the devices and methods of the invention allow one to controllably move a tissue , organ or suborgan , e . g ., to replicate functions lost in a disabled patient . the devices include , e . g ., an electroactive polymer actuator functionally interacting with a biocompatible implant and powered by an electrical power supply . the implant can be fixedly mounted to a tissue of a patient to transfer the actuator motion or force to the tissue . methods of using the electroactive polymer prosthetic devices can include , e . g ., fabricating an actuator that functions to move an implant , surgically mounting the actuator to a secure and properly aligned location in the body of the patient and attaching the implant to a tissue to be moved by activation of the actuator . a voltage can be supplied to the actuator in a fashion controllable , e . g ., by a manual switch or according to signals sent from appropriate sensors . in general , electroactive polymer ( eap ) prosthetic devices of the invention include a biocompatible implant that can be mechanically translated by an eap actuator to appropriately move tissues associated with the implant . the devices can include a power supply , power control circuitry , sensors , and / or mounting hardware . in use , the devices can be implanted under the skin of a patient typically with the actuator fixedly mounted to a bone near a tissue to be moved , and the implant ( e . g ., cord , lever or membrane ) fixedly or slidably attached to the tissue . electroactive polymer actuators of the invention are typically electroactive polymers accessorized function as an actuator when implanted into an animal &# 39 ; s body . the eaps can have a cover , e . g ., casing , to provide biocompatibility , electrical isolation , ion impermeability , power access , secure mounting points , and / or attachment points for implants to be moved . the eaps of the actuators can be of any type appropriate to the particular application . typical eaps are change size in at least one dimension in response to either electronic stimulation or changes to the surrounding ionic environment . for example , electroactive polymers of the invention can optionally be piezoelectric polymers , ionic electroactive polymers ( e . g ., certain conductive polymers , electrorheological fluids , ionic polymer gels , or ionic polymer metallic composites ), or electronic electroactive polymers ( e . g ., certain dielectric eaps , electrostrictive graft elastomers , electrostrictive paper , electro - viscoelastic elastomers or ferroelectric polymers ). the basic mechanism of motion generation ( actuation ) provided by a typical dielectric eap depends on a three - layer material structure , as shown in fig1 . a thin film ( e . g ., 20 to 60 microns ) of a dielectric elastomer , such as silicone or acrylic , is layered on each side with a conductive electrode layer made of carbon particles suspended in a soft polymer matrix . the electronic eap 10 comprises an elastomeric dielectric polymer film 11 sandwiched between compliant electrodes 12 , as shown in fig1 . when a dc voltage is applied to the electrodes , as shown in fig1 b , the attraction between the electrodes squeezes the elastomeric polymer causing it to expand in a plane perpendicular to the force . the outward force of such an expansion , or the retractive recoil on elimination of the voltage , can be used to move an attached implant . the voltages required for such a device can be relatively high , but current requirements can be quite low . when the voltage differential across the electrodes is neutralized , the elastomer polymer can contract back to the original shape with substantial force , so that an attached implant can be pulled back to an original position . the advantages of these “ capacitor ” style eaps can be low current usage , and the ability to provide ample forces across useful distances . a disadvantage in biological systems can be the need to electrically insulate the components against a relatively high working voltage . the qualities of dielectric eaps which make them good candidates for an biologically compatible artificial muscle include : 1 ) thin size , 2 ) ability to expand by as much as 400 percent or more when voltage is applied , 3 ) an ability to provide a strong mechanical force , 4 ) minimal heat generation , and 5 ) minimal current needed to maintain an activated state ( expanded ). in general , a linear relationship of voltage to device expansion is noted until a threshold of voltage is exceeded . at this point , increasing voltage result in less expansion as current flows dielectric silicone . ionic eaps , such as ionic polymer gels , ionomeric polymer - metal composites , conductive polymers and certain carbon nanotubes , work on the basis of electrochemistry . voltages required to affect ion interactions or electroosmotic flows can be relatively low , but the currents can be significant . exposure to excessive voltages can cause problems with electrolytic production of heat and gasses . moreover , in many cases , the ionic environment around the ionic polymers must be maintained within a certain range for the material to operate properly . eaps for use as implanted actuators are typically sealed in a flexible cover or hard case . for example an electronic eap can be covered in a flexible plastic insulator , at least at the electrodes and power supply wire contacts . tough contact areas can be provided for attachment to implants and mounting hardware . ionic eaps can be covered in a flexible capsule , which is impermeable to movement of ions into or out of the capsule interior . alternately , the eaps can be enclosed in a hard capsule or case that provides electrical insulation and / or isolation of ions , as required . when the eap cover is a hard case , a sealed port is typically required to allow force or motion of the eap to be received by the implant . for example , the eap can connect to the implant through a port sealed with a flexible membrane or an o - ring . the cover or case can include a means to fixedly mount the eap to a structural support in the body of a patient . for example , the case can include a hole or grommet to receive a surgical screw or pin for attachment to bone . optionally , the cover or case can have , e . g ., a biocompatible membrane or fabric allowing the case to be attached with sutures to connective tissues , such as tendons , ligaments , cartilage , aponeuroses , skin attachment points of platysma , and the like . it is preferred the outer surface of the actuator be covered in a biocompatible , non - immunogenic material . for example , the eap actuator can be covered with polyvinyl chloride , silicone , polyurethane , polytetrafluoroethylene , polycarbonate , polyethylene , titanium , stainless steel and / or the like . the implants of the present devices function to transfer the force or motion of the eaps to do work on tissues , as desired . the implants can be mechanical structures of suitable geometry and mechanical strength to perform a particular tissue translating task at hand . depending , e . g ., on the force and “ throw ” of a particular eap employed , the implant can be configured to provide the desired mechanical advantage and / or force vectors for the job . the implants are structures that can do the specialized mechanical work of the devices while allowing the eaps to function in the compatible internal environment of the actuator . implants can be unitary components or include multiple interacting parts . in a typical embodiment , an implant of the invention is simply a cord 20 intended to pull on a tissue 21 in response to a constrictive movement of the eap 22 in an actuator 23 , as shown in fig2 . the cord can be , e . g ., a line , string , filament , wire , etc ; single stranded or multi - stranded ; flexible or rigid . the cord can be mounted between the eap and tissue to provide a direct linear pull , e . g ., with the tissue attached at one end of the cord and the eap at the other end of the cord implant . optionally , the cord implant can be mounted as a sling 30 , e . g ., loosely mounted between the actuator 31 and a fixed mount point ( e . g ., on a solid tissue intended to remain relatively motionless ) with excess cord displaced laterally , as shown in fig3 a , while the actuator eap 32 is in an extended position . when a voltage is supplied ( or eliminated , e . g ., in the case of certain dielectric eaps ) from voltage source 33 , actuator 31 can be established in a retracted position . as shown in fig3 b , the sling 30 can be pulled taught ( or at least toward a more linear geometry ) so that displaced portions of the sling are moved , e . g ., toward a center line between the actuator and the fixed mount point . tissue can be fixedly or slidably attached to the sling to be pulled laterally when the actuator is in a retracted position . alternately , the implant can be provided in a constrictive loop or noose configuration . such configurations can aid in constrictions of body system lumens , such as found in the vasculature , alimentary tract , urinary systems , and the like . in constrictive embodiments , the actuator can be mounted on or near the body conduit to be constricted . the implant can be wrapped around the conduit . when the actuator is in the retracted condition , the implant can act to constrict the body conduit and reduce or eliminate the internal lumen cross section . when the actuator is in the expanded condition , the implant cord can be relaxed , allowing expansion ( e . g ., dilation ) of the lumen cross section . in other embodiments , the implant can have one or more planar or membranous components . for example , the implant can be a concave shaped membrane that can be pulled peripherally by eap actuators to urge the membrane into a more flattened topography . such an implant could act as a diaphragm or as part of a fluid pumping mechanism . depending on the force and throw of the eap and actuator assembly , it may be desirable to configure the implant to provide a mechanical advantage . for example , where the actuator is providing a large force with a short throw ( over a short distance ), and where it is desired to move a tissue over a larger distance with a lesser force , the implant can be designed as a lever with a pivot point so that the eap pulls on a short arm of the lever and the tissue is attached at the end , or along , the long arm of the lever . for example , the implant could be a rigid lever pivoting from the hard case of the actuator , with the eap attached close to the pivot point . the implant arm can extend out to a tissue to move the tissue a multiple of the distance from the pivot point to the eap attachment point , but with an inverse fraction of the force , as is known in the art . in preferred embodiments , the implants are one or more biocompatible materials that do not degrade in situ and do not elicit inflammation at the implantation site . the biocompatible implant material can be of a natural material , such as connective tissue from the same patient into whom the implant will be implanted . optionally , the implant can be formed from allograft connective tissue , a ligament , suture material , polyvinyl chloride , silicone , polyurethane , polytetrafluoroethylene , polycarbonate , polyester , polyethylene , a hydrogel , titanium , stainless steel and / or the like . the implant can be associated with tissue so as to transfer motion of the implant to the tissue . in most cases , this entails a fixed or slidable attachment of the implant to the tissue . any appropriate means of attachment can be used between the implant and the tissue , e . g ., a suture , pin , screw , staple , a biologic glue , a cement , and / or the like . in some cases , the implant is also mounted directly to a tissue that is not intended to be moved by the implant . for example , where the tissue is intended to be moved by lateral movement of a sling , the end of the sling can be fixedly mounted to a relatively stationary bone while fixed to the tissue to be moved , or slidably intertwined in the tissue to be moved . electroactive polymer prosthetic devices have actuators that require a voltage source to function . in many cases , the devices require significant amounts of current to function over extensive periods of time . typically , the devices are powered by a battery of some type . the power supply can be housed in the case of the actuator , or mounted at a location separate from the actuator . in most cases , it is desirable to have the power supply for the electroactive device implanted under the skin of the patient . in cases where the current requirements are small ( e . g ., short term prosthetics , prosthetics with small power demands ), a single use battery may be adequate . the battery can be of any appropriate type , such as , e . g ., silver chloride , alkaline , nicad , lithium , fuel cells , etc . it can be useful to have rechargeable batteries , e . g ., rechargeable through external contacts or through transdermal electromagnetic induction to an implanted coil . the devices can be powered by a generator implanted in contact with moving body parts to provide the required power or battery recharge . battery power can be conserved by turning off the device while it is not in use . a switch can be provided in the device circuitry to shut off the device , e . g ., while the patient is sleeping . a manual switch can be provided internally or externally . optionally , a magnetic or radio frequency switch can be provided , e . g ., to toggle on and off in response to appropriate electromagnetic signals . in many cases , it is useful to control energization of the actuators based on detection of a condition . for example , actuators can be triggered to translate an associated tissue in response to a signal from a sensor . the sensor can be , e . g ., a timer , a position sensor , an optical sensor , an electrode , a contact sensor , and / or the like . for example , an optical sensor can detect a projectile near the eye and signal a blink . where the prosthetic device is intended to provide a blink function to a paralytic eyelid , a timer can provide a signal for periodic blink actuation . sensor and signal systems can be used to synchronize ( or , in some cases , intentionally asynchronize ) actuators with patient movements . for example , where one eye is not paralyzed , an optical sensor ( e . g ., mounted to a glasses frame ) can detect blinking of the functional eye and synchronize blinking of the dysfunctional eye . optionally , a myoelectric sensor monitoring , e . g ., orbicularis oculi muscle ( blinking ) of the functional eyelid can be used to signal synchronized blinking of the dysfunctional eyelid . in other embodiments , a contact sensor can be used to appropriately signal actuation . for example , a contact sensor in a glove can signal actuation of a device to open or close a hand . a typical embodiment of the inventive devices is a system for providing eye closure to paralytic eyelids . as shown in fig4 , an eap device 40 includes an actuator 41 having an electroactive polymer 42 in a biocompatible cover 43 . the electroactive polymer is attached to a pair of cord implants 44 and energized by a power supply 45 . a myoelectric sensor 46 is in electrical contact with the actuator to provide an actuation signal . in use , the device is surgically implanted into a patient in need . through one or more incisions , the pair of sling cord implants are anchored to the medial orbit of the eye and run along tissue of the eyelids and around the zygomatic bone at the lateral orbit of the eye . the actuator is mounted at an anchor location on the sphenoid bone . the power supply is placed over the auricularis muscles in electrical contact with the actuator . the myoelectric sensor is placed in contact with the orbicularis muscle and a signal line is run through the scalp to a signal processing circuit housed in the actuator . all incisions are closed and the patient is allowed to heal . the implanted system functions to close the paralytic eyelid whenever the functional eyelid is closed . for example , when the functional eye of the patient blinks , the muscle activity is picked up by the sensor , which sends a signal to the signal processing circuit . the circuit appropriately configures electrical contacts to initiate a contraction of the eap in the actuator , thereby pulling on the sling cords and closing the eyelids over the eye . electroactive polymer prosthetic devices of the invention can be employed by attaching the actuator and implant to tissues of a patient , in a manner appropriate to the regain a disabled function . typically , in a surgical procedure , the actuator and implant are attached to tissues at two different locations . in many embodiments , the actuator is fixedly attached to a relatively stationary solid tissue structure and the implant is attached to a tissue to be moved by the actuator . in many embodiments , the device can replicate the function of a particular non - functional muscle with actuator and implant attachment points at or adjacent to the attachment points of the muscle . in other cases practical considerations necessitate novel arrangements to accomplish the desired animations . the methods generally include manufacture of the eap device with an actuator attached to an implant , creating an incision near the device implantation site , inserting the device through the incision , running the implant through tissues to the transposition points and mounting the actuator at an anchoring location . in one embodiment , the actuator is fixedly mounted to bone , or other dense connective tissue , and the implant is a cord attached to move a softer connective tissue or sub organ . for example , an upper eyelid can be opened by mounting an actuator at an anchoring location above the eyebrow to pull on an implant attached to the tarsal plate of the eyelid . in another embodiment of the invention , aspects of a smile can be reproduced , e . g ., by mounting an eap device of the invention between the zygomatic arch and connective tissue at the corner of a patient &# 39 ; s mouth . in some embodiments , implants do not run directly from the actuator to the tissue for to be moved . for example , a cord type implant can be slidably run around a “ corner ” between the actuator and the tissue . the point of sliding contact can be at a bone , a hole through a bone , or sheath of a connective tissue . optionally , the point of sliding contact can be a surgically implanted material , such as a teflon or stainless steel sliding surface . the following examples are offered to illustrate , but not to limit the claimed invention . some potential uses for artificial muscle in humans include breathing with an artificial diaphragm , movement of fingers and hands , and facial reanimation . of these concepts , we first looked at eyelid closure in the setting of facial paralysis . such a closure was expected to require the relatively small forces and require relatively simple surgery for mounting of the implant . the authors &# 39 ; hypothesis is that a reproducible , long - lasting eyelid blink can be restored in patients with facial paralysis using epam . this preliminary study was conducted as a proof of concept to determine if a novel eyelid sling can be implanted to achieve closure of the eyelids of a cadaver . electroactive polymer artificial muscle ( epam ) is an emerging technology that we believe has the potential to be used in rehabilitating facial movement in patients with paralysis . developed by the stanford research institute ( sri , menlo park , calif . ), these electroactive polymers can act like human muscles by expanding and contracting based on variable voltage input levels . we examined the reanimation of smaller muscle groups , such as those responsible for eyelid closure or facial expression . indications for such rehabilitation may include acquired facial paralysis after oncologic resection or traumatic injury . other patients that may benefit from artificial muscle technology include those with congenital facial nerve disorders such as moebius syndrome . epams can act like human muscles by expanding and contracting based on variable voltage input levels . we seek to establish a reproducible eyelid blink with artificial muscle . the aim of this proof of concept study was to determine if eyelid closure can be created with a novel eyelid sling model . a cadaver model was developed to test the concept of an eyelid sling , which will transduce the epam contraction to the eyelids . fresh cadaver heads from the uc davis body donor program were used in accordance with uc davis policies and procedures . one eye of each cadaver was utilized for the proof of concept experiment . the opposite eye was intended for subsequent study of vector and force requirements and prototype design analysis . using four cadaver heads , an extended upper and lower blepharoplasty incision was used to secure an upper and lower , expanded polytetraflouroethylene implant to the medial orbital wall and tarsal plates . the slings were passed through a hole drilled in the lateral orbital wall or around a titanium screw . lateral pull on the sling created eyelid closure and the necessary distance of pull was measured . dissection technique was as follows . the initial incision was a standard upper blepharoplasty incision at the supraciliary crease ( about 9 - 10 mm above the lash line ). the skin and orbicularis oculi muscle were carefully divided using a 15 blade with particular attention to preservation of the levator aponeurosis . the superior border of the tarsal plate in the upper eyelid was exposed ( similar to that used in gold weight placement ). to simulate the normal eyelid opening of the levator muscle , a 5 - o - nylon suture was secured through the midline levator aponeurosis attachment to the tarsal plate and passed under the skin to exit in the upper eyebrow region . a medial eptfe insertion site was selected . dissection superficial to the tarsal plate ( similar to central fat pocket dissection in blepharoplasty ) was carried medially to the junction of the frontal process of the maxilla and frontal bone . the lacrimal puncta was canulated with a lacrimal probe until the medial canthal dissection was completed . the attachments of the medial canthal ( palpebral ) ligament to the periosteum of the medial orbital wall was isolated and maintained . dissection in a subperiosteal plane with a freer elevator was performed just anterior to the anterior lacrimal crest and inferior to the junction of the frontal process of the maxilla and frontal bone . a 1 . 8 mm × 60 mm expanded polytetraflouroethylene ( eptfe , advanta implants , atrium medical corporation , hudson , n . h .) facial implant was secured under a 1 . 2 mm ( 2 hole ) titanium plate with two titanium screws ( 1 . 2 mm diameter , 3 mm long , stryker leibinger inc , kalamazoo , mich .). the screws were secured anterior to the medial canthal attachments . three 6 - 0 silk sutures were used to attach the epfe sling to the perichondrium of the tarsal plate ( similar to securing a gold weight ). the skin was approximated . the lower lid ( subciliary ) approach was used for the lower eyelid sling to be placed . in this eyelid sling concept , a laterally directed force on the sling pulls the sling from an arched shape to a linear shape , thereby closing the eyelids . the point at which the sling passes over the lateral orbital rim was tested with two techniques . first , a hole was drilled in the lateral orbital bone proximal to whitnall &# 39 ; s tubercle ( as described by alex et al for transorbital facial suspension ). the slings for upper and lower eyelids were passed through the hole and tension applied until the eyelids were closed . the distance of sling displacement through the lateral orbital drill hole was measured . in a second technique , a titanium screw was placed into the lateral orbital rim as a positioning guide for the slings . the slings were passed around the screw . the required distance of pull was measured . the approach was successful at positioning the eepte sling in the upper and lower eyelids to create a sphincteric - like closure of the eyelids when the sling was pulled laterally . the distance of pull required to create complete eyelid closure was 3 mm when both slings were activated , while 6 mm of sling displacement when pulling only the upper sling . the positioning of the lateral orbital wall drill hole was noted to be above whitnall &# 39 ; s tubercle ( attachment of the lateral canthal tendon ) and approximately 1 cm inferior to the frontozygomatic suture line . in one dissection , the drill hole was positioned higher and did not allow for complete eyelid closure laterally due to the inadequate vector . correction with a drill hole placed just above whitnall &# 39 ; s tubercle eliminated lagopthalmosis . this preliminary study established a possible method of converting the energy created by artificial muscle ( epam ) into a reproducible eyelid closure . we have found the required pull distance and required force to be well within the capabilities of available epams . an electroactive polymer will be able to be implanted under the skin with a self - contained energy source as a biologically active , artificial muscle . for comparison , a 1 . 2 gram gold weight implant that has been placed in an upper eyelid facilitates eyelid closure with the force of gravity . the epam device will need to create a similar force to close the eyelids . because one newton of force is equal to about 102 grams on the surface of the earth , significantly less than a newton of force will likely be needed to close the eyelids . this is not a difficult force to obtain using electroactive polymer actuators . it is understood that the examples and embodiments described herein are for illustrative purposes only and that various modifications or changes in light thereof will be suggested to persons skilled in the art and are to be included within the spirit and purview of this application and scope of the appended claims . while the foregoing invention has been described in some detail for purposes of clarity and understanding , it will be clear to one skilled in the art from a reading of this disclosure that various changes in form and detail can be made without departing from the true scope of the invention . for example , many of the techniques and apparatus described above can be used in various combinations . all publications , patents , patent applications , and / or other documents cited in this application are incorporated by reference in their entirety for all purposes to the same extent as if each individual publication , patent , patent application , and / or other document were individually indicated to be incorporated by reference for all purposes .
this invention provides methods and devices for reconstructing muscular responses in patients with paralysis . electroactive polymer actuators power implants attached to tissues in the patients . when the actuators are energized , the implants move the tissues appropriately to provide improved body functions to patients experiencing a paralysis or paresis .