Research
Dr. Marasco and his team study the sensory nervous system and develop intuitive touch and movement feedback for artificial limbs.
In our research, we study the sensory nervous system with a focus on the mechanics of brain organization and neuroplasticity. Our findings allow us to build prosthetic devices with sensory integration, giving amputees a sense of touch through their prosthetic limb.
The lab works with patients who have undergone specific surgeries to reintegrate the nerves that once supplied sensation to the amputated limb back into the skin of the residual limb. This allows us to map sensations from an amputee’s missing limb in their residual limb, and pair these areas with appropriate mechanisms to mimic the sense of touch.
Our work also focuses on establishing an understanding of how sensory channels are organized and integrated to establish a cognitive sense of self, embodiment, and authorship. We use our understanding of these sensory and cognitive pathways to drive cognitive engagement with artificial limbs for amputees.
Biography
Dr. Marasco is a neuroscientist (sensory neurophysiology) who focuses on applied cognitive/perceptual systems integration within a biomedical engineering context. He is an Associate Staff Scientist in the Lerner Research Institute Department of Biomedical Engineering at Cleveland Clinic and a Principal Investigator in the Advanced Platform Technology Center of Excellence at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, where he is also the Director of Amputee Research for the Department of Physical Medicine and Rehabilitation. He heads the Laboratory for Bionic Integration where neural-machine-interfaces are used to provide touch and movement sensation to prosthetic limbs so that individuals with amputation feel like the devices are a part of their body. Dr. Marasco leads a number of multi-institution and international projects funded across the National Institutes of Health (NIH), the Defense Advanced Research Projects Administration (DARPA), the Department of Defense’s Congressionally Directed Medical Research Program (CDMRP), and the Veterans Administration (VA).
In addition to investigating how to use perception and cognition to make prosthetics feel, Dr. Marasco and his teams are also working to develop new validated functional tests for advanced prosthetic systems to measure the tangible benefit of improved sensation on the use of prosthetic devices and help communicate the outcomes to clinicians and payers. They are providing joint movement sensations to amputees without neural-machine-interfaces so that they can move and walk better, and also developing advanced composite approaches to make silicone socket liners more comfortable. Through the VA, Dr. Marasco was recently awarded the Presidential Early Career Award for Scientists and Engineers, which is the highest honor bestowed by the U.S. government on outstanding scientists and engineers beginning their independent careers in the Federal Services.
Education & Professional Highlights
Research
Overview
Neural-Machine Interface and Prosthetics
A neural-machine interface is a machine, such as a bionic limb, that has a connection with the wearer’s brain—in this case, the user’s limb nerves. Our prosthetics utilize a neural-machine interface that surgically reconnects amputated nerves to new muscle and skin sites. The nerves of these amputees are not physically connected to the machine; instead, the bionic prosthetic picks up electrical signals from the reinnervated muscles and small robots push and vibrate against the user’s skin containing the reintegrated nerves.
When an amputee thinks about moving their bionic limb, nerve impulses travel from their brain to the reintegrated nerve endings in their muscles. The mechanical components of the muscles generate electricity when they contract which acts like a biological amplifier; intensifying the nerve impulses so that they control the actions of the prosthetic.
The prosthetic is bidirectional, meaning that it also receives information and relays it back to the nerves. Tactors, or touch robots, are integrated into the limb. These robots send pressure and vibrations through the skin to communicate with their reintegrated nerves which provides information about the prosthetic limb to the user’s brain. The information includes the prosthetic’s movement in space, the shape of the hand’s grip, and the feel of objects that the hand is touching.
Prosthetic Embodiment
We study ownership and agency, and use these concepts to engineer prosthetics that cognitively and perceptually integrate with the user.
Ownership is the sense that one occupies their body, and that the parts of one’s body belong to them. In our research, we use physiologically relevant artificial touch to help amputees feel that their prosthetic limb is a naturally integrated part of their body.
Agency is the feeling that you are the author of your actions. We use perceptual illusions of movement that are coupled to the intended movement of a prosthesis to provide amputees a sense of agency over their devices.
Together the experience of ownership and agency combine to provide a more integrated sense of overall prosthetic embodiment. This provides the amputees with a clear feeling that their prosthetic limb is a natural part of their own body.
Functional Metrics for Humans with Bidirectionally Integrated Prosthetic Limbs: Upper Limb Sensory-Motor Integration Assessments
The Laboratory for Bionic Integration is working closely with Dr. Jacqueline Hebert, MD, FRCPC at the University of Alberta; and Dr. Jon Sensinger, PhD, PEng of the University of New Brunswick to develop a suite of metrics as sophisticated and effective as the devices that they assess. These tests help map system function, so that they may be used as tools to inform technology design, implementation, and translation. The metrics are designed to not have a ceiling effect so that comparisons can be made with able-bodied users. They are rooted in science (psychophysics, cognition/perception, and kinematics) yet they represent functional, real-world tasks that are clinically applicable to users of advanced upper limb sensory-motor integration technologies.
Key Concepts
Sensory nervous system: The nerves responsible for gathering information from your senses
Neuroplasticity: The ability of the brain to reorganize
Embodiment: The feeling that the parts of your body belong to you
Authorship: The feeling that you are in control of your body’s actions
Cognitive engagement: Amputees perceive that their prosthetic limb is under their control, and a part of their body
Our Team
Selected Publications
View publications for Paul Marasco, PhD
(Disclaimer: This search is powered by PubMed, a service of the U.S. National Library of Medicine. PubMed is a third-party website with no affiliation with Cleveland Clinic.)
P.D. Marasco, Navigating the complexity of touch.Science 387,248-249(2025).DOI:10.1126/science.adu7929
P. D. Marasco, J. S. Hebert, J. W. Sensinger, D. T. Beckler, Z. C. Thumser, A. W. Shehata, H. E. Williams, K. R. Wilson, Neurorobotic fusion of prosthetic touch, kinesthesia, and movement in bionic upper limbs promotes intrinsic brain behaviors. Sci. Robot. 6, eabf3368 (2021).
Schofield JS, Battraw MA, Parker ASR, Pilarski PM, Sensinger JW, Marasco PD. Embodied Cooperation to Promote Forgiving Interactions With Autonomous Machines. Front Neurorobot. 2021 Apr 9;15:661603. doi: 10.3389/fnbot.2021.661603. eCollection 2021. PMID: 33897401 Free PMC article.
Keri MI, Shehata AW, Marasco PD, Hebert JS, Vette AH. A Cost-Effective Inertial Measurement System for Tracking Movement and Triggering Kinesthetic Feedback in Lower-Limb Prosthesis Users. Sensors (Basel). 2021 Mar 6;21(5):1844. doi: 10.3390/s21051844. PMID: 33800790 Free PMC article.
Ferrari F, Shell CE, Thumser ZC, Clemente F, Plow EB, Cipriani C, Marasco PD. Proprioceptive Augmentation With Illusory Kinaesthetic Sensation in Stroke Patients Improves Movement Quality in an Active Upper Limb Reach-and-Point Task. Front Neurorobot. 2021 Mar 1;15:610673. doi: 10.3389/fnbot.2021.610673. eCollection 2021.PMID: 33732129 Free PMC article.
Shell CE, Christie BP, Marasco PD, Charkhkar H, Triolo RJ. Lower-Limb Amputees Adjust Quiet Stance in Response to Manipulations of Plantar Sensation. Front Neurosci. 2021 Feb 18;15:611926. doi: 10.3389/fnins.2021.611926. eCollection 2021. PMID: 33679300 Free PMC article.
Schofield JS, Shell CE, Beckler DT, Thumser ZC, Marasco PD. Long-Term Home-Use of Sensory-Motor-Integrated Bidirectional Bionic Prosthetic Arms Promotes Functional, Perceptual, and Cognitive Changes. Front Neurosci. 2020 Feb 19;14:120. doi: 10.3389/fnins.2020.00120. eCollection 2020. PMID: 32140096 Free PMC article.
Fabrication and application of an adjustable myoelectric transhumeral prosthetic socket. Schofield JS, Schoepp KR, Stobbe M, Marasco PD, Hebert JS. Prosthet Orthot Int. 2019 Oct;43(5):564-567. doi: 10.1177/0309364619836353. Epub 2019 Mar 29. PMID: 30922181
Ereifej ES, Shell CE, Schofield JS, Charkhkar H, Cuberovic I, Dorval AD, Graczyk EL, Kozai TDY, Otto KJ, Tyler DJ, Welle CG, Widge AS, Zariffa J, Moritz CT, Bourbeau DJ, Marasco PD. Neural engineering: the process, applications, and its role in the future of medicine. J Neural Eng. 2019 Nov 12;16(6):063002. doi: 10.1088/1741-2552/ab4869. PMID: 31557730 Free PMC article.
Christie BP, Charkhkar H, Shell CE, Marasco PD, Tyler DJ, Triolo RJ. Visual inputs and postural manipulations affect the location of somatosensory percepts elicited by electrical stimulation. Sci Rep. 2019 Aug 12;9(1):11699. doi: 10.1038/s41598-019-47867-1. PMID: 31406122 Free PMC article.
Shehata AW, Keri MI, Gomez M, Marasco PD, Vette AH, Hebert JS. Skin Stretch Enhances Illusory Movement in Persons with Lower-Limb Amputation. IEEE Int Conf Rehabil Robot. 2019 Jun;2019:1233-1238. doi: 10.1109/ICORR.2019.8779477. PMID: 31374798
Beckler DT, Thumser ZC, Schofield JS, Marasco PD. Using sensory discrimination in a foraging-style task to evaluate human upper-limb sensorimotor performance. Sci Rep. 2019 Apr 9;9(1):5806. doi: 10.1038/s41598-019-42086-0. PMID: 30967581 Free PMC article.
Schofield JS, Shell CE, Thumser ZC, Beckler DT, Nataraj R, Marasco PD. Characterization of the Sense of Agency over the Actions of Neural-machine Interface-operated Prostheses. J Vis Exp. 2019 Jan 7;(143). doi: 10.3791/58702. PMID: 30663709
Beckler DT, Thumser ZC, Schofield JS, Marasco PD. Reliability in evaluator-based tests: using simulation-constructed models to determine contextually relevant agreement thresholds. BMC Med Res Methodol. 2018 Nov 19;18(1):141. doi: 10.1186/s12874-018-0606-7. PMID: 30453897 Free PMC article.
Downey JE, Weiss JM, Flesher SN, Thumser ZC, Marasco PD, Boninger ML, Gaunt RA, Collinger JL. Implicit Grasp Force Representation in Human Motor Cortical Recordings. Front Neurosci. 2018 Oct 31;12:801. doi: 10.3389/fnins.2018.00801. eCollection 2018. PMID: 30429772 Free PMC article.
Schoepp KR, Schofield JS, Home D, Dawson MR, Lou E, Keri M, Marasco PD, Hebert JS. Real time monitoring of transtibial elevated vacuum prostheses: A case series on socket air pressure. PLoS One. 2018 Oct 22;13(10):e0202716. doi: 10.1371/journal.pone.0202716. eCollection 2018. PMID: 30346953 Free PMC article.
Charkhkar H, Shell CE, Marasco PD, Pinault GJ, Tyler DJ, Triolo RJ. High-density peripheral nerve cuffs restore natural sensation to individuals with lower-limb amputations. J Neural Eng. 2018 Oct;15(5):056002. doi: 10.1088/1741-2552/aac964. Epub 2018 Jun 1. PMID: 29855427
Thumser ZC, Slifkin AB, Beckler DT, Marasco PD. Fitts' Law in the Control of Isometric Grip Force With Naturalistic Targets. Front Psychol. 2018 Apr 26;9:560. doi: 10.3389/fpsyg.2018.00560. eCollection 2018. PMID: 29773999 Free PMC article.
Marasco PD, Hebert JS, Sensinger JW, Shell CE, Schofield JS, Thumser ZC, Nataraj R, Beckler DT, Dawson MR, Blustein DH, Gill S, Mensh BD, Granja-Vazquez R, Newcomb MD, Carey JP, Orzell BM. Illusory movement perception improves motor control for prosthetic hands. Sci Transl Med. 2018 Mar 14;10(432):eaao6990. doi: 10.1126/scitranslmed.aao6990.PMID: 29540617 Free PMC article.
McDaniel J, Lombardo LM, Foglyano KM, Marasco PD, J Triolo R. Cycle Training Using Implanted Neural Prostheses: Team Cleveland. Eur J Transl Myol. 2017 Dec 6;27(4):7087. doi: 10.4081/ejtm.2017.7087. eCollection 2017 Dec 5. PMID: 29299221 Free PMC article.
Marasco PD. Using proprioception to get a better grasp on embodiment. J Physiol. 2018 Jan 15;596(2):133-134. doi: 10.1113/JP275468. Epub 2017 Dec 28. PMID: 29194626 Free PMC article.
Marasco PD, Bourbeau DJ, Shell CE, Granja-Vazquez R, Ina JG. The neural response properties and cortical organization of a rapidly adapting muscle sensory group response that overlaps with the frequencies that elicit the kinesthetic illusion. PLoS One. 2017 Nov 28;12(11):e0188559. doi: 10.1371/journal.pone.0188559. eCollection 2017. PMID: 29182648 Free PMC article.
McDaniel J, Lombardo LM, Foglyano KM, Marasco PD, Triolo RJ. Setting the pace: insights and advancements gained while preparing for an FES bike race. J Neuroeng Rehabil. 2017 Nov 17;14(1):118. doi: 10.1186/s12984-017-0326-y. PMID: 29149885 Free PMC article.
Schofield JS, Schoepp KR, Williams HE, Carey JP, Marasco PD, Hebert JS. Characterization of interfacial socket pressure in transhumeral prostheses: A case series. PLoS One. 2017 Jun 2;12(6):e0178517. doi: 10.1371/journal.pone.0178517. eCollection 2017.PMID: 28575012 Free PMC article.
Schofield JS, Evans KR, Hebert JS, Marasco PD, Carey JP. The effect of biomechanical variables on force sensitive resistor error: Implications for calibration and improved accuracy. J Biomech. 2016 Mar 21;49(5):786-792. doi: 10.1016/j.jbiomech.2016.01.022. Epub 2016 Feb 9. PMID: 26903413 Free PMC article.
Hebert JS, Olson JL, Morhart MJ, Dawson MR, Marasco PD, Kuiken TA, Chan KM. Novel targeted sensory reinnervation technique to restore functional hand sensation after transhumeral amputation. IEEE Trans Neural Syst Rehabil Eng. 2014 Jul;22(4):765-73. doi: 10.1109/TNSRE.2013.2294907. Epub 2013 Dec 18. PMID: 24760915
Fox JD, Capadona JR, Marasco PD, Rowan SJ. (2013) Bioinspired Water-Enhanced Mechanical Gradient Nanocomposite Films That Mimic the Architecture and Properties of the Squid Beak. J Am Chem Soc.
Marasco PD, Kim K, Colgate JE, Peshkin MA, Kuiken TA. (2011) Robotic touch shifts perception of embodiment to a prosthesis in Targeted Reinnervation amputees. Brain. 134: 747-58
Marasco PD, and Kuiken TA. (2010) Amputation with median nerve redirection (Targeted Reinnervation) reactivates forepaw barrel subfield in rats. Journal of Neuroscience 30:16008-16014.
Marasco PD, Schultz AE, Kuiken TA. (2009) Sensory capacity of reinnervated skin after redirection of amputated upper limb nerves to the chest. Brain. 132(pt 6): 1441-8.
Schultz AE, Marasco PD, Kuiken TA. (2009) Vibrotactile detection thresholds for chest skin of amputees following targeted reinnervation surgery. Brain Research. 1251:121-9.
Kuiken TA*, Marasco PD*, Lock BA, Harden RN, Dewald JP. (2007) Redirection of cutaneous sensation from the hand to the chest skin of human amputees with targeted reinnervation. Proceedings of the National Academy of Sciences U S A. 104: 20061-6. (*these authors contributed equally to this work)
Marasco PD, Tsuruda PR, Bautista DM, Catania KC. (2007) The fine structure of Eimer’s organ in the coast mole (Scapanus orarius). Anatomical Record. 290: 437-448.
Marasco PD, and Catania KC. (2007) Response properties of primary afferents supplying Eimer’s organ. Journal of Experimental Biology. 210: 765-780
Kuiken TA, Miller LA, Lipschutz RD, Lock BA, Stubblefield K, Marasco PD, Zhou P, Dumanian GA. (2007) Targeted reinnervation for enhanced prosthetic arm function in a woman with proximal amputation. The Lancet 369: 371-380
Marasco PD, Tsuruda PR, Bautista DM, Julius D, Catania KC. (2006) Neuroanatomical evidence for segregation of nerve fibers conveying light touch and pain sensation in Eimer's organ of the mole. Proceedings of the National Academy of Sciences U S A. 103: 9339-9344
Henry EC, Marasco PD, Catania KC. (2005) Plasticity of the cortical dentition representation after tooth extraction in naked mole-rats. Journal of Comparative Neurology 485: 64-74
Appel, B., P. Marasco, L. McClung and A.J. Latimer (2003) lunatic fringe Regulates delta- notch induction of hypochord in zebrafish. Developmental Dynamics 228: 281-286
Crish, S.D., C. Comer, P. D. Marasco and K.C. Catania (2003) Somatosensation in the superior colliculus of the star-nosed mole. Journal of Comparative Neurology 464: 415-425
Book Chapters
Marasco PD., “Targeted Sensory Reinnervation”, chapter 8, in: Targeted Muscle Reinnervation, Kuiken and Schultz, Eds. CRC Press Taylor & Francis Group, Boca Raton, 2014 ISBN 978-1-4398-6080-9
Capadona, JR and PD Marasco “Brain Response to Neural Prostheses”, chapter 6, in: The Textbook of Neural Repair, Seltzer et al. Eds, 2nd Edition. (in-press)
Careers
Postdoctoral Fellows
We are currently seeking postdoctoral research fellows to work in the Laboratory for Bionic Integration at the Biomedical Engineering Department of Cleveland Clinic's Lerner Research Institute. Successful applicants must be excited to work within a multidisciplinary team of researchers, neuroscientists, engineers and clinicians. Candidate must have a strong research background as demonstrated through journal publications, and high-level conference participation. Applicants must be independent and highly motivated with a PhD in Biomedical Engineering, Neuro Sciences, Physiology, Electrical Engineering, Mechanical Engineering or related field.
As a Postdoctoral fellow you will be expected to lead exciting research contributing to the fields of neural-machine interfaces, limb prosthesis, or the mechanistic understandings of sensory processes. Previous experience with human or preclinical trials is preferred. Qualified applicants should submit a one-page research statement and a CV to Dr. Paul Marasco, [email protected].
Research News
Dr. Marasco was honored for engineering a prosthetic that allows the wearer to “think” and function like an able-bodied person.
Dr. Marasco and his collaborators designed a novel system that combines intuitive motor control, touch and grip kinesthesia for patients with upper-limb amputations.
The breakthrough may enhance the ability to control prostheses, independently manage activities of daily living and improve quality of life.