Bionic prosthetic hands: A review of present technology and future aspirations

Assessment of TENS-Evoked Tactile Sensations for Transradial Amputees via EEG Investigation

Most of current prostheses can offer motor function restoration for limb amputees but usually lack natural and intuitive sensory feedback. Many studies have demonstrated that Transcutaneous Electrical Nerve Stimulation (TENS) is promising in non-invasive sensation evoking for amputees. However, the objective evaluation and mechanism analysis on sensation feedback are still limited. This work utilized multi-channel TENS with diverse stimulus patterns to evoke sensations on four non-disabled subjects and two transradial amputees. Meanwhile, electroencephalogram (EEG) was collected to objectively assess the evoked sensations, where event-related potentials (ERPs), brain electrical activity maps (BEAMs), and functional connectivity (FC) were computed. The results show that various sensations could be successfully evoked for both amputees and non-disabled subjects by customizing stimulus parameters. The ERP confirmed the sensation and revealed the sensory-processing-related components like N100 and P200; the BEAMs confirmed the corresponding regions of somatosensory cortex were activated by stimulation; the FC indicated an increase of interactions between the regions of sensorimotor cortex. This study may shed light on how the brain responds to external stimulation as sensory feedback and serve as a pilot for further bidirectional closed-loop prosthetic control.

Towards higher load capacity: innovative design of a robotic hand with soft jointed structure

In this paper, the innovative design of a robotic hand with soft jointed structure is carried out and a tendon-driven mechanism, a master-slave motor coordinated drive mechanism, a thumb coupling transmission mechanism and a thumb steering mechanism are proposed. These innovative designs allow for more effective actuation in each finger, enhancing the load capacity of the robotic hand while maintaining key performance indicators such as dexterity and adaptability. A mechanical model of the robotic finger was made to determine the application limitations and load capacity. The robotic hand was then prototyped for a set of experiments. The experimental results showed that the proposed theoretical model were reliable. Also, the fingertip force of the robotic finger could reach up to 10.3 N, and the load force could reach up to 72.8 N. When grasping target objects of different sizes and shapes, the robotic hand was able to perform the various power grasping and precision grasping in the Cutkosky taxonomy. Moreover, the robotic hand had good flexibility and adaptability by means of adjusting the envelope state autonomously.

An Improved Approach for Grasp Force Sensing and Control of Upper Limb Soft Robotic Prosthetics

The following research proposes a closed loop force control system, which is implemented on a soft robotic prosthetic hand. The proposed system uses a force sensing approach that does not require any sensing elements to be embedded in the prosthetic's fingers, therefore maintaining their monolithic structural integrity, and subsequently decreasing the cost and manufacturing complexity. This is achieved by embedding an aluminum test specimen with a full bridge strain gauge circuit directly inside the actuator's housing rather than in the finger. The location of the test specimen is precisely at the location of the critical section of the bending moment on the actuator housing due to the tension in the driving tendon. Therefore, the resulting loadcell can acquire a signal proportional to the prosthetic's grasping force. A PI controller is implemented and tested using this force sensing approach. The experiment design includes a flexible test object, which serves to visually demonstrate the force controller's performance through the deformation that the test object experiences. Setpoints corresponding to "light", "medium", and "hard" grasps were tested with pinch, tripod, and full grasps and the results of these tests are documented in this manuscript. The developed controller was found to have an accuracy of ±2%. Additionally, the deformation of the test object increased proportionally with the given grasp force setpoint, with almost no deformation during the light grasp test, slight deformation during the medium grasp test, and relatively large deformation of the test object during the hard grasp test.

Does Trans-radial Longitudinal Compression Influence Myoelectric Control?

BACKGROUND

Existing trans-radial prosthetic socket designs are not optimised to facilitate reliable myoelectric control. Many socket designs pre-date the introduction of myoelectric devices. However, socket designs featuring improved biomechanical stability, notably longitudinal compression sockets, have emerged in more recent years. Neither the subsequent effects, if any, of stabilising the limb on myoelectric control nor in which arrangement to apply the compression have been reported.

METHODOLOGY

Twelve able-bodied participants completed two tasks whilst wearing a longitudinal compression socket simulator in three different configurations: 1) compressed, where the compression strut was placed on top of the muscle of interest, 2) relief, where the compression struts were placed either side of the muscle being recorded and 3) uncompressed, with no external compression. The tasks were 1) a single-channel myoelectric target tracking exercise, followed by 2), a high-intensity grasping task. The wearers' accuracy during the tracking task, the pressure at opposing sides of the simulator during contractions and the rate at which the limb fatigued were observed.

FINDINGS

No significant difference between the tracking-task accuracy scores or rate of fatigue was observed for the different compression configurations. Pressure recordings from the compressed configuration showed that pressure was maintained at opposing sides of the simulator during muscle contractions.

CONCLUSION

Longitudinal compression does not inhibit single-channel EMG control, nor improve fatigue performance. Longitudinal compression sockets have the potential to improve the reliability of multi-channel EMG control due to the maintenance of pressure during muscle contractions.

Evaluation of feature projection techniques in object grasp classification using electromyogram signals from different limb positions

A myoelectric prosthesis is manipulated using electromyogram (EMG) signals from the existing muscles for performing the activities of daily living. A feature vector that is formed by concatenating data from many EMG channels may result in a high dimensional space, which may cause prolonged computation time, redundancy, and irrelevant information. We evaluated feature projection techniques, namely principal component analysis (PCA), linear discriminant analysis (LDA), t-Distributed Stochastic Neighbor Embedding (t-SNE), and spectral regression extreme learning machine (SRELM), applied to object grasp classification. These represent feature projections that are combinations of either linear or nonlinear, and supervised or unsupervised types. All pairs of the four types of feature projection with seven types of classifiers were evaluated, with data from six EMG channels and an IMU sensors for nine upper limb positions in the transverse plane. The results showed that SRELM outperformed LDA with supervised feature projections, and t-SNE was superior to PCA with unsupervised feature projections. The classification errors from SRELM and t-SNE paired with the seven classifiers were from 1.50% to 2.65% and from 1.27% to 17.15%, respectively. A one-way ANOVA test revealed no statistically significant difference by classifier type when using the SRELM projection, which is a nonlinear supervised feature projection (p = 0.334). On the other hand, we have to carefully select an appropriate classifier for use with t-SNE, which is a nonlinear unsupervised feature projection. We achieved the lowest classification error 1.27% using t-SNE paired with a k-nearest neighbors classifier. For SRELM, the lowest 1.50% classification error was obtained when paired with a neural network classifier.

Towards Robust, Adaptive and Reliable Upper-limb Motion Estimation Using Machine Learning and Deep Learning--A Survey in Myoelectric Control

To develop multi-functional human-machine interfaces that can help disabled people reconstruct lost functions of upper-limbs, machine learning (ML) and deep learning (DL) techniques have been widely implemented to decode human movement intentions from surface electromyography (sEMG) signals. However, due to the high complexity of upper-limb movements and the inherent non-stable characteristics of sEMG, the usability of ML/DL based control schemes is still greatly limited in practical scenarios. To this end, tremendous efforts have been made to improve model robustness, adaptation, and reliability. In this article, we provide a systematic review on recent achievements, mainly from three categories: multi-modal sensing fusion to gain additional information of the user, transfer learning (TL) methods to eliminate domain shift impacts on estimation models, and post-processing approaches to obtain more reliable outcomes. Special attention is given to fusion strategies, deep TL frameworks, and confidence estimation. \textcolor{red}{Research challenges and emerging opportunities, with respect to hardware development, public resources, and decoding strategies, are also analysed to provide perspectives for future developments.

Bionic design of universal gripper for nursing robot with hybrid joints and variable Equivalent Link Length

Currently, most rehabilitation/nursing robots attach the human body to the end of the robot by ‘binding’ solution, which makes the operation complicated and greatly limits their applications. Therefore, it is necessary to study a universal gripper that can directly grasp human limbs as the end-effector of the robot. Inspired by the human hand, this paper proposes a bionic under-actuated gripper that imitates the structure of human hand. The concept of Equivalent Link Length (ELL) is proposed to optimize the envelope effect. And the structure with hybrid rotational and translational joints is proposed to increase gripping stiffness and to avoid the harmful component in the grip force. Theoretical analyses and experiments on envelope effect, force distribution and load capacity show that the propose gripper can grasp cylindrical (limb-shaped) objects with wide applicable size range, and also has a high load capacity. Furthermore, the gripper has the characteristic of almost constant force transfer ratio, which reduces the number of sensors required by the system. These results show that the gripper has the potential to be used in the nursing robot system.

A Way of Bionic Control Based on EI, EMG, and FMG Signals

Creating highly functional prosthetic, orthotic, and rehabilitation devices is a socially relevant scientific and engineering task. Currently, certain constraints hamper the development of such devices. The primary constraint is the lack of an intuitive and reliable control interface working between the organism and the actuator. The critical point in developing these devices and systems is determining the type and parameters of movements based on control signals recorded on an extremity. In the study, we investigate the simultaneous acquisition of electric impedance (EI), electromyography (EMG), and force myography (FMG) signals during basic wrist movements: grasping, flexion/extension, and rotation. For investigation, a laboratory instrumentation and software test setup were made for registering signals and collecting data. The analysis of the acquired signals revealed that the EI signals in conjunction with the analysis of EMG and FMG signals could potentially be highly informative in anthropomorphic control systems. The study results confirm that the comprehensive real-time analysis of EI, EMG, and FMG signals potentially allows implementing the method of anthropomorphic and proportional control with an acceptable delay.

Flexible Photodriven Actuator Based on Gradient-Paraffin-Wax-Filled Ti3C2Tx MXene Film for Bionic Robots

Due to their high flexibility and adaptability, bionic robots have great potential in applications such as healthcare, rescue, and surveillance. The flexible actuator is an essential component of the bionic robot and determines its performance. Even though much progress has been achieved in bionic robot research, there still exists a great challenge in preparing a flexible actuator with a large stroke, high sensitivity, fast response, low triggering power, and long lifetime. This study presents a flexible actuator based on a paraffin wax and Ti₃C₂T_x MXene (PW-MX) film composite. Such a flexible actuator delivers an excellent actuation performance, including a large curvature change (2.2 × 10² m^-1), high thermal sensitivity (4.6 m^-1/°C), low triggering power of light (76 mW/cm²), wavelength selectivity, fast response (0.38 s), and long lifetime (>20000 cycles). Due to the high thermal sensitivity and the strong infrared absorption of the PW-MX film, crawling motion of an inchworm robot based on PW-MX film can be triggered by infrared irradiation from the human finger. To mimic living organisms with bioluminescence, we prepared a PW-MX actuator with green fluorescence by doping PW-MX film with CdSe/ZnS quantum dots. The integration of luminescent function enables the PW-MX actuator to deliver information under light stimulation and to camouflage under a background of green foliage actively. With its merits of ease of fabrication and high actuation performance, the flexible PW-MX actuator is expected to lend itself to more applications in the future.

Radiocapitellar joint pressures following transradial amputation increase during elbow motion

This study aimed to compare the contact area, mean pressure, and peak pressure of the radiocapitellar joint (RCJ) in the upper limb after transradial amputation with those of the normal upper limb during elbow flexion and forearm rotation. Testing was performed using ten fresh-frozen upper limbs, and the transradial amputation was performed 5 cm proximal to the radial styloid process. The specimens were connected to a custom-designed apparatus for testing. A pressure sensor was inserted into the RCJ. The biomechanical indices of the RCJ were measured during elbow flexion and forearm rotation in all specimens. There was no significant difference in the contact area between the normal and transradial amputated upper limbs. However, in the upper limbs after transradial amputation, the mean pressure was higher than that in the normal upper limbs at all positions of elbow flexion and forearm rotation. The peak pressure was significantly higher in the upper limbs after transradial amputation than in the normal upper limbs, and was especially increased during pronation at 45° of elbow flexion. In conclusion, these results could cause cartilage erosion in the RCJ of transradial amputees. Thus, methods to reduce the pressure of the RCJ should be considered when a myoelectric prosthesis is developed.

Advanced Materials and Technologies for Touch Sensing in Prosthetic Limbs

Neuroscience studies have proved that the absence of proper tactile feedback can affect human behavior. A qualitative and quantitative growth in flexible artificial touch sensing technologies has been witnessed over the recent years. The development of flexible, sensitive, cost-effective, and durable artificial tactile sensors is crucial for prosthetic rehabilitation. Many researchers are working on realizing a smart touch sensing system for prosthetic devices. To mimic the human sensory system is extremely difficult. The practical uses of the newly invented techniques in the industry are limited by complex fabrication processes and lack of proper data processing techniques. Many compatible flexible substrates, materials, and strategies for tactile sensors have been identified to enhance the amputee population. This paper reviews the flexible substrates, functional materials, preparation methods, and several computational techniques for artificial tactile sensors.

Biomimetic Prosthetic Hand Enabled by Liquid Crystal Elastomer Tendons

As one of the most important prosthetic implants for amputees, current commercially available prosthetic hands are still too bulky, heavy, expensive, complex and inefficient. Here, we present a study that utilizes the artificial tendon to drive the motion of fingers in a biomimetic prosthetic hand. The artificial tendon is realized by combining liquid crystal elastomer (LCE) and liquid metal (LM) heating element. A joule heating-induced temperature increase in the LCE tendon leads to linear contraction, which drives the fingers of the biomimetic prosthetic hand to bend in a way similar to the human hand. The responses of the LCE tendon to joule heating, including temperature increase, contraction strain and contraction stress, are characterized. The strategies of achieving a constant contraction stress in an LCE tendon and accelerating the cooling for faster actuation are also explored. This biomimetic prosthetic hand is demonstrated to be able to perform complex tasks including making different hand gestures, holding objects of different sizes and shapes, and carrying weights. The results can find applications in not only prosthetics, but also robots and soft machines.

Can Prosthetic Hands Mimic a Healthy Human Hand?

Historical evidence suggests that prostheses have been used since ancient Egyptian times. Prostheses were usually utilized for function and cosmetic appearances. Nowadays, with the advancement of technology, prostheses such as artificial hands can not only improve functional, but have psychological advantages as well and, therefore, can significantly enhance an individual’s standard of living. Combined with advanced science, a prosthesis is not only a simple mechanical device, but also an aesthetic, engineering and medical marvel. Prosthetic limbs are the best tools to help amputees reintegrate into society. In this article, we discuss the background and advancement of prosthetic hands with their working principles and possible future implications. We also leave with an open question to the readers whether prosthetic hands could ever mimic and replace our biological hands.

A review of technology, materials and R&D challenges of upper limb prosthesis for improved user suitability

Introduction

Hand amputation significantly challenges one's independence in carrying out daily activities. With the UK and Italy recoding circa 5200 and 3500 upper limb (UL) amputations (ULAs) yearly, respectively, and about 541,000 Americans losing ULs in 2005, incidence victims constitute a considerable proportion of our population and should be adequately supported. The use of upper limb prosthesis (ULP) offers amputees a new opportunity of living a quality life - but poses challenges on the physically and psychologically traumatised. With reports that up to 20% of adult UL amputees choose not to use a prosthesis, roughly 26% of adults and 45% of children and adolescents are dissatisfied with their devices and abandon them with reasons of poor solution to basic needs, a review of ULP for suitability has become crucial.

Objectives

These include, to review UL prosthetic technology (PT), the materials used in the manufacturing of ULP, challenges in research and development of ULP, and to advise on the suitability of different devices to the needs of amputees.

Methods

They involve an extensive review of relevant literature and application of statistics to analyse data obtained from literature.

Results

ULAs are characterised to show affected bones in seven types of amputations. The characterisation depicts key causes of incidences that lead to amputations while advising on device suitability. PT is classified in terms of cost, nature, functions/operations of each type of device while providing the design challenges. Users' opinions on PT materials are analysed and used to suggest new materials for the next generation of the devices. R&D challenges hindering future developments of PT is reviewed and results used to identify characteristics for the next generation of the technology.

Conclusions

To increase user satisfaction and reduce device abandonment, amputees need useful information on the trend in PT and engineers need information about device field performance for improvements. The use of better performing ULP will improve users' everyday lives.

One-step Implantation of a 3D Neural Microelectrode Array

This paper presents a neurosurgical device called NEIT 2 (Nerve Electrode Insertion Tool) to implant a 3D microelectrode array into a peripheral nervous system. Using an elastomer-made nerve holder, the device is able to stable target a flexible nerve, and then safely inserts an electrode array into the fixed nerve. Finally, a nerve containment assembly is made at once. We conducted animal experiments to evaluate the proposed scenario using a 3D printed prototype and commercial microelectrodes. The results show that microelectrodes are successfully implanted into sciatic nerves of rats and neural signals are recorded through the chronically implanted electrodes.

Development of an Anthropomorphic Prosthetic Hand with Underactuated Mechanism

An anthropomorphic prosthetic hand for wrist or forearm amputees is developed herein. The prosthetic hand was designed with an underactuated mechanism, which makes self-adaptive grasping possible, as well as natural motions such as flexion and extension. The finger and thumb modules were designed with four degrees of freedom by motions of the distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints. In this research, we pursued several novel trials in prosthetic hand design. By using two four-bar linkages composed of a combination of linkages and gears for coupling joints at each finger, it was possible to make a compact design, and the linkage has advantages such as accurate positioning, uniform power transmission, and high payload. Also, by using constant-velocity joints, torque is transferred to finger modules regardless of adduction/abduction motions. In addition, adduction/abduction and self-adaptive grasping motions are passively realized using torsional springs. The developed prosthetic hand was fabricated with a weight of 475 g and a human hand size of 175 mm. Experiments with diverse objects showed its good functionality.

A practical 3D-printed soft robotic prosthetic hand with multi-articulating capabilities

Soft robotic hands with monolithic structure have shown great potential to be used as prostheses due to their advantages to yield light weight and compact designs as well as its ease of manufacture. However, existing soft prosthetic hands design were often not geared towards addressing some of the practical requirements highlighted in prosthetics research. The gap between the existing designs and the practical requirements significantly hampers the potential to transfer these designs to real-world applications. This work addressed these requirements with the consideration of the trade-off between practicality and performance. These requirements were achieved through exploiting the monolithic 3D printing of soft materials which incorporates membrane enclosed flexure joints in the finger designs, synergy-based thumb motion and cable-driven actuation system in the proposed hand prosthesis. Our systematic design (tentatively named X-Limb) achieves a weight of 253gr, three grasps types (with capability of individual finger movement), power-grip force of 21.5N, finger flexion speed of 1.3sec, a minimum grasping cycles of 45,000 (while maintaining its original functionality) and a bill of material cost of 200 USD (excluding quick disconnect wrist but without factoring in the cost reduction through mass production). A standard Activities Measure for Upper-Limb Amputees benchmark test was carried out to evaluate the capability of X-Limb in performing grasping task required for activities of daily living. The results show that all the practical design requirements are satisfied, and the proposed soft prosthetic hand is able to perform all the real-world grasping tasks of the benchmark tests, showing great potential in improving life quality of individuals with upper limb loss.

The current state of bionic limbs from the surgeon's viewpoint

Amputations have a devastating impact on patients' health with consequent psychological distress, economic loss, difficult reintegration into society, and often low embodiment of standard prosthetic replacement.The main characteristic of bionic limbs is that they establish an interface between the biological residuum and an electronic device, providing not only motor control of prosthesis but also sensitive feedback.Bionic limbs can be classified into three main groups, according to the type of the tissue interfaced: nerve-transferred muscle interfacing (targeted muscular reinnervation), direct muscle interfacing and direct nerve interfacing.Targeted muscular reinnervation (TMR) involves the transfer of the remaining nerves of the amputated stump to the available muscles.With direct muscle interfacing, direct intramuscular implants record muscular contractions which are then wirelessly captured through a coil integrated in the socket to actuate prosthesis movement.The third group is the direct interfacing of the residual nerves using implantable electrodes that enable reception of electric signals from the prosthetic sensors. This can improve sensation in the phantom limb.The surgical procedure for electrode implantation consists of targeting the proximal nerve area, competently introducing, placing, and fixing the electrodes and cables, while retaining movement of the arm/leg and nerve, and avoiding excessive neural damage.Advantages of bionic limbs are: the improvement of sensation, improved reintegration/embodiment of the artificial limb, and better controllability. Cite this article: EFORT Open Rev 2020;5:65-72. DOI: 10.1302/2058-5241.5.180038.

A UV damage-sensing nociceptive device for bionic applications

Artificial limbs have been widely investigated in the past several decades, and multifuncional bionic limbs have already been constructed. However, due the lack of nociceptive systems, amputees still cannot feel ubiquitous noxious stimuli through bionic limbs. The construction of artificial nociceptors can bring bionic limbs closer to real flesh and bone. In daily life, UV irradiation is an invisible potential noxious stimulus to human skin and eyes. Furthermore, it is well known that the synthetic polymers widely used in bionic limbs can be degraded by UV radiation, accelerating their aging. Based on the above, UV damage-sensing nociceptors could be a feasible strategy to solve these existing problems. Here, azobenzene-functionalized gold nanoparticles (Azo-Au NPs) are embedded in insulating poly(methyl methacrylate) (PMMA) to construct a two-terminal memristor. With UV irradiation as a light damage medium, major nociceptive behaviors such as "threshold", "relaxation" and "sensitization" are successfully emulated, demonstrating its potential application as a nociceptive system.

Residual rotation of forearm amputation: cadaveric study

Background

The purpose of this study was to investigate residual rotation of patients with forearm amputation and the contribution of involved muscle to residual rotation.

Methods

Testing was performed using five fresh-frozen cadaveric specimens prepared by isolating muscles involved in forearm rotation. Amputation was implemented at 25 cm (wrist disarticulation), 18 cm, or 10 cm from the tip of olecranon. Supination and pronation in the amputation stump were simulated with traction of involved muscle (supinator, biceps brachii, pronator teres, pronator quadratus) using an electric actuator. The degree of rotation was examined at 30°, 60°, 90°, and 120° in flexion of elbow.

Results

Average rotation of 25 cm forearm stump was 148° (SD: 23.1). The rotation was decreased to 117.5° (SD: 26.6) at 18 cm forearm stump. It was further decreased to 63° (SD 31.5) at 10 cm forearm stump. Tendency of disorganized rotation was observed in close proximity of the amputation site to the elbow. Full residual pronation was achieved with traction of each pronator teres and pronator quadratus. Although traction of supinator could implement residual supination, the contribution of biceps brachii ranged from 4 to 88% according to the degree of flexion.

Conclusions

Close proximity of the amputation site to the elbow decreased the residual rotation significantly compared to residual rotation of wrist disarticulation. The preservation of pronosupination was 80% at 18 cm forearm stump. Although the pronator teres and the pronator quadratus could make a full residual pronation separately, the supinator was essential to a residual supination.

Self-health monitoring and wearable neurotechnologies

Brain-computer interfaces and wearable neurotechnologies are now used to measure real-time neural and physiologic signals from the human body and hold immense potential for advancements in medical diagnostics, prevention, and intervention. Given the future role that wearable neurotechnologies will likely serve in the health sector, a critical state-of-the-art assessment is necessary to gain a better understanding of their current strengths and limitations. In this chapter we present wearable electroencephalography systems that reflect groundbreaking innovations and improvements in real-time data collection and health monitoring. We focus on specifications reflecting technical advantages and disadvantages, discuss their use in fundamental and clinical research, their current applications, limitations, and future directions. While many methodological and ethical challenges remain, these systems host the potential to facilitate large-scale data collection far beyond the reach of traditional research laboratory settings.

What microsurgeon, orthopaedic and plastic surgeon should know about bionic hand

Hand loss is a catastrophic event that generates significant demands for orthopedics and prosthetics. In the course of history, prostheses evolved from passive esthetic replacements to sophisticated robotic hands. Yet, their actuation and particularly, their capacity to provide patients with sensations, remain an unsolved problem. Sensations associated with the hand, such as touch, pain, pressure and temperature detection are very important, since they enable humans to gather information from the environment. Recently, through a synergistic multidisciplinary effort, medical doctors and engineers have attempted to address these issues by developing bionic limbs. The aim of the bionic hands is to replace the amputated hands while restoring sensation and reintroducing hand-motor control. Recently, several different approaches have been made to interface this sophisticated prosthesis with residual neuro-muscular structures. Different types of implants, such as intramuscular, epineural and intraneural, each have their own complementary advantages and disadvantages, which are discussed in this paper. After initial trials with percutaneous leads, present research is aimed at making long-term implantable electrodes that give rich, natural feedback and allow for effortless control. Finally, a pivotal part in the development of this technology is the surgical technique which will be described in this paper. The surgeons' insights into this procedure are given. These kinds of prostheses compared with the classic one, hold a promise of dramatic health and quality of life increase, together with the decrease the rejection rate.

Quantitative Eye Gaze and Movement Differences in Visuomotor Adaptations to Varying Task Demands Among Upper-Extremity Prosthesis Users

IMPORTANCE

New treatments for upper-limb amputation aim to improve movement quality and reduce visual attention to the prosthesis. However, evaluation is limited by a lack of understanding of the essential features of human-prosthesis behavior and by an absence of consistent task protocols.

OBJECTIVE

To evaluate whether task selection is a factor in visuomotor adaptations by prosthesis users to accomplish 2 tasks easily performed by individuals with normal arm function.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study was conducted in a single research center at the University of Alberta, Edmonton, Alberta, Canada. Upper-extremity prosthesis users were recruited from January 1, 2016, through December 31, 2016, and individuals with normal arm function were recruited from October 1, 2015, through November 30, 2015. Eight prosthesis users and 16 participants with normal arm function were asked to perform 2 goal-directed tasks with synchronized motion capture and eye tracking. Data analysis was performed from December 3, 2018, to April 15, 2019.

MAIN OUTCOME AND MEASURES

Movement time, eye fixation, and range of motion of the upper body during 2 object transfer tasks (cup and box) were the main outcomes.

RESULTS

A convenience sample comprised 8 male prosthesis users with acquired amputation (mean [range] age, 45 [30-64] years), along with 16 participants with normal arm function (8 [50%] of whom were men; mean [range] age, 26 [18-43] years; mean [range] height, 172.3 [158.0-186.0] cm; all right handed). Prosthesis users spent a disproportionately prolonged mean (SD) time in grasp and release phases when handling the cups (grasp: 2.0 [2.3] seconds vs 0.9 [0.8] seconds; P < .001; release: 1.1 [0.6] seconds vs 0.7 [0.4] seconds; P < .001). Prosthesis users also had increased mean (SD) visual fixations on the hand for the cup compared with the box task during reach (10.2% [12.1%] vs 2.2% [2.8%]) and transport (37.1% [9.7%] vs 22.3% [7.6%]). Fixations on the hand for both tasks were significantly greater for prosthesis users compared with normative values. Prosthesis users had significantly more trunk flexion and extension for the box task compared with the cup task (mean [SD] trunk range of motion, 32.1 [10.7] degrees vs 21.2 [3.7] degrees; P = .01), with all trunk motions greater than normative values. The box task required greater shoulder movements compared with the cup task for prosthesis users (mean [SD] flexion and extension; 51.3 [12.6] degrees vs 41.0 [9.4] degrees, P = .01; abduction and adduction: 40.5 [7.2] degrees vs 32.3 [5.1] degrees, P = .02; rotation: 50.6 [15.7] degrees vs 35.5 [10.0] degrees, P = .02). However, other than shoulder abduction and adduction for the box task, these values were less than those seen for participants with normal arm function.

CONCLUSIONS AND RELEVANCE

This study suggests that prosthesis users have an inherently different way of adapting to varying task demands, therefore suggesting that task selection is crucial in evaluating visuomotor performance. The cup task required greater compensatory visual fixations and prolonged grasp and release movements, and the box task required specific kinematic compensatory strategies as well as increased visual fixation. This is the first study to date to examine visuomotor differences in prosthesis users across varying task demands, and the findings appear to highlight the advantages of quantitative assessment in understanding human-prosthesis interaction.

Specialized Smartphone Intervention Apps: Review of 2014 to 2018 NIH Funded Grants

Background

The widespread adoption of smartphones provides researchers with expanded opportunities for developing, testing and implementing interventions. National Institutes of Health (NIH) funds competitive, investigator-initiated grant applications. Funded grants represent the state of the science and therefore are expected to anticipate the progression of research in the near future.

Objective

The objective of this paper is to provide an analysis of the kinds of smartphone-based intervention apps funded in NIH research grants during the five-year period between 2014 and 2018.

Methods

We queried NIH Reporter to identify candidate funded grants that addressed mHealth and the use of smartphones. From 1524 potential grants, we identified 397 that met the requisites of including an intervention app. Each grant’s abstract was analyzed to understand the focus of intervention. The year of funding, type of activity (eg, R01, R34, and so on) and funding were noted.

Results

We identified 13 categories of strategies employed in funded smartphone intervention apps. Most grants included either one (35.0%) or two (39.0%) intervention approaches. These included artificial intelligence (57 apps), bionic adaptation (33 apps), cognitive and behavioral therapies (68 apps), contingency management (24 apps), education and information (85 apps), enhanced motivation (50 apps), facilitating, reminding and referring (60 apps), gaming and gamification (52 apps), mindfulness training (18 apps), monitoring and feedback (192 apps), norm setting (7 apps), skills training (85 apps) and social support and social networking (59 apps). The most frequently observed grant types included Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) grants (40.8%) and Research Project Grants (R01s) (26.2%). The number of grants funded increased through the five-year period from 60 in 2014 to 112 in 2018.

Conclusions

Smartphone intervention apps are increasingly competitive for NIH funding. They reflect a wide diversity of approaches that have significant potential for use in applied settings.

Prosthetic Rehabilitation and Vascularized Composite Allotransplantation following Upper Limb Loss

BACKGROUND

Upper limb loss is a devastating condition with dramatic physical, psychological, financial, and social consequences. Improvements in the fields of prosthetics and vascularized composite allotransplantation have opened exciting new frontiers for treatment and rehabilitation following upper limb loss. Each modality offers a unique set of advantages and limitations with regard to the restoration of hand function following amputation.

METHODS

Presented in this article is a discussion outlining the complex considerations and decisions encountered when determining patient appropriateness for either prosthetic rehabilitation or vascularized composite allotransplantation following upper limb loss. In this review, the authors examine how psychosocial factors, nature of injury, rehabilitation course, functional outcomes, and risks and benefits may affect overall patient selection for either rehabilitative approach.

RESULTS

This review summarizes the current state of the literature. Advancements in both prosthetic and biological strategies demonstrate promise with regard to facilitating rehabilitation following upper limb loss. However, there remains a dearth of research directly comparing outcomes in prosthetic rehabilitation to that following upper extremity transplantation.

CONCLUSIONS

Few studies have performed a direct comparison between patients undergoing vascularized composite allotransplantation and those undergoing prosthetic rehabilitation. Upper extremity transplantation and prosthetic reconstruction should not be viewed as competing options, but rather as two treatment modalities with different risk-to-benefit profiles and indications.

A review on the advancements in the field of upper limb prosthesis

Amputation is one of the serious issue across the globe which is mainly caused by trauma, medical illness or congenital condition. Because of steep increase in amputation incidences, the need for progress in technicality of prosthesis is becoming imperative. In this article, the journey of advancements in upper arm prosthesis has been discussed step by step. Moreover, it has also been enunciated that how from a simple replacement for an arm it now has reached the mark of giving a patient a fully functional limb with the help of sensors and myoelectric transducers that are able to translate the remaining muscle signals into full movement of the prosthesis. However, researches are still going on to make the design of the prosthetic more impressive having better range of movement, to establish its interface with brain more efficiently and to make the control of prosthetic more user friendly. In this review, a special emphasis has also been given to myoelectric prosthesis as this prosthetic system possesses a decisive influence on rehabilitation results. Moreover, this prosthetic system is extremely elegant and cutting-edge in both design and technology and offers a great wearer comfort.

Principle of Least Psychomotor Action: Modelling Situated Entropy in Optimization of Psychomotor Work Involving Human, Cyborg and Robot Workers

Entropy in workplaces is situated amidst workers and their work. In this paper, findings are reported from a study encompassing psychomotor work by three types of workers: human, cyborg and robot; together with three aspects of psychomotor work: setting, composition and uncertainty. The Principle of Least Psychomotor Action (PLPA) is introduced and modelled in terms of situated entropy. PLPA is founded upon the Principle of Least Action. Situated entropy modelling of PLPA is informed by theoretical studies concerned with connections between information theory and thermodynamics. Four contributions are provided in this paper. First, the situated entropy of PLPA is modelled in terms of positioning, performing and perfecting psychomotor skills. Second, with regard to workers, PLPA is related to the state-of-the-art in human, cyborg and robot psychomotor skills. Third, with regard to work, situated entropy is related to engineering of work settings, work composition and work uncertainty. Fourth, PLPA and modelling situated entropy are related to debate about the future of work. Overall, modelling situated entropy is introduced as a means of objectively modelling relative potential of humans, cyborgs, and robots to carry out work with least action. This can introduce greater objectivity into debates about the future of work.

Long-term results of early myoelectric prosthesis fittings: A prospective case-control study

BACKGROUND

Different recommendations exist regarding what age is best for first-time fitting of myoelectric hand prostheses in children.

OBJECTIVES

To compare prosthetic skill, prosthetic use and risk for rejection over time between children fitted with myoelectric hand prostheses before or after 2½ years of age.

STUDY DESIGN

Prospective case-control design.

METHODS

The cases were nine children fitted with myoelectric hand prostheses before the age of 2½ years, whereas the controls were 27 children who were fitted with myoelectric hand prostheses after the age of 2½ years. The Skills Index Ranking Scale was used to classify prosthetic skill, and prosthetic use was categorised based on wearing time and pattern. Independent samples tests were used to compare data between groups. To estimate and compare the risk of prosthesis rejection between groups and over time, survival analysis was used.

RESULTS

Cases showed prosthetic skill early, but controls had caught up by the age of 3½ years. Cases had a significant ( p = 0.046) decrease in prosthetic use at the age of 9 years. In the long term, cases had a higher percentage of prosthesis rejection.

CONCLUSIONS

Considering young children's development of prosthetic skill and prosthetic use over time, this study shows no additional advantages from fitting a myoelectric hand prosthesis before 2½ years of age. Clinical relevance Children may be fitted with myoelectric hand prostheses to assist in daily tasks and to prevent future over-use problems. Most children fitted with myoelectric hand prostheses before 4 years of age become regular users. No advantages of fitting myoelectric hand prostheses before 2½ years of age were observed.

Novel neural interface electrode array for the peripheral nerve

Peripheral neural interface (PNI) is becoming an essential technology in the field of robotic prosthesis due to its potential for providing bidirectional neural signal communication between the prosthetic arm and the brain. However, current PNIs inefficiently trade off neural signal selectivity and the invasiveness of the device. We designed and fabricated a new PNI electrode array that has high signal selectivity yet maintains low invasiveness by incorporating a design that allows for three-dimensional spiral insertion around the peripheral nerve. The neural signal acquisition capability was confirmed through impedance measurement in vitro, and the proposed device had an average impedance of 296 ± 52 kΩ at 1000 Hz.

A handheld device for magnetically inserting a neural interface into a peripheral nervous system

This paper proposes a compact handheld device for magnetically inserting a neural interface into a peripheral nervous system (PNS). Users can pull and hold a flexible peripheral nerve (e.g., sciatic nerve) at the front of the device for the accurate and stable targeting process. The device automatically inserts a neural interface using magnetic impacts that are generated by a miniature motor and a pair of magnets. We investigate the characteristics of the employed mechanism, and present the preliminary experimental results.

Examining the Spatiotemporal Disruption to Gaze When Using a Myoelectric Prosthetic Hand

The aim of this study was to provide a detailed account of the spatial and temporal disruptions to eye-hand coordination when using a prosthetic hand during a sequential fine motor skill. Twenty-one able-bodied participants performed 15 trials of the picking up coins task derived from the Southampton Hand Assessment Procedure with their anatomic hand and with a prosthesis simulator while wearing eye-tracking equipment. Gaze behavior results revealed that when using the prosthesis, performance detriments were accompanied by significantly greater hand-focused gaze and a significantly longer time to disengage gaze from manipulations to plan upcoming movements. The study findings highlight key metrics that distinguish disruptions to eye-hand coordination that may have implications for the training of prosthesis use.

Literature Review on Needs of Upper Limb Prosthesis Users

The loss of one hand can significantly affect the level of autonomy and the capability of performing daily living, working and social activities. The current prosthetic solutions contribute in a poor way to overcome these problems due to limitations in the interfaces adopted for controlling the prosthesis and to the lack of force or tactile feedback, thus limiting hand grasp capabilities. This paper presents a literature review on needs analysis of upper limb prosthesis users, and points out the main critical aspects of the current prosthetic solutions, in terms of users satisfaction and activities of daily living they would like to perform with the prosthetic device. The ultimate goal is to provide design inputs in the prosthetic field and, contemporary, increase user satisfaction rates and reduce device abandonment. A list of requirements for upper limb prostheses is proposed, grounded on the performed analysis on user needs. It wants to (i) provide guidelines for improving the level of acceptability and usefulness of the prosthesis, by accounting for hand functional and technical aspects; (ii) propose a control architecture of PNS-based prosthetic systems able to satisfy the analyzed user wishes; (iii) provide hints for improving the quality of the methods (e.g., questionnaires) adopted for understanding the user satisfaction with their prostheses.

Transradial Amputee Gesture Classification Using an Optimal Number of sEMG Sensors: An Approach Using ICA Clustering

Surface electromyography (sEMG)-based pattern recognition studies have been widely used to improve the classification accuracy of upper limb gestures. Information extracted from multiple sensors of the sEMG recording sites can be used as inputs to control powered upper limb prostheses. However, usage of multiple EMG sensors on the prosthetic hand is not practical and makes it difficult for amputees due to electrode shift/movement, and often amputees feel discomfort in wearing sEMG sensor array. Instead, using fewer numbers of sensors would greatly improve the controllability of prosthetic devices and it would add dexterity and flexibility in their operation. In this paper, we propose a novel myoelectric control technique for identification of various gestures using the minimum number of sensors based on independent component analysis (ICA) and Icasso clustering. The proposed method is a model-based approach where a combination of source separation and Icasso clustering was utilized to improve the classification performance of independent finger movements for transradial amputee subjects. Two sEMG sensor combinations were investigated based on the muscle morphology and Icasso clustering and compared to Sequential Forward Selection (SFS) and greedy search algorithm. The performance of the proposed method has been validated with five transradial amputees, which reports a higher classification accuracy ( > 95%). The outcome of this study encourages possible extension of the proposed approach to real time prosthetic applications.

Development of a control system for artificially rehabilitated limbs: a review

Development of an advanced control system for prostheses (artificial limbs) is necessary to provide functionality, effectiveness, and preferably the feeling of a sound living limb. The development of the control system has introduced varieties of control strategies depending on the application. This paper reviews some control systems used for prosthetics, orthotics, and exoskeletons. The advantages and limitations of different control systems for particular applications have been discussed and presented in a comparative manner to help in deciding the appropriate method for pertinent application.

Tactile Feedback in Upper Limb Prosthetic Devices Using Flexible Textile Force Sensors

Many upper limb amputees are faced with the difficult challenge of using a prosthesis that lacks tactile sensing. State of the art research caliber prosthetic hands are often equipped with sophisticated sensors that provide valuable information regarding the prosthesis and its surrounding environment. Unfortunately, most commercial prosthetic hands do not contain any tactile sensing capabilities. In this paper, a textile based tactile sensor system was designed, built, and evaluated for use with upper limb prosthetic devices. Despite its simplicity, we demonstrate the ability of the sensors to determine object contact and perturbations due to slip during a grasping task with a prosthetic hand. This suggests the use of low-cost, customizable, textile sensors as part of a closed-loop tactile feedback system for monitoring grasping forces specifically in an upper limb prosthetic device.

The extraction of neural information from the surface EMG for the control of upper-limb prostheses: emerging avenues and challenges

Despite not recording directly from neural cells, the surface electromyogram (EMG) signal contains information on the neural drive to muscles, i.e., the spike trains of motor neurons. Using this property, myoelectric control consists of the recording of EMG signals for extracting control signals to command external devices, such as hand prostheses. In commercial control systems, the intensity of muscle activity is extracted from the EMG and used for single degrees of freedom activation (direct control). Over the past 60 years, academic research has progressed to more sophisticated approaches but, surprisingly, none of these academic achievements has been implemented in commercial systems so far. We provide an overview of both commercial and academic myoelectric control systems and we analyze their performance with respect to the characteristics of the ideal myocontroller. Classic and relatively novel academic methods are described, including techniques for simultaneous and proportional control of multiple degrees of freedom and the use of individual motor neuron spike trains for direct control. The conclusion is that the gap between industry and academia is due to the relatively small functional improvement in daily situations that academic systems offer, despite the promising laboratory results, at the expense of a substantial reduction in robustness. None of the systems so far proposed in the literature fulfills all the important criteria needed for widespread acceptance by the patients, i.e. intuitive, closed-loop, adaptive, and robust real-time ( 200 ms delay) control, minimal number of recording electrodes with low sensitivity to repositioning, minimal training, limited complexity and low consumption. Nonetheless, in recent years, important efforts have been invested in matching these criteria, with relevant steps forwards.

Can we regrow a human arm? A negative perspective from an upper-limb surgeon

If we would like to devote time and money to the task of regrowing a human arm, we should feel free to do it, in principle. However, if we recognize a purpose in biomedical research, we must scrutinize this task in the light of a possible clinical application. We will then discover that regrowing a human arm is not only likely to be not possible, but also not required in the clinic. Bionic arms and better reconstructive surgery already provide a different, simpler and easier solution to the loss of a human arm, and should be promoted. Probably, ‘‘can we regrow a human arm?’’ is not the right question. Instead, we should ask, ‘‘can we restore the function of a lost human arm?’’.

Experimental characterization of a flexible thermal slip sensor

Tactile sensors are needed for effectively controlling the interaction between a robotic hand and the environment, e.g., during manipulation of objects, or for the tactile exploration of unstructured environments, especially when other sensing modalities, such as vision or audition, become ineffective. In the case of hand prostheses, mainly intended for dexterous manipulation of daily living objects, the possibility of quickly detecting slip occurrence, thus avoiding inadvertent falling of the objects, is prodromal to any manipulation task. In this paper we report on a slip sensor with no-moving parts, based on thermo-electrical phenomena, fabricated on a flexible substrate and suitable for integration on curved surfaces, such as robotic finger pads. Experiments performed using a custom made test bench, which is capable of generating controlled slip velocities, show that the sensor detects slip events in less than 50 ms. This response time is short enough for enabling future applications in the field of hand prosthetics.

Current management of the mangled upper extremity

Mangled describes an injury caused by cutting, tearing, or crushing, which leads to the limb becoming unrecognizable; in essence, there are two treatment options for mangled upper extremities, amputation and salvage reconstruction. With advances in our understanding of human physiology and basic science, and with the development of new fixation devices, modern microsurgical techniques and the possibility of different types of bony and soft tissue reconstruction, the clinical and functional outcomes are often good, and certainly preferable to those of contemporary prosthetics. Early or even immediate (emergency) complete upper extremity reconstruction appears to give better results than delayed or late reconstruction and should be the treatment of choice where possible. Before any reconstruction is attempted, injuries to other organs must be excluded. Each step in the assessment and treatment of a mangled extremity is of utmost importance. These include radical tissue debridement, prophylactic antibiotics, copious irrigation with a lavage system, stable bone fixation, revascularization, nerve repair, and soft tissue coverage. Well-planned and early rehabilitation leads to a better functional outcome. Despite the use of scoring systems to help guide decisions and predict outcomes, the decision to reconstruct or to amputate still ultimately lies with the surgical judgment and experience of the treating surgeon.