Estimation of distal arm joint angles from EMG and shoulder orientation for transhumeral prostheses

Pain and Functional Outcomes following Targeted Muscle Reinnervation: A Systematic Review

BACKGROUND

It is estimated that by 2050, a total of 3.6 million patients will be living with an amputation in the United States. The objective of this systematic review is to evaluate the effect of targeted muscle reinnervation (TMR) on pain and physical functioning in amputees.

METHODS

A literature search was performed on PubMed, Embase, and MEDLINE up to November 28, 2021. Clinical studies assessing the outcomes of TMR (pain, prosthesis control, life quality, limb function, and disability) were included.

RESULTS

Thirty-nine articles were included. The total number of patients who underwent TMR was 449, and 716 were controls. Mean follow-up was 25 months. A total of 309 (66%) lower-limb and 159 (34%) upper-limb amputations took place in the TMR group, the most common being below-knee amputations (39%). The control group included a total of 557 (84%) lower-limb and 108 (16%) upper-limb amputations; the greatest proportion being below-knee amputations in this group as well (54%). Trauma was the most common indication for amputation. Phantom limb pain scores were lower by 10.2 points for intensity ( P = 0.01), 4.67 points for behavior ( P = 0.01), and 8.9 points for interference ( P = 0.09). Similarly, residual limb pain measures were lower for cases for intensity, behavior, and interference, but they failed to reach significance. Neuroma symptoms occurred less frequently, and functional and prosthesis control outcomes improved following TMR.

CONCLUSION

The literature evidence suggests that TMR is a promising therapy for improving pain, prosthesis use, and functional outcomes after limb amputation.

Transhumeral Arm Reaching Motion Prediction through Deep Reinforcement Learning-Based Synthetic Motion Cloning

The lack of intuitive controllability remains a primary challenge in enabling transhumeral amputees to control a prosthesis for arm reaching with residual limb kinematics. Recent advancements in prosthetic arm control have focused on leveraging the predictive capabilities of artificial neural networks (ANNs) to automate elbow joint motion and wrist pronation-supination during target reaching tasks. However, large quantities of human motion data collected from different subjects for various activities of daily living (ADL) tasks are required to train these ANNs. For example, the reaching motion can be altered when the height of the desk is changed; however, it is cumbersome to conduct human experiments for all conditions. This paper proposes a framework for cloning motion datasets using deep reinforcement learning (DRL) to cater to training data requirements. DRL algorithms have been demonstrated to create human-like synergistic motion in humanoid agents to handle redundancy and optimize movements. In our study, we collected real motion data from six individuals performing multi-directional arm reaching tasks in the horizontal plane. We generated synthetic motion data that mimicked similar arm reaching tasks by utilizing a physics simulation and DRL-based arm manipulation. We then trained a CNN-LSTM network with different configurations of training motion data, including DRL, real, and hybrid datasets, to test the efficacy of the cloned motion data. The results of our evaluation showcase the effectiveness of the cloned motion data in training the ANN to predict natural elbow motion accurately across multiple subjects. Furthermore, motion data augmentation through combining real and cloned motion datasets has demonstrated the enhanced robustness of the ANN by supplementing and diversifying the limited training data. These findings have significant implications for creating synthetic dataset resources for various arm movements and fostering strategies for automatized prosthetic elbow motion.

Synergy-Space Recurrent Neural Network for Transferable Forearm Motion Prediction from Residual Limb Motion

Transhumeral amputees experience considerable difficulties with controlling a multifunctional prosthesis (powered hand, wrist, and elbow) due to the lack of available muscles to provide electromyographic (EMG) signals. The residual limb motion strategy has become a popular alternative for transhumeral prosthesis control. It provides an intuitive way to estimate the motion of the prosthesis based on the residual shoulder motion, especially for target reaching tasks. Conventionally, a predictive model, typically an artificial neural network (ANN), is directly trained and relied upon to map the shoulder-elbow kinematics using the data from able-bodied subjects without extracting any prior synergistic information. However, it is essential to explicitly identify effective synergies and make them transferable across amputee users for higher accuracy and robustness. To overcome this limitation of the conventional ANN learning approach, this study explicitly combines the kinematic synergies with a recurrent neural network (RNN) to propose a synergy-space neural network for estimating forearm motions (i.e., elbow joint flexion-extension and pronation-supination angles) based on residual shoulder motions. We tested 36 training strategies for each of the 14 subjects, comparing the proposed synergy-space and conventional neural network learning approaches, and we statistically evaluated the results using Pearson's correlation method and the analysis of variance (ANOVA) test. The offline cross-subject analysis indicates that the synergy-space neural network exhibits superior robustness to inter-individual variability, demonstrating the potential of this approach as a transferable and generalized control strategy for transhumeral prosthesis control.

Neurorehabilitation in Adults With Traumatic Upper Extremity Amputation: A Scoping Review

BACKGROUND

Most of the current literature around amputation focuses on lower extremity amputation or engineering aspects of prosthetic devices. There is a need to more clearly understand neurobehavioral mechanisms related to upper extremity amputation and how such mechanisms might influence recovery and utilization of prostheses.

OBJECTIVE

This scoping review aims to identify and summarize the current literature on adult traumatic upper limb amputation in regard to recovery and functional outcomes and how neuroplasticity might influence these findings.

METHODS

We identified appropriate articles using Academic Search Complete EBSCO, OVID Medline, and Cochrane databases. The resulting articles were then exported, screened, and reviewed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines.

RESULTS

Eleven (11) studies met the study criteria. Of these studies, 7 focused on sensory involvement, 3 focused on neuroplastic changes post-amputation related to functional impact, and 1 study focused on motor control and learning post-amputation. Overall, these studies revealed an incomplete understanding of the neural mechanisms involved in motor rehabilitation in the central and peripheral nervous systems, while also demonstrating the value of an individualized approach to neurorehabilitation in upper limb loss.

CONCLUSIONS

There is a gap in our understanding of the role of neurorehabilitation following amputation. Overall, focused rehabilitation parameters, demographic information, and clarity around central and peripheral neural mechanisms are needed in future research to address neurobehavioral mechanisms to promote functional recovery following traumatic upper extremity amputation.

Separability of Input Features and the Resulting Accuracy in Classifying Target Poses for Active Transhumeral Prosthetic Interfaces

In active prostheses, it is desired to achieve target poses for a given family of tasks, for example, in the task of forward reaching using a transhumeral prosthesis with coordinated joint movements. To do so, it is necessary to distinguish these target poses accurately using the input features (e.g. kinematic and sEMG) obtained from the human users. However, the input features have conventionally been selected through human observations and influenced heavily by the availability of sensors in this context, which may not always yield the most relevant information to differentiate the target poses in the given task. In order to better select from a pool of available input features, those most appropriate for a given set of target poses, a measure that correlates well with the resulting classification accuracy is required so that it can inform the interface design process. In this paper, a scatter-matrix based class separability measure is adopted to quantitatively evaluate the separability of the target poses from their corresponding input features. A human experiment was performed on ten able-bodied subjects. Subjects were asked to perform forward-reaching movements with their arms on nine target poses in a virtual reality (VR) platform and the corresponding kinematic information of their arm movement and muscle activities were recorded. The accuracy of the prosthetic interface in determining the intended target poses of the human user during forward reaching is evaluated for different combinations of input features, selected from the kinematic and sEMG sensors worn by the users. The results demonstrate that employing input features that yield a high separability measure between target poses results in a high accuracy in identifying the intended target poses in the execution of the task.

Personalized Online Adaptation of Kinematic Synergies for Human-Prosthesis Interfaces

Synergies have been adopted in prosthetic limb applications to reduce the complexity of design, but typically involve a single synergy setting for a population and ignore individual preference or adaptation capacity. However, personalization of the synergy setting is necessary for the effective operation of the prosthetic device. Two major challenges hinder the personalization of synergies in human-prosthesis interfaces (HPIs). The first is related to the process of human motor adaptation and the second to the variation in motor learning dynamics of individuals. In this paper, a systematic personalization of kinematic synergies for HPIs using online measurements from each individual is proposed. The task of reaching using the upper limb is described by an objective function and the interface is parameterized by a kinematic synergy. Consequently, personalizing the interface for a given individual can be formulated as finding an optimal personalized parameter. A structure to model the observed motor behavior that allows for the personalized traits of motor preference and motor learning is proposed, and subsequently used in an online optimization scheme to identify the synergies for an individual. The knowledge of the common features contained in the model enables online adaptation of the HPI to happen concurrently to human motor adaptation without the need to retune the personalization algorithm for each individual. Human-in-the-loop experimental results with able-bodied subjects, performed in a virtual reality environment to emulate amputation and prosthesis use, show that the proposed personalization algorithm was effective in obtaining optimal synergies with a fast uniform convergence speed across a group of individuals.

Task-Space Synergies for Reaching Using Upper-Limb Prostheses

Synergistic prostheses enable the coordinated movement of the human-prosthetic arm, as required by activities of daily living. This is achieved by coupling the motion of the prosthesis to the human command, such as the residual limb movement in motion-based interfaces. Previous studies demonstrated that developing human-prosthetic synergies in joint-space must consider individual motor behaviour and the intended task to be performed, requiring personalisation and task calibration. In this work, an alternative synergy-based strategy, utilising a synergistic relationship expressed in task-space, is proposed. This task-space synergy has the potential to replace the need for personalisation and task calibration with a model-based approach requiring knowledge of the individual user's arm kinematics, the anticipated hand motion during the task and voluntary information from the prosthetic user. The proposed method is compared with surface electromyography-based and joint-space synergy-based prosthetic interfaces in a study of motor behaviour and task performance on able-bodied subjects using a VR-based transhumeral prosthesis. Experimental results showed that for a set of forward reaching tasks the proposed task-space synergy achieves comparable performance to joint-space synergies without the need to rely on time-consuming calibration processes or human motor learning. Case study results with an amputee subject motivate the further development of the proposed task-space synergy method.

Shoulder kinematics plus contextual target information enable control of multiple distal joints of a simulated prosthetic arm and hand

Background

Prosthetic restoration of reach and grasp function after a trans-humeral amputation requires control of multiple distal degrees of freedom in elbow, wrist and fingers. However, such a high level of amputation reduces the amount of available myoelectric and kinematic information from the residual limb.

Methods

To overcome these limits, we added contextual information about the target’s location and orientation such as can now be extracted from gaze tracking by computer vision tools. For the task of picking and placing a bottle in various positions and orientations in a 3D virtual scene, we trained artificial neural networks to predict postures of an intact subject’s elbow, forearm and wrist (4 degrees of freedom) either solely from shoulder kinematics or with additional knowledge of the movement goal. Subjects then performed the same tasks in the virtual scene with distal joints predicted from the context-aware network.

Results

Average movement times of 1.22s were only slightly longer than the naturally controlled movements (0.82 s). When using a kinematic-only network, movement times were much longer (2.31s) and compensatory movements from trunk and shoulder were much larger. Integrating contextual information also gave rise to motor synergies closer to natural joint coordination.

Conclusions

Although notable challenges remain before applying the proposed control scheme to a real-world prosthesis, our study shows that adding contextual information to command signals greatly improves prediction of distal joint angles for prosthetic control.

Towards Control of a Transhumeral Prosthesis with EEG Signals

Robotic prostheses are expected to allow amputees greater freedom and mobility. However, available options to control transhumeral prostheses are reduced with increasing amputation level. In addition, for electromyography-based control of prostheses, the residual muscles alone cannot generate sufficiently different signals for accurate distal arm function. Thus, controlling a multi-degree of freedom (DoF) transhumeral prosthesis is challenging with currently available techniques. In this paper, an electroencephalogram (EEG)-based hierarchical two-stage approach is proposed to achieve multi-DoF control of a transhumeral prosthesis. In the proposed method, the motion intention for arm reaching or hand lifting is identified using classifiers trained with motion-related EEG features. For this purpose, neural network and k-nearest neighbor classifiers are used. Then, elbow motion and hand endpoint motion is estimated using a different set of neural-network-based classifiers, which are trained with motion information recorded using healthy subjects. The predictions from the classifiers are compared with residual limb motion to generate a final prediction of motion intention. This can then be used to realize multi-DoF control of a prosthesis. The experimental results show the feasibility of the proposed method for multi-DoF control of a transhumeral prosthesis. This proof of concept study was performed with healthy subjects.