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Aljuhani W, Sayyad Y. Orthopedic Research Funding: Assessing the Relationship between Investments and Breakthroughs. Orthop Rev (Pavia) 2024; 16:120368. [PMID: 38993375 PMCID: PMC11236838 DOI: 10.52965/001c.120368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/01/2024] [Indexed: 07/13/2024] Open
Abstract
Orthopedic research plays a crucial role in improving patient outcomes for musculoskeletal disorders. This narrative review explores the intricate interplay between funding patterns and the trajectory of breakthroughs achieved in this dynamic field. A meticulous search strategy identified studies illuminating the diverse sources of orthopedic research funding, including public funding (government agencies), philanthropic organizations, private sector investment, and international funding bodies. The review further delved into the spectrum of breakthroughs, encompassing fundamental scientific discoveries, technological advancements, and personalized medicine approaches. Public funding emerged as a significant pillar, supporting foundational research that lays the groundwork for future advancements. Philanthropic organizations addressed specific musculoskeletal disorders, often focusing on patient-centric applications. International funding bodies played a role in supporting research in low- and middle-income countries. Breakthroughs extended beyond cutting-edge prosthetics and minimally invasive surgeries, encompassing fundamental discoveries in areas like gene therapy and biomaterials science. Technological advancements included brain-computer interface prosthetics and 3D-printed implants. Personalized medicine offered the potential for tailored treatments based on individual needs and genetic profiles. This review underscores the complex interplay between funding patterns and breakthroughs in orthopedic research. A multifaceted approach is essential for continued progress. Fostering collaboration, optimizing funding models, and prioritizing both foundational and translational research hold the key to unlocking the true potential of orthopedic research and transforming the lives of patients suffering from musculoskeletal disorders.
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Affiliation(s)
- Wazzan Aljuhani
- Department of Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Bhargava A, Mahakalkar C, Kshirsagar S. Understanding Gangrene in the Context of Peripheral Vascular Disease: Prevalence, Etiology, and Considerations for Amputation-Level Determination. Cureus 2023; 15:e49026. [PMID: 38116352 PMCID: PMC10728580 DOI: 10.7759/cureus.49026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Gangrene is a grave complication of peripheral vascular disease (PVD), characterised by tissue necrosis due to inadequate blood supply. This review article comprehensively explores gangrene in PVD, encompassing its prevalence, aetiology, clinical presentation, diagnostic modalities, management strategies, prognosis, and future directions. Key factors influencing outcomes, including the timeliness of intervention and the choice between limb salvage and amputation, are identified. Moreover, this review underscores the importance of early detection and multidisciplinary care, emphasising the significance of patient-centred approaches. It also calls for increased awareness, continued research, and innovative solutions to improve the lives of individuals grappling with gangrene in the context of PVD.
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Affiliation(s)
- Abhilasha Bhargava
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chandrashekhar Mahakalkar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shivani Kshirsagar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ornaghi HL, Monticeli FM, Agnol LD. A Review on Polymers for Biomedical Applications on Hard and Soft Tissues and Prosthetic Limbs. Polymers (Basel) 2023; 15:4034. [PMID: 37836083 PMCID: PMC10575019 DOI: 10.3390/polym15194034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
In the past decades, there has been a significant increase in the use of polymers for biomedical applications. The global medical polymer market size was valued at USD 19.92 billion in 2022 and is expected to grow at a CAGR of 8.0% from 2023 to 2030 despite some limitations, such as cost (financial limitation), strength compared to metal plates for bone fracture, design optimization and incorporation of reinforcement. Recently, this increase has been more pronounced due to important advances in synthesis and modification techniques for the design of novel biomaterials and their behavior in vitro and in vivo. Also, modern medicine allows the use of less invasive surgeries and faster surgical sutures. Besides their use in the human body, polymer biomedical materials must have desired physical, chemical, biological, biomechanical, and degradation properties. This review summarizes the use of polymers for biomedical applications, mainly focusing on hard and soft tissues, prosthetic limbs, dental applications, and bone fracture repair. The main properties, gaps, and trends are discussed.
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Affiliation(s)
- Heitor Luiz Ornaghi
- Mantova Indústria de Tubos Plásticos Ltd.a., R. Isidoro Fadanelli, 194-Centenário, Caxias do Sul 95045-137, RS, Brazil
| | - Francisco Maciel Monticeli
- Department of Aerospace Structures and Materials, Faculty of Aerospace Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands;
| | - Lucas Dall Agnol
- Postgraduate Program in Materials Science and Engineering (PGMAT), University of Caxias do Sul, Caxias do Sul 95070-560, RS, Brazil;
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Rask DMG, Adams MH, Liverneaux P, Plucknette BF, Wilson DJ, Alderete JF, Sabbag CM. Targeted muscle reinnervation in upper extremity amputation in military hand surgery: A systematic review. HAND SURGERY & REHABILITATION 2023; 42:392-399. [PMID: 37499798 DOI: 10.1016/j.hansur.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Targeted Muscle Reinnervation (TMR) is a surgical technique utilized to alleviate post-amputation neuroma pain, reduce reliance on narcotic pain medication, and enhance control of prosthetic devices. Motor targets for upper extremity TMR vary depending on injury patterns and amputation levels, with conventional transfer patterns serving as general guides. This study aims to summarize the common patterns of TMR in transradial and transhumeral amputations, focusing on anatomic and surgical considerations. METHODS A comprehensive systematic review of TMR literature was conducted by two independent physician reviewers (M.H.A. and D.M.G.R.) to identify the prevailing motor targets, while considering injury patterns and amputation levels. INCLUSION CRITERIA 1) TMR techniques, outcomes, or advancements; 2) Original research, systematic reviews, meta-analyses, or clinical trials; 3) Peer-reviewed journal articles or reputable conference proceedings. EXCLUSION CRITERIA non-English resources, editorials, opinion pieces, and case reports. The databases utilized include MEDLINE (PubMed), EMBASE (Scopus) and Cochrane CENTRAL, last searched 01APR2023. RESULTS The reviewed literature revealed multiple motor targets described for upper extremity TMR out of our included 51 studies. However, the selection of motor targets is influenced by the availability of viable options based on injury patterns and amputation levels. Conventional transfer patterns provide useful guidance for determining appropriate motor targets in transradial and transhumeral amputations. DISCUSSION TMR has played a significant role in military medicine, particularly in addressing the impact of blast-related injuries. The energy associated with such injuries often results in substantial soft tissue defects, higher amputation levels, and increased post-amputation pain. TMR, in conjunction with advancements in prosthetic technology and ongoing military research, offers improved outcomes to help achieve the goals of active-duty service members. The capabilities and applications of TMR continue to expand rapidly due to its high surgical success rate, technological innovations in prosthetic care, and favorable patient outcomes. As technology evolves to include implantable devices, osseointegration techniques, and bidirectional neuroprosthetic devices, the future of amputation surgery and TMR holds immense promise, offering innovative solutions to optimize patient outcomes. It is important to note, this review was limited to the data available in the included resources which was mostly qualitative; thus, it did not involve primary data analysis.
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Affiliation(s)
- Dawn M G Rask
- Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
| | - Mason H Adams
- Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA.
| | - Philippe Liverneaux
- ICube, University of Strasbourg, CNRS, 2-4 rue Boussingault, 67000 Strasbourg, France; Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200 Strasbourg, France
| | | | - David J Wilson
- Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
| | - Joseph F Alderete
- Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
| | - Casey M Sabbag
- Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
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Egle F, Di Domenico D, Marinelli A, Boccardo N, Canepa M, Laffranchi M, De Michieli L, Castellini C. Preliminary Assessment of Two Simultaneous and Proportional Myocontrol Methods for 3-DoFs Prostheses Using Incremental Learning. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941277 DOI: 10.1109/icorr58425.2023.10304813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Despite progressive developments over the last decades, current upper limb prostheses still lack a suitable control able to fully restore the functionalities of the lost arm. Traditional control approaches for prostheses fail when simultaneously actuating multiple Degrees of Freedom (DoFs), thus limiting their usability in daily-life scenarios. Machine learning, on the one hand, offers a solution to this issue through a promising approach for decoding user intentions but fails when input signals change. Incremental learning, on the other hand, reduces sources of error by quickly updating the model on new data rather than training the control model from scratch. In this study, we present an initial evaluation of a position and a velocity control strategy for simultaneous and proportional control over 3-DoFs based on incremental learning. The proposed controls are tested using a virtual Hannes prosthesis on two healthy participants. The performances are evaluated over eight sessions by performing the Target Achievement Control test and administering SUS and NASA-TLX questionnaires. Overall, this preliminary study demonstrates that both control strategies are promising approaches for prosthetic control, offering the potential to improve the usability of prostheses for individuals with limb loss. Further research extended to a wider population of both healthy subjects and amputees will be essential to thoroughly assess these control paradigms.
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Li J, Zhu Z, Boyd WJ, Martinez-Luna C, Dai C, Wang H, Wang H, Huang X, Farrell TR, Clancy EA. Virtual regression-based myoelectric hand-wrist prosthesis control and electrode site selection using no force feedback. Biomed Signal Process Control 2023; 82:104602. [PMID: 36875964 PMCID: PMC9979864 DOI: 10.1016/j.bspc.2023.104602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Most transradial prosthesis users with conventional "Sequential" myoelectric control have two electrode sites which control one degree of freedom (DoF) at a time. Rapid EMG co-activation toggles control between DoFs (e.g., hand and wrist), providing limited function. We implemented a regression-based EMG control method which achieved simultaneous and proportional control of two DoFs in a virtual task. We automated electrode site selection using a short-duration (90 s) calibration period, without force feedback. Backward stepwise selection located the best electrodes for either six or 12 electrodes (selected from a pool of 16). We additionally studied two, 2-DoF controllers: "Intuitive" control (hand open-close and wrist pronation-supination controlled virtual target size and rotation, respectively) and "Mapping" control (wrist flexion-extension and ulnar-radial deviation controlled virtual target left-right and up-down movement, respectively). In practice, a Mapping controller would be mapped to control prosthesis hand open-close and wrist pronation-supination. Eleven able-bodied subjects and 4 limb-absent subjects completed virtual target matching tasks (fixed target moves to a new location after being "matched," and subject immediately pursues) and fixed (static) target tasks. For all subjects, both 2-DoF controllers with 6 optimally-sited electrodes had statistically better target matching performance than Sequential control in number of matches (average of 4-7 vs. 2 matches, p< 0.001) and throughput (average of 0.75-1.25 vs. 0.4 bits/s, p< 0.001), but not overshoot rate and path efficiency. There were no statistical differences between 6 and 12 optimally-sited electrodes for both 2-DoF controllers. These results support the feasibility of 2-DoF simultaneous, proportional myoelectric control.
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Affiliation(s)
- Jianan Li
- Department of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA 01609 U.S.A
| | - Ziling Zhu
- Department of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA 01609 U.S.A
| | - William J. Boyd
- Department of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA 01609 U.S.A
| | | | - Chenyun Dai
- Department of Electrical Engineering, Fudan University, Shanghai 200433, China
| | - Haopeng Wang
- Department of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA 01609 U.S.A
| | - He Wang
- Department of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA 01609 U.S.A
| | - Xinming Huang
- Department of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA 01609 U.S.A
| | | | - Edward A. Clancy
- Department of Electrical and Computer Engineering, Worcester Polytechnic Institute, Worcester, MA 01609 U.S.A
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Wilson L, Dohan D, Garibaldi M, Szeto D, Timmerman M, Matheny J. Prosthesis preferences for those with upper limb loss: Discrete choice study of PULLTY® for use in regulatory decisions. J Rehabil Assist Technol Eng 2023; 10:20556683231152418. [PMID: 36698551 PMCID: PMC9869218 DOI: 10.1177/20556683231152418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction The patient's voice in shared decision-making has progressed from physician's office to regulatory decision-making for medical devices with FDA's Patient Preference Initiative. A discrete-choice preference measure for upper limb prosthetic devices was developed to investigate patient's risk/benefit preference choices for regulatory decision making. Methods Rapid ethnographic procedures were used to design a discrete-choice measure describing risk and benefits of osseointegration with myoelectric control and test in a pilot preference study in adults with upper limb loss. Primary outcome is utility of each choice based conjoint (CBC) attribute using mixed-effects regression. Utilities with and without video, and between genders were compared. Results Strongest negative preference was for avoiding infection risk (B = -1.77, p < 0.001) and chance of daily pain (B = -1.22, p, 0.001). Strongest positive preference was for attaining complete independence when cooking dinner (B = 1.62, p < 0.001) and smooth grip patterns at all levels (B = 1.62, B = 1.28, B = 1.26, p < 0.001). Trade-offs showed a 1% increase in risk of serious/treatable infection resulted in a 1.77 decrease in relative preference. There were gender differences, and where video was used, preferences were stronger. Conclusions Strongest preferences were for attributes of functionality and independence versus connectedness and sensation but showed willingness to make risk-benefit trade-offs. Findings provide valuable information for regulatory benefit-risk decisions for prosthetic device innovations. Trial Registration This study is not a clinical trial reporting results of a health care intervention so is not registered.
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Affiliation(s)
- Leslie Wilson
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA,Leslie Wilson, Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, 480 16th street Office 32f, Box 0613, San Francisco, CA 94143-3402, USA.
| | - Dan Dohan
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Garibaldi
- Director, Orthotics Prosthetics, University of California San Francisco, San Francisco, CA, USA
| | - David Szeto
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA
| | - Molly Timmerman
- General Physical Medicine & Rehabilitation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Johnny Matheny
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA
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Shi P, Fang K, Yu H. Design and control of intelligent bionic artificial hand based on image recognition. Technol Health Care 2023; 31:21-35. [PMID: 35723126 DOI: 10.3233/thc-213320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND At present, the popular control method for intelligent bionic prosthetic hands is EMG control. However, the control accuracy of this method is low. It is a trend to integrate computer vision into the prosthetic hand. OBJECTIVE The purpose of this paper is to design an intelligent prosthetic hand based on image recognition, improve the control accuracy and the quality of life of the disabled. METHODS Convolutional neural network is used to recognize the object to be grasped, and the recognition result is used as a trigger signal to control our intelligent prosthetic hand. We have designed a four-bar linkage mechanism and a side swing mechanism in the structure, which can not only achieve the flexion and extension of fingers but also realize the adduction and abduction of the four fingers and the lateral swing of the thumb. RESULTS Through the method of image recognition, the new intelligent bionic hand can achieve five kinds of Human action. Including grasp, side pinch, three-finger pinch, two-finger pinch, and pinch between fingers. CONCLUSIONS The experiment result proves that the precision of image recognition control is very excellent, the intelligent prosthetic hand can be completed the corresponding task.
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Asogbon MG, Samuel OW, Nsugbe E, Li Y, Kulwa F, Mzurikwao D, Chen S, Li G. Ascertaining the optimal myoelectric signal recording duration for pattern recognition based prostheses control. Front Neurosci 2023; 17:1018037. [PMID: 36908798 PMCID: PMC9992216 DOI: 10.3389/fnins.2023.1018037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction Electromyogram-based pattern recognition (EMG-PR) has been widely considered an essentially intuitive control method for multifunctional upper limb prostheses. A crucial aspect of the scheme is the EMG signal recording duration (SRD) from which requisite motor tasks are characterized per time, impacting the system's overall performance. For instance, lengthy SRD inevitably introduces fatigue (that alters the muscle contraction patterns of specific limb motions) and may incur high computational costs in building the motion intent decoder, resulting in inadequate prosthetic control and controller delay in practical usage. Conversely, relatively shorter SRD may lead to reduced data collection durations that, among other advantages, allow for more convenient prosthesis recalibration protocols. Therefore, determining the optimal SRD required to characterize limb motion intents adequately that will aid intuitive PR-based control remains an open research question. Method This study systematically investigated the impact and generalizability of varying lengths of myoelectric SRD on the characterization of multiple classes of finger gestures. The investigation involved characterizing fifteen classes of finger gestures performed by eight normally limb subjects using various groups of EMG SRD including 1, 5, 10, 15, and 20 s. Two different training strategies including Between SRD and Within-SRD were implemented across three popular machine learning classifiers and three time-domain features to investigate the impact of SRD on EMG-PR motion intent decoder. Result The between-SRD strategy results which is a reflection of the practical scenario showed that an SRD greater than 5 s but less than or equal to 10 s (>5 and < = 10 s) would be required to achieve decent average finger gesture decoding accuracy for all feature-classifier combinations. Notably, lengthier SRD would incur more acquisition and implementation time and vice-versa. In inclusion, the study's findings provide insight and guidance into selecting appropriate SRD that would aid inadequate characterization of multiple classes of limb motion tasks in PR-based control schemes for multifunctional prostheses.
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Affiliation(s)
- Mojisola Grace Asogbon
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen, China
| | - Oluwarotimi Williams Samuel
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen, China
| | - Ejay Nsugbe
- Nsugbe Research Labs, Swindon, United Kingdom
| | - Yongcheng Li
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen, China
| | - Frank Kulwa
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen, China
| | - Deogratias Mzurikwao
- Unit of Biomedical Engineering, Department of Physiology, School of Engineering, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Shixiong Chen
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen, China
| | - Guanglin Li
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology (SIAT), Chinese Academy of Sciences (CAS), Shenzhen Institute of Artificial Intelligence and Robotics for Society, Shenzhen, China
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Kerver N, van der Sluis CK, van Twillert S, Krabbe PFM. Towards assessing the preferred usage features of upper limb prostheses: most important items regarding prosthesis use in people with major unilateral upper limb absence-a Dutch national survey. Disabil Rehabil 2022; 44:7554-7565. [PMID: 34813394 DOI: 10.1080/09638288.2021.1988734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine which items regarding prosthesis use were considered most important by adults with major unilateral upper limb absence (ULA) and to develop a patient-reported outcome measure to assess the preferred usage features of upper limb prostheses: PUF-ULP. MATERIALS AND METHODS Based on a qualitative meta-synthesis combined with input from patients and clinicians a graphical diagram of 79 items related to prosthesis use was developed. Adults with ULA (N = 358; mean age = 55.4 ± 16.5 years; 52.0% male/40.8% female/7.3% unknown) selected their top-10 of most important items from this diagram. This study is registered in the Netherlands Trial Register: NL7682. RESULTS Most selected items were "wearing comfort" (54.0% of cases), "grabbing, picking up, and holding" (34.3%), and "weight" (31.4%). All subpopulations (i.e. age, sex, origin of ULA, level of ULA, and prosthesis type), except multi-grip myoelectric hand prosthesis users (MHP), selected "wearing comfort" most. Nine items were included in the PUF-ULP: "wearing comfort," "functionality," "independence," "work, hobby, and household," "user-friendly," "life-like appearance," "phantom limb pain," "overuse complaints," and "reliability." CONCLUSIONS All prosthesis users, except MHP-users, considered wearing comfort most important, which might be of interest for future research and industry. The PUF-ULP can be used to reflect the match between users and their prostheses.IMPLICATIONS FOR REHABILITATIONAll persons with upper limb absence, except multi-grip myoelectric hand prosthesis users, considered "wearing comfort" most important regarding prosthesis use, which highlights that prosthesis wearing comfort deserves more attention in future research to increase the value placed by the user on their upper limb prosthesis.Regarding prosthesis use, men considered "ease of control" more important compared to the overall population, while women considered "independence," "household," "life-like appearance," "overuse complaints," and "anonymity" more important.Persons with a mono- or multi-grip myoelectric upper limb prosthesis rated function-related items as more important compared to the overall population, while persons with a passive/cosmetic prosthesis rated comfort-related and appearance-related items as more important.The newly developed measurement tool, also called the PUF-ULP, provides a single score that represents the match between the user and their upper limb prosthesis.
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Affiliation(s)
- Nienke Kerver
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sacha van Twillert
- University of Groningen, University Medical Center Groningen, UMC Staff Policy and Management Support, Groningen, The Netherlands
| | - Paul F M Krabbe
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Tham JL, Sood A, Saffari TM, Khajuria A. The effect of targeted muscle reinnervation on post-amputation pain and functional outcomes: a systematic review and meta-analysis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-02021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Touillet A, Gouzien A, Badin M, Herbe P, Martinet N, Jarrassé N, Roby-Brami A. Kinematic analysis of impairments and compensatory motor behavior during prosthetic grasping in below-elbow amputees. PLoS One 2022; 17:e0277917. [PMID: 36399487 PMCID: PMC9674132 DOI: 10.1371/journal.pone.0277917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/06/2022] [Indexed: 11/19/2022] Open
Abstract
After a major upper limb amputation, the use of myoelectric prosthesis as assistive devices is possible. However, these prostheses remain quite difficult to control for grasping and manipulation of daily life objects. The aim of the present observational case study is to document the kinematics of grasping in a group of 10 below-elbow amputated patients fitted with a myoelectric prosthesis in order to describe and better understand their compensatory strategies. They performed a grasping to lift task toward 3 objects (a mug, a cylinder and a cone) placed at two distances within the reaching area in front of the patients. The kinematics of the trunk and upper-limb on the non-amputated and prosthetic sides were recorded with 3 electromagnetic Polhemus sensors placed on the hand, the forearm (or the corresponding site on the prosthesis) and the ipsilateral acromion. The 3D position of the elbow joint and the shoulder and elbow angles were calculated thanks to a preliminary calibration of the sensor position. We examined first the effect of side, distance and objects with non-parametric statistics. Prosthetic grasping was characterized by severe temporo-spatial impairments consistent with previous clinical or kinematic observations. The grasping phase was prolonged and the reaching and grasping components uncoupled. The 3D hand displacement was symmetrical in average, but with some differences according to the objects. Compensatory strategies involved the trunk and the proximal part of the upper-limb, as shown by a greater 3D displacement of the elbow for close target and a greater forward displacement of the acromion, particularly for far targets. The hand orientation at the time of grasping showed marked side differences with a more frontal azimuth, and a more "thumb-up" roll. The variation of hand orientation with the object on the prosthetic side, suggested that the lack of finger and wrist mobility imposed some adaptation of hand pose relative to the object. The detailed kinematic analysis allows more insight into the mechanisms of the compensatory strategies that could be due to both increased distal or proximal kinematic constraints. A better knowledge of those compensatory strategies is important for the prevention of musculoskeletal disorders and the development of innovative prosthetics.
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Affiliation(s)
- Amélie Touillet
- Louis Pierquin Centre of the Regional Institute of Rehabilitation, UGECAM Nord Est, Nancy, France
| | - Adrienne Gouzien
- Service de psychiatrie, Pôle Paris Centre, Hôpitaux de Saint-Maurice, Saint-Maurice, France
| | - Marina Badin
- Louis Pierquin Centre of the Regional Institute of Rehabilitation, UGECAM Nord Est, Nancy, France
| | - Pierrick Herbe
- Louis Pierquin Centre of the Regional Institute of Rehabilitation, UGECAM Nord Est, Nancy, France
| | - Noël Martinet
- Louis Pierquin Centre of the Regional Institute of Rehabilitation, UGECAM Nord Est, Nancy, France
| | - Nathanaël Jarrassé
- Institute of Intelligent Systems and Robotics (ISIR), UMR 7222, CNRS/INSERM, U1150 Agathe-ISIR, Sorbonne University, Paris, France
| | - Agnès Roby-Brami
- Institute of Intelligent Systems and Robotics (ISIR), UMR 7222, CNRS/INSERM, U1150 Agathe-ISIR, Sorbonne University, Paris, France
- * E-mail:
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Gonzalez M, Bismuth A, Lee C, Chestek CA, Gates DH. Artificial referred sensation in upper and lower limb prosthesis users: a systematic review. J Neural Eng 2022; 19:10.1088/1741-2552/ac8c38. [PMID: 36001115 PMCID: PMC9514130 DOI: 10.1088/1741-2552/ac8c38] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/23/2022] [Indexed: 11/12/2022]
Abstract
Objective.Electrical stimulation can induce sensation in the phantom limb of individuals with amputation. It is difficult to generalize existing findings as there are many approaches to delivering stimulation and to assessing the characteristics and benefits of sensation. Therefore, the goal of this systematic review was to explore the stimulation parameters that effectively elicited referred sensation, the qualities of elicited sensation, and how the utility of referred sensation was assessed.Approach.We searched PubMed, Web of Science, and Engineering Village through January of 2022 to identify relevant papers. We included papers which electrically induced referred sensation in individuals with limb loss and excluded papers that did not contain stimulation parameters or outcome measures pertaining to stimulation. We extracted information on participant demographics, stimulation approaches, and participant outcomes.Main results.After applying exclusion criteria, 49 papers were included covering nine stimulation methods. Amplitude was the most commonly adjusted parameter (n= 25), followed by frequency (n= 22), and pulse width (n= 15). Of the 63 reports of sensation quality, most reported feelings of pressure (n= 52), paresthesia (n= 48), or vibration (n= 40) while less than half (n= 29) reported a sense of position or movement. Most papers evaluated the functional benefits of sensation (n= 33) using force matching or object identification tasks, while fewer papers quantified subjective measures (n= 16) such as pain or embodiment. Only 15 studies (36%) observed percept intensity, quality, or location over multiple sessions.Significance.Most studies that measured functional performance demonstrated some benefit to providing participants with sensory feedback. However, few studies could experimentally manipulate sensation location or quality. Direct comparisons between studies were limited by variability in methodologies and outcome measures. As such, we offer recommendations to aid in more standardized reporting for future research.
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Affiliation(s)
- Michael Gonzalez
- Department of Robotics, University of Michigan, Ann Arbor, MI, United States of America
| | - Alex Bismuth
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States of America
| | - Christina Lee
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
| | - Cynthia A Chestek
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
| | - Deanna H Gates
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States of America
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Heng W, Solomon S, Gao W. Flexible Electronics and Devices as Human-Machine Interfaces for Medical Robotics. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2107902. [PMID: 34897836 PMCID: PMC9035141 DOI: 10.1002/adma.202107902] [Citation(s) in RCA: 107] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/08/2021] [Indexed: 05/02/2023]
Abstract
Medical robots are invaluable players in non-pharmaceutical treatment of disabilities. Particularly, using prosthetic and rehabilitation devices with human-machine interfaces can greatly improve the quality of life for impaired patients. In recent years, flexible electronic interfaces and soft robotics have attracted tremendous attention in this field due to their high biocompatibility, functionality, conformability, and low-cost. Flexible human-machine interfaces on soft robotics will make a promising alternative to conventional rigid devices, which can potentially revolutionize the paradigm and future direction of medical robotics in terms of rehabilitation feedback and user experience. In this review, the fundamental components of the materials, structures, and mechanisms in flexible human-machine interfaces are summarized by recent and renowned applications in five primary areas: physical and chemical sensing, physiological recording, information processing and communication, soft robotic actuation, and feedback stimulation. This review further concludes by discussing the outlook and current challenges of these technologies as a human-machine interface in medical robotics.
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Affiliation(s)
- Wenzheng Heng
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Samuel Solomon
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Wei Gao
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
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Arauz PG, Chiriboga P, García MG, Kao I, Díaz EA. New technologies applied to canine limb prostheses: A review. Vet World 2021; 14:2793-2802. [PMID: 34903941 PMCID: PMC8654758 DOI: 10.14202/vetworld.2021.2793-2802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
Although only a few studies have investigated about the development of animal prosthesis, currently, there is an increasing interest in canine limb prosthesis design and its clinical application since they offer an alternative to killing the animal in extreme situations where amputating the limb is the only option. Restoring normal function of amputated canine limbs with the use of a prosthesis is challenging. However, recent advances in surgical procedures and prosthesis design technology appear promising in developing devices that closely recreate normal canine limb function. Surgical advances such as evolution of osseointegration (bone-anchored) prostheses present great promise. Likewise, modern computer-aided design and manufacturing technology, as well as novel motion analysis systems are now providing improved prosthesis designs. Advances in patient-customized prostheses have the potential to reduce the risk of implant failure. The objective of this investigation is to present a general review of the existing literature on modern surgical approaches, design and manufacturing methods, as well as biomechanical analyses so that veterinarians can make more and better-informed decisions on the development and selection of proper canine limb prosthesis. Isolated research efforts have made possible an improvement in stability, comfort, and performance of canine limb prosthesis. However, continued multidisciplinary research collaboration and teamwork among veterinarians, engineers, designers, and industry, with supporting scientific evidence, is required to better understand the development of canine limb prosthesis designs that closely replicate the normal limb function.
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Affiliation(s)
- Paul G Arauz
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Patricio Chiriboga
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - María-Gabriela García
- Department of Industrial Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Imin Kao
- Department of Mechanical Engineering, Stony Brook University, Stony Brook, United States
| | - Eduardo A Díaz
- Department of Veterinary Medicine, Universidad San Francisco de Quito, Quito, Ecuador
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Stefański D, Jach Ł. What do people think about technological enhancements of human beings? An introductory study using the Technological Enhancements Questionnaire in the context of values, the scientistic worldview, and the accepted versions of humanism. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2021; 10:71-84. [PMID: 38013752 PMCID: PMC10653345 DOI: 10.5114/cipp.2021.110061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/10/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Rapid development of technologies increases the possibility of technological enhancements of human beings, e.g., in their cognitive skills or physical fitness. Attitudes towards such enhancements may result in their social acceptance or rejection. PARTICIPANTS AND PROCEDURE One hundred and thirty-nine young Polish adults participated in the study. Participants completed the designed Technological Enhancements Questionnaire (TEQ) and questionnaires to measure values, the scientistic worldview, and the accepted versions of humanism. RESULTS The study showed a one-dimensional TEQ structure and its satisfactory reliability. Attitudes towards technological enhancements correlated positively with achievement, self-direction in thought, power over resources, the scientistic worldview, and the evolutionary version of humanism. They also correlated negatively with tradition and the liberal version of humanism. CONCLUSIONS The TEQ questionnaire is a short, reliable tool to measure attitudes towards technological enhancements. This preliminary study provided some significant results, but future work to validate the questionnaire is needed.
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Karczewski AM, Dingle AM, Poore SO. The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements. Front Neurorobot 2021; 15:711028. [PMID: 34366820 PMCID: PMC8334559 DOI: 10.3389/fnbot.2021.711028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022] Open
Abstract
Over the last few decades there has been a push to enhance the use of advanced prosthetics within the fields of biomedical engineering, neuroscience, and surgery. Through the development of peripheral neural interfaces and invasive electrodes, an individual's own nervous system can be used to control a prosthesis. With novel improvements in neural recording and signal decoding, this intimate communication has paved the way for bidirectional and intuitive control of prostheses. While various collaborations between engineers and surgeons have led to considerable success with motor control and pain management, it has been significantly more challenging to restore sensation. Many of the existing peripheral neural interfaces have demonstrated success in one of these modalities; however, none are currently able to fully restore limb function. Though this is in part due to the complexity of the human somatosensory system and stability of bioelectronics, the fragmentary and as-yet uncoordinated nature of the neuroprosthetic industry further complicates this advancement. In this review, we provide a comprehensive overview of the current field of neuroprosthetics and explore potential strategies to address its unique challenges. These include exploration of electrodes, surgical techniques, control methods, and prosthetic technology. Additionally, we propose a new approach to optimizing prosthetic limb function and facilitating clinical application by capitalizing on available resources. It is incumbent upon academia and industry to encourage collaboration and utilization of different peripheral neural interfaces in combination with each other to create versatile limbs that not only improve function but quality of life. Despite the rapidly evolving technology, if the field continues to work in divided "silos," we will delay achieving the critical, valuable outcome: creating a prosthetic limb that is right for the patient and positively affects their life.
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Affiliation(s)
| | - Aaron M. Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin–Madison, Madison, WI, United States
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