Long-term implant of intramuscular sensors and nerve transfers for wireless control of robotic arms in above-elbow amputees
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The use of implantable myoelectric sensors showed substantial improvements in prosthetic function of above-elbow amputees.
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A recent prospective study with three above-elbow amputees observed for two and a half years demonstrated that TMR surgery combined with IMES implantation allowed subjects to attain intuitive and reliable control of their prostheses.
“A recent prospective study conducted with three above-elbow amputees observed for two and a half years clearly demonstrates the functional outcomes of TMR surgery combined with IMES implantation [174], where the subjects attained intuitive and reliable control of their prostheses.”
From Interfaces with the peripheral nervous system for the control of a neuroprosthetic limb: a review (2020) · cites this paper as [174]
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“5 mm in diameter and 16-mm long, can be inserted into a muscle during the TMR surgery, and acts as an independent differential amplifier consisting of custom electronics housed within a biocompatible, hermetically sealed ceramic cylinder with titanium end caps (16, 33).”
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“Despite the potential high impact of IMES for man-machine interfacing in robotics, so far, there has been only one case report of their use in humans (16).”
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“To improve the man-machine interface in above-elbow amputees, a direct skeletal attachment penetrating the skin has been proposed (10, 13).”
BackgroundDevelopment of a regenerative peripheral nerve interface for control of a neuroprosthetic limb
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“The use of a threshold determines the need for relatively strong muscular contractions, which limits the accuracy in proportional myoelectric control and may result in fatigue (10, 19).”
BackgroundFirst clinical experience with BION implants for therapeutic electrical stimulation
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“The housing of the IMES sensor was previously used in an implantable microstimulation device (the BION) for poststroke hemiplegic patients with shoulder subluxation (20).”
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“In patients with IMES, however, the signal quality from the implanted sensors is superior to that from surface systems and allows for direct simultaneous and proportional control without retraining (23, 24).”
BackgroundMotor Unit Characteristics after Targeted Muscle Reinnervation
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“In patients with IMES, however, the signal quality from the implanted sensors is superior to that from surface systems and allows for direct simultaneous and proportional control without retraining (23, 24).”
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“Despite the limitations of surface EMG as source of control signals, the increased number of EMG sites achieved by TMR surgery using selective nerve transfers enables prosthetic control in a more intuitive manner than with naturally innervated muscles alone (11).”
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“Here, we establish a man-machine interface for robotic arm control in above-elbow amputees based on a wireless implantable myoelectric sensor (IMES) system originally developed by Weir and colleagues (15) and then by the Alfred Mann Foundation (California, USA) (16).”
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Prothetische Rekonstruktion hoher Amputationen der oberen Extremität
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Upper Extremity Prosthetics: Current Options and Future Innovations
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“…from the initially devised use for augmenting the number and quality of EMG signals for prosthetic control (Kuiken et al., 2009; Myers et al., 2020; Salminger et al., 2019), TMR is now widely investigated (and applied) as a means to treat and even prevent phantom limb and neuroma pain (Dumanian et…”
BackgroundMethodInfluentialSelf-citationNg, K. A., Rusly, A., Gammad, G. G. L., Le, N., Liu, S.-C., Leong, K.-W., Zhang, M., Ho, J. S., Yoo, J., & Yen, S. (2020) · IEEE Transactions on Biomedical Circuits and Systems · doi:10.1109/tbcas.2020.3009088 · Cited by 13 · see citing works
“The IMES implantable device has been validated in human subjects [3], [4].”
MethodBecerra-Fajardo, L., Krob, M. O., Minguillón, J., Rodrigues, C., Welsch, C., Tudela-Pi, M., Comerma-Montells, A., Barroso, F. O., Schneider, A., & Ivorra, A. (2022) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-022-01033-3 · Cited by 16 · see citing works
“The architecture has also demonstrated the possibility to 704 perform electrical stimulation, opening the possibility to use the devices in multiple applications, including tremor 705 management in essential tremor and Parkinson’s disease, and prosthetics control with sensory feedback [53].”
MethodKarczewski, A. M., Dingle, A. M., & Poore, S. O. (2021) · Frontiers in Neurorobotics · doi:10.3389/fnbot.2021.711028 · Cited by 13 · see citing works
Proof of concept for multiple nerve transfers to a single target muscle
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“Earlier studies revealed that EMG technology can record and decipher neuronal signals from those reinnervated areas into signals for prosthetic movement (Bergmeister et al., 2017; Muceli et al., 2019b; Salminger et al., 2019).”
BackgroundSelf-citationThe Next Frontier in Neuroprosthetics: Integration of Biomimetic Somatosensory Feedback
Tian, Y., Valle, G., Cederna, P. S., & Kemp, S. W. P. (2025) · Biomimetics · doi:10.3390/biomimetics10030130 · Cited by 14 · see citing works
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“Most notably, we recently reported on the first long-term implantation of the Implantable Myoelectric Sensors system in three patients with targeted muscle reinnervation, demonstrating improved prosthetic control through the benefits of intramuscular signal pickup [36].”
BackgroundMethodInfluentialSelf-citationSégas, E., Mick, S., Leconte, V., Dubois, O., Klotz, R., Cattaert, D., & de Rugy, A. (2023) · eLife · doi:10.7554/elife.87317 · Cited by 12 · see citing works
“…communication with the nervous system ( Ortiz-Catalan et al., 2020 ; Ortiz-Catalan et al., 2014a ; D’Anna et al., 2019 ; Zollo et al., 2019 ; Salminger et al., 2019 ), and advanced signal processing to encode and decode sensorimotor signals ( Jezernik et al., 2001 ; Farina et al., 2023 ;…”
Hybrid Tongue - Myoelectric Control Improves Functional Use of a Robotic Hand Prosthesis
Johansen, D., Popović, D. B., Dosen, S. S., & Struijk, L. N. S. A. (2021) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2021.3052065 · Cited by 12 · see citing works
“, TMR and Implantable Myoelectric Sensors (IMESs) [34]–[36].”
BackgroundGarcía-Moreno, A., Comerma-Montells, A., Tudela-Pi, M., Minguillón, J., Becerra-Fajardo, L., & Ivorra, A. (2022) · Journal of Neural Engineering · doi:10.1088/1741-2552/ac8dc4 · Cited by 12 · see citing works
“More recently, intramuscularly implantable myographic sensors based on the BION technology have been demonstrated for controlling robotic arms in amputees [9].”
BackgroundTereshenko, V., Dotzauer, D. C., Schmoll, M., Harnoncourt, L., Rojas, G. C., Gfrerer, L., Eberlin, K. R., Austen, W. G., Blumer, R., Farina, D., et al. (2024) · Science Advances · doi:10.1126/sciadv.adj3872 · Cited by 10 · see citing works
Self-citationEnhancing prosthetic hand control: A synergistic multi-channel electroencephalogram
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“These challenges include the invasiveness of the surgery, risks of infection, rejection, and long-term biocompatibility issues (Salminger et al., 2019).”
Ultrasound-powered tiny neural stimulators
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Sturma, A., Boesendorfer, A., Gstoettner, C., Baumgartner, B., Salminger, S., Farina, D., Brånemark, R., Vujaklija, I., Hobusch, G. M., & Aszmann, O. C. (2024) · Journal of Rehabilitation Medicine · doi:10.2340/jrm.v56.34141 · Cited by 9 · see citing works
Self-citationLong-term implantable flexible neural interfaces for electrophysiological monitoring
Chen, B., Lu, J., Chen, Z., Han, X., Sun, Y., Lin, X., Tang, Z., Jia, S., Xie, G., Huo, F., et al. (2024) · Journal of Materials Chemistry C · doi:10.1039/d4tc04289a · Cited by 10 · see citing works
Taghlabi, K. M., Cruz-Garza, J. G., Hassan, T., Potnis, O., Bhenderu, L. S. S., Guerrero, J. R., Whitehead, R. E., Wu, Y. C., Luan, L., Xie, C., et al. (2024) · Journal of Neural Engineering · doi:10.1088/1741-2552/ad200f · Cited by 8 · see citing works
“Furthermore, a study highlights the need to incorporate real-time sensory feedback into prosthetic limbs [199].”
BackgroundGates, D. H., Gonzalez, M. A., Kung, T. A., & Chestek, C. A. (2023) · Current Opinion in Biomedical Engineering · doi:10.1016/j.cobme.2023.100497 · Cited by 8 · see citing works
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“61,62 IMES has enabled classification of up to seven distinct finger movements and prosthesis control of three DoFs in rhesus monkeys and humans, respectively.”
BackgroundInfluentialDistaNet: grasp-specific distance biofeedback promotes the retention of myoelectric skills
Ma, C., & Nazarpour, K. (2024) · Journal of Neural Engineering · doi:10.1088/1741-2552/ad4af7 · Cited by 9 · see citing works
“Similarly, both one-day and multi-day studies of myoelectric control with machine learning based decoders reveal improvement in control with practice; with fixed, recalibrated, or adaptive decoders [11, 15–18].”
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Self-citationHighly Accurate Real-Time Decomposition of Single Channel Intramuscular EMG
Yu, T., Akhmadeev, K., Carpentier, É. L., Aoustin, Y., & Farina, D. (2021) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2021.3104621 · Cited by 7 · see citing works
Self-citationToward Natural Limb Function: A New Era in Prosthetic Innovation
Tian, Y., Wallace, D. M., Cederna, P. S., Chestek, C. A., & Kemp, S. W. P. (2025) · Annals of Neurology · doi:10.1002/ana.27287 · Cited by 8 · see citing works
“41 One limitation of TMR is that the size mismatch between the large donor nerve and the smaller motor branch of the muscle may prevent some motor axons in the proximal nerve from regenerating distally and reinnervating the target muscle due to the limited number of endoneurial conduits present.”
Design trends in actuated lower-limb prosthetic systems: a narrative review
Sun, H., He, C., & Vujaklija, I. (2023) · Expert Review of Medical Devices · doi:10.1080/17434440.2023.2279999 · Cited by 7 · see citing works
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Tereshenko, V., Giorgino, R., Eberlin, K. R., Valerio, I. L., Souza, J. M., Bonetti, M. A., Peretti, G. M., & Aszmann, O. C. (2024) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000005850 · Cited by 6 · see citing works
“41 Although osseointegrated implants provide a robust biomechanical fixation of the prosthesis itself, they can also act as a viable option for the bidirectional transmission of neural signals.”
BackgroundSelf-citationImproving Upper-limb Prosthesis Usability: Cognitive Workload Measures Quantify Task DifficultyPreprint
Paskett, M. D., Garcia, J. K., Jones, S. T., Brinton, M. R., Davis, T. S., Duncan, C. C., Cooper, J. M., Strayer, D. L., & Clark, G. A. (2022) · medRxiv · doi:10.1101/2022.08.02.22278038 · Cited by 6 · see citing works
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“Intramuscular recordings indeed provide higher resolution, signal fidelity and access to deep muscle fibres, enabling more accurate decoding of motor intent 42 .”
Self-citationAmin, K., & Fildes, J. E. (2022) · Frontiers in Surgery · doi:10.3389/fsurg.2022.873507 · Cited by 5 · see citing works
“Two IMES are required for each DoF collectively making this a less than ideal practical solution (82).”
BackgroundCross-Individual Gesture Recognition Based on Long Short-Term Memory Networks
Min, H., Chen, Z., Fang, B., Xia, Z., Song, Y., Wang, Z., Zhou, Q., Sun, F., & Liu, C. (2021) · Scientific Programming · doi:10.1155/2021/6680417 · Cited by 5 · see citing works
Gherardini, M., Sturma, A., Boesendorfer, A., Ianniciello, V., Mannini, A., Aszmann, O. C., & Cipriani, C. (2022) · IEEE Robotics and Automation Letters · doi:10.1109/lra.2022.3181748 · Cited by 5 · see citing works
Self-citationToward self-contained bidirectional bionic limbs with high information throughput
Dosen, S. S. (2023) · Science Robotics · doi:10.1126/scirobotics.adk6086 · Cited by 4 · see citing works
“The signals can also be transmitted wirelessly ( 6 ), but sending power and data efficiently through the body wire-lessly with compact electronics is still a challenge.”
BackgroundPan, L., Ren, Z., Zhu, K., & Li, J. (2023) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-023-02923-x · Cited by 4 · see citing works
“Therefore, several researchers have attempted to elicit tactile sensations in the hand [2, 3].”
A fast gradient convolution kernel compensation method for surface electromyogram decomposition
Lin, C., Cui, Z., Chen, C., Liu, Y., Chen, C., & Jiang, N. (2024) · Journal of Electromyography and Kinesiology · doi:10.1016/j.jelekin.2024.102869 · Cited by 5 · see citing works
A Sensor-Based Classification for Neuromotor Robot-Assisted Rehabilitation
Vaida, C. L., Rus, G., & Pisla, D. L. (2025) · Bioengineering · doi:10.3390/bioengineering12030287 · Cited by 4 · see citing works
Implantable Myoelectric Sensors for Prosthetic Control
Gstoettner, C., Salminger, S., Bergmeister, K. D., Willensdorfer, A., Aman, M., & Aszmann, O. C. (2021) · Springer eBooks · doi:10.1007/978-3-030-60746-3_14 · Cited by 3 · see citing works
Self-citationAI with Robotics for leg support to skiers and snowboarders
Liu, S., Liu, Z., Alfred Daniel, J., & Thilak, K. D. (2021) · Journal of Intelligent & Fuzzy Systems · doi:10.3233/jifs-219012 · Cited by 3 · see citing works
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“Intramuscular EMG improves controller reliability by providing stable signals with a high signal-to-noise ratio.(15,67) However, it also may allow for techniques such as the HMM to confidently estimate grasp states on faster timescales.”
MethodIntramuscular EMG For Abstract Myoelectric Control: A Proof Of Concept Study
Dupan, S. S. G., Krasoulis, A., & Nazarpour, K. (2020) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc44109.2020.9175402 · Cited by 3 · see citing works
“A possible additional advantage to intramuscular measurements is that the resulting signals might be less affected by changes in arm position [6, 7].”
BackgroundMethodResultInfluentialDevelopment of Human Mashine Interface for an Electromyogram Recorder
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Spinal Interfacing via Muscle Recordings for Neuroprosthesis Control
Muceli, S., & Farina, D. (2021) · Handbook of Neuroengineering · doi:10.1007/978-981-15-2848-4_29-1 · Cited by 2 · see citing works
Self-citationSégas, E., Mick, S., Leconte, V., Dubois, O., Klotz, R., Cattaert, D., & de Rugy, A. (2023) · eLife · doi:10.7554/elife.87317.3 · Cited by 2 · see citing works
Long-term upper-extremity prosthetic control using Regenerative Peripheral Nerve InterfacesPreprint
Vu, P. P., Vaskov, A. K., Lee, C., Jillala, R., Davis, A. J., Kung, T. A., Kemp, S. W. P., Gates, D. H., Chestek, C. A., & Cederna, P. S. (2022) · Research Square · doi:10.21203/rs.3.rs-1578680/v1 · Cited by 2 · see citing works
Yu, T., Muceli, S., Akhmadeev, K., Carpentier, É. L., Aoustin, Y., & Farina, D. (2025) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2025.3556853 · Cited by 1 · see citing works
Self-citationSpinal Interfacing via Muscle Recordings for Neuroprosthesis Control
Muceli, S., & Farina, D. (2023) · Handbook of Neuroengineering · doi:10.1007/978-981-16-5540-1_29 · Cited by 1 · see citing works
Self-citationHarnoncourt, L., Gstoettner, C., Laengle, G., Boesendorfer, A., & Aszmann, O. C. (2024) · Handchirurgie · Mikrochirurgie · Plastische Chirurgie · doi:10.1055/a-2260-9842 · Cited by 1 · see citing works
“Darüber hinaus konnte von unserer Forschungsgruppe die Langzeitverträglichkeit und Effektivität eines solchen Systems bestätigt und eine langfristig stabile und intuitive Prothesensteuerung nachgewiesen werden [43].”
BackgroundSelf-citationProthetische Versorgung und therapeutische Intervention nach Targeted Muscle Reinnervation (TMR)
Sturma, A., & Oppel, H. (2025) · Springer eBooks · doi:10.1007/978-3-662-67795-7_11 · Cited by 1 · see citing works
Self-citationA Novel Interface Device Developed based on MRT for Prosthetic Hand
Fang, B., Chen, Z., Sun, F., Yang, Y., Min, H., Liu, H., Hou, S., & Sun, B. (2020) · Chinese Automation Congress · doi:10.1109/cac51589.2020.9327035 · Cited by 1 · see citing works
“However, the extracted signals can only reflect the intention of the superficial muscle of the residual limb [2] with strong randomness and instability, such as background noise, easily suffering from skin sweat and muscle fatigue.”
BackgroundSégas, E., Mick, S., Leconte, V., Dubois, O., Klotz, R., Cattaert, D., & de Rugy, A. (2022) · medRxiv · doi:10.1101/2022.10.15.22281053 · Cited by 1 · see citing works
Nazarpour, K. (2023) · eLife · doi:10.7554/elife.87317.1.sa3 · Cited by 1 · see citing works
Implantable Devices, Nano-, and Micro-Capsules for Future Nanomedicine and Life Sciences Nano-ToolsPreprint
Palacios, L. R. G., Amé, M., Martinez, S., Tettamanti, C. S., Amé, M. V., Quinteros, D. A., & Bracamonte, A. G. (2023) · Preprints.org · doi:10.20944/preprints202308.1090.v1 · Cited by 1 · see citing works
Rolling 2D Bioelectronic film into 1D: a Suturable Long-term Implantable Soft MicrofiberPreprint
Xie, R., Yu, Q., Li, D., Xu, H., Xu, X., Huang, J., Yan, W., Zhou, X., Deng, X., Tian, Q., et al. (2023) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2023.10.02.560392 · Cited by 1 · see citing works
A Robust Neuromuscular Interface to Restore Lost Function in People with AmputationsPreprint
Vaskov, A. K., Wallace, D. M., Desai, K., Laidlaw, A. T., Kung, T. A., Gates, D. H., Kemp, S. W. P., Chestek, C. A., & Cederna, P. S. (2025) · Research Square · doi:10.21203/rs.3.rs-5989030/v1 · Cited by 1 · see citing works
“The four patients had an age range of 33– 74 and were implanted with electrodes 1.0–4.7 years after amputation.”
InfluentialPeripheral nerve surgery: Impact and importance – Making a difference in patients’ lives
Rasulić, L. (2026) · Brain and Spine · doi:10.1016/j.bas.2026.105941 · Cited by 1 · see citing works
Upper limb prostheses control based on user's body compensations
Legrand, M. L. (2021) · doi:10.70675/ed6006b7zd285z46deza981zccb011324956 · Cited by 2 · see citing works
- Authors
- Salminger, S., Sturma, A., Hofer, C., Evangelista, M., Perrin, M., Bergmeister, K. D., Roche, A. D., Hasenoehrl, T., Dietl, H., Farina, D., & Aszmann, O. C.
- Affiliations
- Medical University of Vienna (AT)
- Imperial College London (GB)
- Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
- Alfred Mann Foundation (US)
- NHS Lothian (GB)
- Ottobock (Austria) (AT)
- Corresponding author
- Aszmann, O. C.
- ORCID
- Venue
- Science Robotics
- Published
- 2019-07-17
- Volume
- 4
- Issue
- 32
- ISSN
- 2470-9476 (ISSN-L)
- OpenAlex
- W2956204178
- Cited by
- 139
- References
- 36
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 19 · 2023: 39 · 2022: 19 · 2021: 19 · 2020: 17 · 2019: 2
- FWCI
- 5.00
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- cc-by
- Locations
- Science Robotics (publishedVersion)
- PubMed (publishedVersion)
- Zenodo (CERN European Organization for Nuclear Research) (cc-by)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Muscle activation and electromyography studies
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neural Engineering
- Physical Sciences › Engineering › Biomedical Engineering › Prosthetics and Rehabilitation Robotics
- Keywords
- targeted muscle reinnervation, above-elbow amputation, robotic arm control, nerve transfer, prosthetic control, surface electrodes, amputee rehabilitation
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