie P. Lacour
Arthur Hirsch, Ivan Minev



Janos Vrs
Flurin Stauffer, Alexandre Larmagnac

Andreas Hierlemann
YongHong Tao, Yihui Chen



Alain-Serge Porret
Daniel Severac, Vincent Peiris, Pierre-Franois Ruedi, Dragan Manic
The Team
Bert Mller, UniBas

SmartSphincter
Panel discussion: Smart prosthetics
and body repair - SmartSphincter
Annual Plenary Meeting Nano-Tera.ch
SwissTech Convention Center, EPF Lausanne
May 20, 2014

Bert Mller
University of Basel and University Hospital Basel, Switzerland
SmartSphincter: Smart muscle for
incontinence treatment
From the medical point of view: complex muscles
From an engineering point of view: simplest muscles
Open/Close
Definition of the target specifications for biomimetic
design
Anatomical restrictions (geometry, comfort)
Necessary mechanical parameters (forces/pressures)
Time response (more critical for urinary than fecal
incontinence)
Choice of actuator
Challenge: Stretchable electrodes for
dielectric EAP-based actuators
Hundred thousands of nanometer-thin polymer layers
Hundred thousands of contacts
Conventional electrodes (e.g. 20 nm Au) dominate the
mechanics:
Liquid metal electrodes (demonstrated on m scale)
Unidirectional wrinkles
Applications of low-voltage, dielectric
EAP nanometer-thin actuators
Fecal and urinary incontinence
Actuators and sensors within the human body (similarities to
tissues: high fracture toughness, large actuation strain,
inherent vibration damping, low energy consumption)
Tactile displays often termed artificial skin
Hinge-less devices in robotics incl. grippers and wipers
Flow control in micro- and nano-fluidics (lab-on-a-chip)

High-risk but wide variety of potential applications
Collaborative initiative of
clinics, academia, and industry
Stefan Weber, UniBE

HearRestore
HearRestore: Image-guided micro surgery
for hearing aid implantation
Stefan Weber
University of Bern

Hearing impairment A common disability

Social and clinical relevance
Humans: 25% with hearing loss
Newborns: 4 hearing disorders
Gold standard for deafness
Hearing aid implantation (i.e. CI)
Problems
Invasiveness
Hospitalization
Developed world only
30

Cochlea Implants
31
MED-EL Innsbruck
Imaging &
3D Planning
Safety
-2 -1 0 1 2
-1.5
-1
-0.5
0
0.5
1
1.5
Transformed distance from planned target (mm)
T
r
a
n
s
f
o
r
m
e
d

d
i
s
t
a
n
c
e

f
r
o
m

p
l
a
n
n
e
d

t
a
r
g
e
t

(
m
m
)
32
Approach: Image Guided Microsurgery
Modelling
Precision guidance

Preparation for clinical trials (Tera)

33
University of Bern
ARTORG Center,
Inselspital ENT Department
Institute for Surgical Technologies and Biomechanics
Bern University of Applied Science
CSEM Neuchatel
Industry
Project Partners
34