Restoring Somatosensation: Advantages and Current Limitations of Targeting the Brainstem Dorsal Column Nuclei Complex

Current neural prostheses can restore limb movement to tetraplegic patients by translating brain signals coding movements to control a variety of actuators. Fast and accurate somatosensory feedback is essential for normal movement, particularly dexterous tasks, but is currently lacking in motor neural prostheses. Attempts to restore somatosensory feedback have largely focused on cortical stimulation which, thus far, have succeeded in eliciting minimal naturalistic sensations. Yet, a question that deserves more attention is whether the cortex is the best place to activate the central nervous system to restore somatosensation. Here, we propose that the brainstem dorsal column nuclei are an ideal alternative target to restore somatosensation. We review some of the recent literature investigating the dorsal column nuclei functional organization and neurophysiology and highlight some of the advantages and limitations of the dorsal column nuclei as a future neural prosthetic target. Recent evidence supports the dorsal column nuclei as a potential neural prosthetic target, but also identifies several gaps in our knowledge as well as potential limitations which need to be addressed before such a goal can become reality.