"Si vis sanri de morbo nescio quali;

accipas herbam, sed quam vel nescio qualem;

ponas nescio quo, sanabere nescio quando."

 

“If you do not understand the disease you suffer,

and you use drugs and treatment that you do not understand,

you will not know when you will be healthy again.”

 

FOREWORD

The objectives of the Fifth Neural Prosthe­ses: Motor System Confer­ence and the second meeting of the International  Functional  Electri­cal  Stimulation  Society (­IFESS) are to:

1) educate young research­ers in a highly spe­cial­ized but rapidly devel­oping field;

2) expe­dite the transfer of neural pros­theses through the devel­opment cycle from the engi­neer­ing labora­tory to the clinic and the manu­factur­ing indus­try; and

3) inte­grate engineering and clinical exper­tise in the development and appli­ca­tion of devices to restore motor function for indi­vidu­als with motor disabilities.

 

The focus of this joint meeting is the inte­gra­tion of engineering and neuro­sci­ence research efforts in order to accomplish those three objectives.

 

The Neural Prostheses meeting be­longs to a series of conferences held every three years under the primary spon­sorship of the Engineer­ing Foun­dation, New York, which sponsored more than 500 confer­enc­es in its history. The inten­tion of the orga­nizers of the fifth Neural Prostheses (NP­'97) meeting was to change somewhat the format of the meeting be­cause it runs jointly with the International Functional Electrical Stimula­tion Society (IFESS'97) annual meeting with­out the help of the Engineering Foun­dation. The IFESS annual conference at­tracts more than 150 partici­pants who are working in various aspects of rehabilitation engineering and applied neu­rosciences to hu­mans with disabilities. Many participants that are typically attend­ing the NP Confer­ences are active members of the IFESS.

 

Neural prostheses are systems which exter­nally stimulate neural tissue to restore function which is lost or diminished due to disease or injury. The best example of this approach is the cardi­ac pacemaker, which now produced in millions and used all around the world is approximately a 1.6 billion dollar industry, is in common use throughout the world, saving and extending lives and allowing more normal lives for people using this technology. Researcher have been working with some success to instrument other organs and control their behavior. The most common approach is to use electrical currents and apply them to the neural tissue; that is to use functional electrical stimulation (FES), or functional neuromuscular stimulation (FNS). The idea of using electrical currents to control motor function or other organs is not new, but the first U.S. patent was awarded to Dr. Liber­son and colleagues (1961). Since that time many patents and devices resulted from the research and there are several systems that are being available as commer­cial devices, as cochlear implants, phrenic nerve pacers, the micturition assist devices, grasping devices and similar. The cochlear prosthe­sis is commercial success already, the phrenic pacemaker is also success, but is orphan device, Parastep has just become FDA approved and commercially available, and others are expected soon.

 

Although neural prostheses for motor con­trol have been somewhat slow to appear on the market, remarkable advances have occurred internationally lately. There are many multi­center trials which include international collabo­ration and world wide testing of devices (the CWRU grasping system, The Bionic Glove grasping system, the Parastep II walking sys­tem, etc.). A number of textbooks and other publication appeared concentrating to the prob­lem investigated in this field, leading the Insti­tute of Electrical and Electronics Engineers (IEEE) to start a whole new Transaction quar­terly series relating to problems of rehabilita­tion (IEEE Transactions in Reha­bilitation Engineering).

 

The organizers of the meeting are aware that a neural prostheses development has two compet­ing directions: 1) regenera­tion of the central and periph­eral nervous sys­tem, regeneration of the lost mus­cles, etc; and 2) advanced bioengi­neering and motor control trying to externally replace some of the lost communication links and activate still preserved paralyzed structures. The encouraging results of the regenera­tion studies (The Miami Project to Cure Paraly­sis, Canadian Neuroscience Network, etc.) are another reason to speed up and improve the research that is the main topic of the NP'97 meeting.

 

As progress has occurred in the develop­ment of neural prostheses, consum­er inter­est has also been heightened. The FES Information Center of Case Western Re­serve University, started about eight years ago, and the FES network started in 1993 serving as a public clearing­house on the topic of neural prosthesis. More than 50 percent of all inquires are from the lay public, including disabled consumers and their friends and family.

 

This field is attracting many young re­searchers and the investigations are taking place at very many universities and other institutions around the world. The number of people with disabili­ties in each of the research centers is small, and the disabili­ties are very much different from subject to subject. To be effective it is of importance that the efforts of all research centers are integrated as much as possible. Given the international, interdisci­plinary nature of this work a forum is needed which gives numerous leading investigators the opportunity to share their experience with each other and with stu­dents new to the field in an effort to ad­vance the wide­spread application of neural prostheses. We are anticipating that the NP'97 meeting will provide such a forum.

 

The conference is timely in that a similar meeting has not occurred since 1994 when the last meeting in the Neural Prostheses IV: Motor System Confer­ence was held. Each of the previous meetings held in the series was de­signed with a unique and distinct focus. The first in the series of Conferences Motor System I, was held in 1985 in Henniker, New Hamp­shire, under the chairmanship of Dr. J.­Thomas Morti­mer. The purpose of this meeting was to bring together international leaders in the neuro­prosthetic field to begin a dialogue based on sharing experience. The second in the series, Motor System II, chaired by Dr. Donald McNeal, was held in Potosi, Mis­souri. This conference was focused on engineering advanc­es in neural prostheses. Motor system III, held in Banff, Alberta, Canada, and chaired by Dr. Richard Stein, had a focus on better under­standing the physiology underlying neural prostheses. More than 100 individuals from a dozen countries attended, including engineers, neuroscien­tists, clinicians, indus­try and govern­ment representa­tives and individuals with disabilities. A book has been pub­lished Neural Prostheses: Replac­ing Motor Function After Disease or Dis­ability by R.B.Stein, P.H.Pec­kham & D.B.Popovi}.

 

The previous Motor System IV confer­ence, chaired by Dr. H.P.Peckham, was held in Deer Creek, Ohio, focused to two prob­lems: 1) in‑depth assess­ment of the state of clinical motor system neural pros­theses (ambulation assistance, upper ex­tremity grasping systems, urinary control, respira­tory control and cough­ing, heart assist, fecal inconti­nence, laryngeal control and tenolysis applications); and 2) assess­ments of the relevant technical and physi­o­logical issues that are precluding the suc­cess­ful clinical implementation of these systems. A final point of the meeting was the analysis of the efficacy of the transfer of the re­search work to industry and clin­ics. More than 160 partici­pants spent five work­ing days in Deer Creek and actively con­tributed to the success of the meeting.

 

The discus­sion and presentation from the meet­ing were prepared with the help of medical writer Mrs. C.Kantor and pub­lished in the Rehabilita­tion R & D Journal in 1995. The co‑chair of the Motor System IV was Dr. J.A.Hoffer from the Simon Fraser Univer­sity, Burna­by, British Colum­bia, Canada. Partici­pants at the 1994 meeting recom­mended that a continuing conference be held on the Motor Systems topic in 1997. The Conference Chair and Co‑Chair for the 1997 meeting were select­ed at the 1994 Confer­ence.

 

The NP'97 is devot­ed to address the rele­vant neuro­science and physiological issues that can be integrat­ed into the new systems which may greatly enhance the usefulness of the motor neural prosthe­ses. Specifically the questions of the central vs. periphe-r­al control in humans and animals, natural and artificial reflexes, avail­ability of the neural recording techniques and ability to process these recordings in real time to replace lost sensory component of control and feed­back, synergistic behaviors which may simplify control paradigms will be discus­sed. The mod­erators will be asked to bring together discus­sants with somewhat contro­versial ap­proaches in order to moti­vate brainstorm­ing and open new prospec­tive to younger research­ers.

 

Dejan Popovi}                                              July 15, 1997