Artificial limb representation in amputees

The Use of ABILHAND-Kids in Children with Unilateral Congenital Below-Elbow Deficiencies and Acquired Amputation: An Italian Cross-Sectional Study

Congenital or acquired hand differences, including unilateral below-elbow deficiencies, present complex challenges in pediatric rehabilitation. Surgical management and prosthetic provision represent a big challenge to find a good balance for guaranteeing optimal hand function. There is no specific assessment tool for measuring these aspects in the Italian context. The present study investigates the psychometric properties of the ABILHAND-Kids in children with congenital unilateral below-elbow deficiencies and acquired amputation of the upper limb. We measure internal consistency using Cronbach coefficient alpha and the intraclass correlation coefficient (ICC) for measuring test-retest reliability. Differences in hand function in both children with acquired or congenital diseases were also investigated. Participants to the study were 107 (49 F and 58 M) children, with a mean (SD) age of 8.88 (4.25). For test retest reliability, conducted on a sub-sample of 58 children, the ICC was 0.92, while for internal consistency, the Cronbach coefficient alpha was 0.90. We did not find statistically significant differences in scoring (p = 0.33) in the use (mean 29.25 SD 6.58) or non-use of a prosthetic device (mean 30.74 SD 7.43), while statistically significant differences were found in hand function (p < 0.01) for children who had a congenital impairment (mean 31.87 SD 6.49) and children who had an acquired amputation (mean 27.77 SD 6.60). In conclusion, the ABILHAND-Kids showed good internal consistency and reliability and can capture differences in hand function in children with both congenital and acquired hand disorders.

Processing Language Partly Shares Neural Genetic Basis with Processing Tools and Body Parts

Language is an evolutionarily salient faculty for humans that relies on a distributed brain network spanning across frontal, temporal, parietal, and subcortical regions. To understand whether the complex language network shares common or distinct genetic mechanisms, we examined the relationships between the genetic effects underlying the brain responses to language and a set of object domains that have been suggested to coevolve with language: tools, faces (indicating social), and body parts (indicating social and gesturing). Analyzing the twin datasets released by the Human Connectome Project that had functional magnetic resonance imaging data from human twin subjects (monozygotic and dizygotic) undergoing language and working memory tasks contrasting multiple object domains (198 females and 144 males for the language task; 192 females and 142 males for the working memory task), we identified a set of cortical regions in the frontal and temporal cortices and subcortical regions whose activity to language was significantly genetically influenced. The heterogeneity of the genetic effects among these language clusters was corroborated by significant differences of the human gene expression profiles (Allen Human Brain Atlas dataset). Among them, the bilateral basal ganglia (mainly dorsal caudate) exhibited a common genetic basis for language, tool, and body part processing, and the right superior temporal gyrus exhibited a common genetic basis for language and tool processing across multiple types of analyses. These results uncovered the heterogeneous genetic patterns of language neural processes, shedding light on the evolution of language and its shared origins with tools and bodily functions.

Prosthetic home intervention induces cortical plasticity in paediatrics with congenital limb reduction

Paediatrics with congenital upper-limb reduction deficiency often face difficulties with normal development such as motor skills, needing assistance with daily activities such as self-care limitations with certain movements, sports, or activities. The purpose of this non-randomized longitudinal controlled trial was to assess, using intent-to-treat analysis, the effects of an 8-week home intervention of prosthetic use on the sensorimotor cortex in paediatrics with congenital upper-limb reduction deficiency. A paediatric population with congenital upper-limb reduction deficiency (n = 14) who were aged 6-18 years and who had a 20° or greater range of motion in the appropriate joint of the affected arm to move the body-powered prosthesis were enrolled. An age- and sex-matched control group (n = 14) was also enrolled. Participants were non-randomized and fitted with a custom low-cost 3D printed prosthesis and participated in 8 weeks of prosthetic use training at home. Control participants utilized a prosthetic simulator. The home intervention incorporated daily use training and exercises utilizing the prosthesis in direct use and assistive tasks explained by the researchers. After the home intervention, both groups displayed significant improvements in gross manual dexterity. During prosthetic use with the affected limb, significant increases in oxygenated hemodynamic responses were only displayed in the left premotor cortex of the upper-limb reduction deficiency group. The novel findings of this non-randomized longitudinal controlled trial suggest that the intervention may have improved the functional role of the left hemisphere which translated to the improvement of learning direction during adaptation to visuomotor control. The prosthetic home intervention was assumed to provide closed-loop training which could provide a direct benefit to the motor development of paediatrics with upper-limb reduction deficiency.

A framework for understanding prosthetic embodiment for the plastic surgeon

Plastic surgeons play a critical role in the management of amputations and are uniquely positioned to improve the lives and functional abilities of patients with limb loss. The embodiment of a prosthesis describes how effectively it replaces a missing limb and is an important aspect of patient care. Despite its importance, the current prosthetics literature lacks a formal definition of embodiment, and descriptions are often vague or incomplete. In this narrative review, we assess the current literature on prosthetic embodiment to explore the main mechanisms of embodiment and how each allows a prosthesis to interface with the human body. In doing so, we provide a comprehensive, holistic framework for understanding this concept.

Grasping with a Twist: Dissociating Action Goals from Motor Actions in Human Frontoparietal Circuits

In daily life, prehension is typically not the end goal of hand-object interactions but a precursor for manipulation. Nevertheless, functional MRI (fMRI) studies investigating manual manipulation have primarily relied on prehension as the end goal of an action. Here, we used slow event-related fMRI to investigate differences in neural activation patterns between prehension in isolation and prehension for object manipulation. Sixteen (seven males and nine females) participants were instructed either to simply grasp the handle of a rotatable dial (isolated prehension) or to grasp and turn it (prehension for object manipulation). We used representational similarity analysis (RSA) to investigate whether the experimental conditions could be discriminated from each other based on differences in task-related brain activation patterns. We also used temporal multivoxel pattern analysis (tMVPA) to examine the evolution of regional activation patterns over time. Importantly, we were able to differentiate isolated prehension and prehension for manipulation from activation patterns in the early visual cortex, the caudal intraparietal sulcus (cIPS), and the superior parietal lobule (SPL). Our findings indicate that object manipulation extends beyond the putative cortical grasping network (anterior intraparietal sulcus, premotor and motor cortices) to include the superior parietal lobule and early visual cortex.SIGNIFICANCE STATEMENT A simple act such as turning an oven dial requires not only that the CNS encode the initial state (starting dial orientation) of the object but also the appropriate posture to grasp it to achieve the desired end state (final dial orientation) and the motor commands to achieve that state. Using advanced temporal neuroimaging analysis techniques, we reveal how such actions unfold over time and how they differ between object manipulation (turning a dial) versus grasping alone. We find that a combination of brain areas implicated in visual processing and sensorimotor integration can distinguish between the complex and simple tasks during planning, with neural patterns that approximate those during the actual execution of the action.

Loss of action-related function and connectivity in the blind extrastriate body area

The Extrastriate Body Area (EBA) participates in the visual perception and motor actions of body parts. We recently showed that EBA’s perceptual function develops independently of visual experience, responding to stimuli with body-part information in a supramodal fashion. However, it is still unclear if the EBA similarly maintains its action-related function. Here, we used fMRI to study motor-evoked responses and connectivity patterns in the congenitally blind brain. We found that, unlike the case of perception, EBA does not develop an action-related response without visual experience. In addition, we show that congenital blindness alters EBA’s connectivity profile in a counterintuitive way—functional connectivity with sensorimotor cortices dramatically decreases, whereas connectivity with perception-related visual occipital cortices remains high. To the best of our knowledge, we show for the first time that action-related functions and connectivity in the visual cortex could be contingent on visuomotor experience. We further discuss the role of the EBA within the context of visuomotor control and predictive coding theory.

Neural Bypasses: Literature Review and Future Directions in Developing Artificial Neural Connections

Reported neuro-modulation schemes in the literature are typically classified as closed-loop or open-loop. A novel group of recently developed neuro-modulation devices may be better described as a neural bypass, which attempts to transmit neural data from one location of the nervous system to another. The most common form of neural bypasses in the literature utilize EEG recordings of cortical information paired with functional electrical stimulation for effector muscle output, most commonly for assistive applications and rehabilitation in spinal cord injury or stroke. Other neural bypass locations that have also been described, or may soon be in development, include cortical-spinal bypasses, cortical-cortical bypasses, autonomic bypasses, peripheral-central bypasses, and inter-subject bypasses. The most common recording devices include EEG, ECoG, and microelectrode arrays, while stimulation devices include both invasive and noninvasive electrodes. Several devices are in development to improve the temporal and spatial resolution and biocompatibility for neuronal recording and stimulation. A major barrier to entry includes neuroplasticity and current decoding mechanisms that regularly require retraining. Neural bypasses are a unique class of neuro-modulation. Continued advancement of neural recording and stimulating devices with high spatial and temporal resolution, combined with decoding mechanisms uninhibited by neuroplasticity, can expand the therapeutic capability of neural bypassing. Overall, neural bypasses are a promising modality to improve the treatment of common neurologic disorders, including stroke, spinal cord injury, peripheral nerve injury, brain injury and more.

Understanding Human Object Vision: A Picture Is Worth a Thousand Representations

Objects are the core meaningful elements in our visual environment. Classic theories of object vision focus upon object recognition and are elegant and simple. Some of their proposals still stand, yet the simplicity is gone. Recent evolutions in behavioral paradigms, neuroscientific methods, and computational modeling have allowed vision scientists to uncover the complexity of the multidimensional representational space that underlies object vision. We review these findings and propose that the key to understanding this complexity is to relate object vision to the full repertoire of behavioral goals that underlie human behavior, running far beyond object recognition. There might be no such thing as core object recognition, and if it exists, then its importance is more limited than traditionally thought.

Embodiment for Robotic Lower-Limb Exoskeletons: A Narrative Review

Research on embodiment of objects external to the human body has revealed important information about how the human nervous system interacts with robotic lower limb exoskeletons. Typical robotic exoskeleton control approaches view the controllers as an external agent intending to move in coordination with the human. However, principles of embodiment suggest that the exoskeleton controller should ideally coordinate with the human such that the nervous system can adequately model the input-output dynamics of the exoskeleton controller. Measuring embodiment of exoskeletons should be a necessary step in the exoskeleton development and prototyping process. Researchers need to establish high fidelity quantitative measures of embodiment, rather than relying on current qualitative survey measures. Mobile brain imaging techniques, such as high-density electroencephalography, is likely to provide a deeper understanding of embodiment during human-machine interactions and advance exoskeleton research and development. In this review we show why future exoskeleton research should include quantitative measures of embodiment as a metric of success.

Use-dependent increase in attention to the prosthetic foot in patients with lower limb amputation

Patients with lower limb amputation experience “embodiment” while using a prosthesis, perceiving it as part of their body. Humans control their biological body parts and receive appropriate information by directing attention toward them, which is called body-specific attention. This study investigated whether patients with lower limb amputation similarly direct attention to prosthetic limbs. The participants were 11 patients with lower limb amputation who started training to walk with a prosthesis. Attention to the prosthetic foot was measured longitudinally by a visual detection task. In the initial stage of walking rehabilitation, the index of attention to the prosthetic foot was lower than that to the healthy foot. In the final stage, however, there was no significant difference between the two indexes of attention. Correlation analysis revealed that the longer the duration of prosthetic foot use, the greater the attention directed toward it. These findings indicate that using a prosthesis focuses attention akin to that of an individual’s biological limb. Moreover, they expressed that the prosthesis felt like a part of their body when they could walk independently. These findings suggest that the use of prostheses causes integration of visual information and movement about the prosthesis, resulting in its subjective embodiment.

Embodiment of a virtual prosthesis through training using an EMG-based human-machine interface: Case series

Therapeutic strategies capable of inducing and enhancing prosthesis embodiment are a key point for better adaptation to and acceptance of prosthetic limbs. In this study, we developed a training protocol using an EMG-based human-machine interface (HMI) that was applied in the preprosthetic rehabilitation phase of people with amputation. This is a case series with the objective of evaluating the induction and enhancement of the embodiment of a virtual prosthesis. Six men and a woman with unilateral transfemoral traumatic amputation without previous use of prostheses participated in the study. Participants performed a training protocol with the EMG-based HMI, composed of six sessions held twice a week, each lasting 30 mins. This system consisted of myoelectric control of the movements of a virtual prosthesis immersed in a 3D virtual environment. Additionally, vibrotactile stimuli were provided on the participant’s back corresponding to the movements performed. Embodiment was investigated from the following set of measurements: skin conductance response (affective measurement), crossmodal congruency effect (spatial perception measurement), ability to control the virtual prosthesis (motor measurement), and reports before and after the training. The increase in the skin conductance response in conditions where the virtual prosthesis was threatened, recalibration of the peripersonal space perception identified by the crossmodal congruency effect, ability to control the virtual prosthesis, and participant reports consistently showed the induction and enhancement of virtual prosthesis embodiment. Therefore, this protocol using EMG-based HMI was shown to be a viable option to achieve and enhance the embodiment of a virtual prosthetic limb.

Physiological and Neural Changes with Rehabilitation Training in a 53-Year Amputee: A Case Study

Many people who received amputation wear sEMG prostheses to assist in their daily lives. How these prostheses promote muscle growth and change neural activity remains elusive. We recruited a subject who had his left hand amputated for over 53 years to participate in a six-week rehabilitation training using an sEMG prosthesis. We tracked the muscle growth of his left forearm and changes in neural activity over six weeks. The subject showed an increase in fast muscle fiber in his left forearm during the training period. In an analysis of complex networks of neural activity, we observed that the α-band network decreased in efficiency but increased in its capability to integrate information. This could be due to an expansion of the network to accommodate new movements enabled by rehabilitation training. Differently, we found that in the β-band network, a band frequency related to motor functions, the efficiency of the network initially decreased but started to increase after approximately three weeks. The ability to integrate network information showed an opposite trend compared with its efficiency. rMT values, a measure that negatively correlates with cortical excitability, showed a sharp decrease in the first three weeks, suggesting an increase in cortical excitability. In the last three weeks, there was little to no change. These data indicate that rehabilitation training promoted fast muscle fiber growth and introduced neural activity changes in the subject during the first three weeks of training. Our study gave insights into how rehabilitation training with an sEMG prosthesis could lead to physiological and neural changes in amputees.

Motor Imagery-Related Changes of Neural Oscillation in Unilateral Lower Limb Amputation

An amputation is known to seriously affect patient quality of life. This study aimed to investigate changes in neural activity in amputees during the postoperative period using neural electrophysiological techniques. In total, 14 patients with left lower limb amputation and 18 healthy participants were included in our study. All participants were required to perform motor imagery paradigm tasks while electroencephalogram (EEG) data were recorded. Data analysis results indicated that the beta frequency band showed significantly decreased oscillatory activity in motor imaging-related brain regions such as the frontal lobe and the precentral and postcentral gyri in amputees. Furthermore, the functional independent component analysis (fICA) value of neural oscillation negatively correlated with the C4 electrode power value of the motor imagery task in amputees (p < 0.05). Therefore, changes in neural oscillations and beta frequency band in motor imagery regions may be related to brain remodeling in amputees.

Subjective Response Measurement to Prosthesis or Device Use: Validation of the Prosthetic-Bionic Paradigm Questionnaire (PBP-Q)

Many subjects with somatic pathologies or traumas in their recent anamnesis tend to experience symptoms and changes to their daily life parameters after technically successful treatment. Hence, this study aims to validate an investigation tool inspired by the prosthetic-bionic paradigm-namely, the PBP-Q-which allows for the evaluation of variation in questions relating to identity, psychosociality, and psychopathology in relation to the use of a prosthesis or device. We gathered 118 participants (68 females and 50 males) aged between 27 and 94 years (Mean = 58.42 ± 15.17). We performed both exploratory (EFA) and confirmatory (CFA) factor analyses on this sample. Moreover, we calculated the internal consistency for the PBP-Q scales and the total score for the questionnaire's final 26-item and 5-factor versions. The five scales are psychological well-being; interpersonal relationships; professional relationships; autonomy and safety; addictions, compulsions, and obsessions. The internal consistency is good for both the total score and the subscales. In conclusion, overall, the PBP-Q has satisfactory psychometric properties, especially considering the measure's complexity. It provides a quick and effective way to evaluate the changes that might arise after the use of a prosthesis or device and, subsequently, has implications for clinical practice.

Prosthetic embodiment: systematic review on definitions, measures, and experimental paradigms

The term embodiment has become omnipresent within prosthetics research and is often used as a metric of the progress made in prosthetic technologies, as well as a hallmark for user acceptance. However, despite the frequent use of the term, the concept of prosthetic embodiment is often left undefined or described incongruently, sometimes even within the same article. This terminological ambiguity complicates the comparison of studies using embodiment as a metric of success, which in turn hinders the advancement of prosthetics research. To resolve these terminological ambiguities, we systematically reviewed the used definitions of embodiment in the prosthetics literature. We performed a thematic analysis of the definitions and found that embodiment is often conceptualized in either of two frameworks based on body representations or experimental phenomenology. We concluded that treating prosthetic embodiment within an experimental phenomenological framework as the combination of ownership and agency allows for embodiment to be a quantifiable metric for use in translational research. To provide a common reference and guidance on how to best assess ownership and agency, we conducted a second systematic review, analyzing experiments and measures involving ownership and agency. Together, we highlight a pragmatic definition of prosthetic embodiment as the combination of ownership and agency, and in an accompanying article, we provide a perspective on a multi-dimensional framework for prosthetic embodiment. Here, we concluded by providing recommendations on metrics that allow for outcome comparisons between studies, thereby creating a common reference for further discussions within prosthetics research.

Towards optimizing the non-invasive sensory feedback interfaces in a neural prosthetic control

Objective. The somatotopic interface (SI) and non-somatotopic interface (NI) are commonly used to provide non-invasive sensory feedback. Nevertheless, differences between SI and NI are rarely reported, and objective evaluations of the corresponding brain response are missing as well. Few studies have reported how to design the stimulation encoding based on the two interfaces. The objective of this study was to investigate the difference in sensory characteristics between SI and NI, and propose an optimal encoding method for non-invasive feedback interfaces. Approach. We recruited seven amputees and compared the tactile sensitivity to stimulated positions and intensities between SI (phantom finger area) and NI (upper arm) in a tactile discrimination task. Electroencephalography (EEG) evaluation task was subsequently conducted to objectively evaluate the stimulus-evoked brain response. Finally, the two kinds of tactile information (stimulated position and intensity) was applied to an object recognition task. Specifically, the object size was reflected by the prosthetic finger position through stimulated position encoding, and the object stiffness was reflected by the contact force of prosthetic fingers through stimulated intensity encoding. We compared the performance under four feedback conditions (combinations between two kinds of tactile information and two interfaces). Results. Behavioral results showed that NI was more sensitive to position information while SI was more sensitive to intensity information. EEG results were consistent with behavioral results, showing a higher sensitivity of sensory alpha ERD for NI in the position discrimination, while the trend was opposite in the intensity discrimination. The feedback encoding allowed amputees to discriminate the size and stiffness of nine objects with the best performance of 62% overall accuracy (84% for size discrimination, 71% for stiffness discrimination) when position and intensity information was delivered on the NI and SI, respectively. Signicance. Our results provided an instructive strategy for sensory feedback via non-invasive solutions.

Mind over matter: Perceived phantom/prosthesis co-location contributes to prosthesis embodiment in lower limb amputees

Prosthesis embodiment - the cognitive integration of a prosthesis into an amputees' body representation - has been identified as important for prosthetic rehabilitation. However, the underlying cognitive mechanisms remain unclear. There is reason to assume that phantom limbs that are experienced as part of the bodily self (phantom self-consciousness) can affect prosthesis embodiment, but only if the phantom and the prosthesis can be brought into perceived co-location (phantom prosthesis tolerance, PPT). In the present study, phantom-prosthesis interactions were examined in lower limb amputees, and a PPT component was psychometrically extracted. Mediation analysis revealed an indirect-only effect, where the relationship between phantom self-consciousness and prosthesis embodiment was mediated by PPT, indicating that phantom limbs can transfer their immanent vividness to the prosthesis. Subsequent analyses suggested that this effect can compensate for negative consequences on prosthesis embodiment that arise from phantom limb awareness. These results shape theoretical considerations about the cognitive processes contributing to the bodily self.

Limb apparent motion perception: Modification by tDCS, and clinically or experimentally altered bodily states

Limb apparent motion perception (LAMP) refers to the illusory visual perception of a moving limb upon observing two rapidly alternating photographs depicting the same limb in two different postures. Fast stimulus onset asynchronies (SOAs) induce the more visually guided perception of physically impossible movements. Slow SOAs induce the perception of physically possible movements. According to the motor theory of LAMP, the latter perception depends upon the observer's sensorimotor representations. Here, we tested this theory in two independent studies by performing a central (study 1) and peripheral (study 2) manipulation of the body's sensorimotor states during two LAMP tasks. In the first sham-controlled transcranial direct current stimulation between-subject designed study, we observed that the dampening of left sensorimotor cortex activity through cathodal stimulation biased LAMP towards the more visually guided perception of physically impossible movements for stimulus pairs at slow SOAs. In the second, online within-subject designed study, we tested three participant groups twice: (1) individuals with an acquired lower limb amputation, either while wearing or not wearing their prosthesis (2) individuals with body integrity dysphoria (i.e., with a desire for amputation of a healthy leg) while sitting in a regular position or binding up the undesired leg (to simulate the desired amputation); (3) able-bodied individuals while sitting in a normal position or sitting on one of their legs. We found that the momentary sensorimotor state crucially impacted LAMP in individuals with an amputation and able-bodied participants, but not in BID individuals. Taken together, the results of these two studies substantiate the motor theory of LAMP.

Early life experience sets hard limits on motor learning as evidenced from artificial arm use

The study of artificial arms provides a unique opportunity to address long-standing questions on sensorimotor plasticity and development. Learning to use an artificial arm arguably depends on fundamental building blocks of body representation and would therefore be impacted by early life experience. We tested artificial arm motor-control in two adult populations with upper-limb deficiencies: a congenital group—individuals who were born with a partial arm, and an acquired group—who lost their arm following amputation in adulthood. Brain plasticity research teaches us that the earlier we train to acquire new skills (or use a new technology) the better we benefit from this practice as adults. Instead, we found that although the congenital group started using an artificial arm as toddlers, they produced increased error noise and directional errors when reaching to visual targets, relative to the acquired group who performed similarly to controls. However, the earlier an individual with a congenital limb difference was fitted with an artificial arm, the better their motor control was. Since we found no group differences when reaching without visual feedback, we suggest that the ability to perform efficient visual-based corrective movements is highly dependent on either biological or artificial arm experience at a very young age. Subsequently, opportunities for sensorimotor plasticity become more limited.

Hand-Selective Visual Regions Represent How to Grasp 3D Tools: Brain Decoding during Real Actions

Most neuroimaging experiments that investigate how tools and their actions are represented in the brain use visual paradigms where tools or hands are displayed as 2D images and no real movements are performed. These studies discovered selective visual responses in occipitotemporal and parietal cortices for viewing pictures of hands or tools, which are assumed to reflect action processing, but this has rarely been directly investigated. Here, we examined the responses of independently visually defined category-selective brain areas when participants grasped 3D tools (N = 20; 9 females). Using real-action fMRI and multivoxel pattern analysis, we found that grasp typicality representations (i.e., whether a tool is grasped appropriately for use) were decodable from hand-selective areas in occipitotemporal and parietal cortices, but not from tool-, object-, or body-selective areas, even if partially overlapping. Importantly, these effects were exclusive for actions with tools, but not for biomechanically matched actions with control nontools. In addition, grasp typicality decoding was significantly higher in hand than tool-selective parietal regions. Notably, grasp typicality representations were automatically evoked even when there was no requirement for tool use and participants were naive to object category (tool vs nontools). Finding a specificity for typical tool grasping in hand-selective, rather than tool-selective, regions challenges the long-standing assumption that activation for viewing tool images reflects sensorimotor processing linked to tool manipulation. Instead, our results show that typicality representations for tool grasping are automatically evoked in visual regions specialized for representing the human hand, the primary tool of the brain for interacting with the world.

Robotic hand augmentation drives changes in neural body representation

Humans have long been fascinated by the opportunities afforded through augmentation. This vision not only depends on technological innovations but also critically relies on our brain's ability to learn, adapt, and interface with augmentation devices. Here, we investigated whether successful motor augmentation with an extra robotic thumb can be achieved and what its implications are on the neural representation and function of the biological hand. Able-bodied participants were trained to use an extra robotic thumb (called the Third Thumb) over 5 days, including both lab-based and unstructured daily use. We challenged participants to complete normally bimanual tasks using only the augmented hand and examined their ability to develop hand-robot interactions. Participants were tested on a variety of behavioral and brain imaging tests, designed to interrogate the augmented hand's representation before and after the training. Training improved Third Thumb motor control, dexterity, and hand-robot coordination, even when cognitive load was increased or when vision was occluded. It also resulted in increased sense of embodiment over the Third Thumb. Consequently, augmentation influenced key aspects of hand representation and motor control. Third Thumb usage weakened natural kinematic synergies of the biological hand. Furthermore, brain decoding revealed a mild collapse of the augmented hand's motor representation after training, even while the Third Thumb was not worn. Together, our findings demonstrate that motor augmentation can be readily achieved, with potential for flexible use, reduced cognitive reliance, and increased sense of embodiment. Yet, augmentation may incur changes to the biological hand representation. Such neurocognitive consequences are crucial for successful implementation of future augmentation technologies.

Brain lateralization in children with upper-limb reduction deficiency

BACKGROUND

The purpose of the current study was to determine the influence of upper-limb prostheses on brain activity and gross dexterity in children with congenital unilateral upper-limb reduction deficiencies (ULD) compared to typically developing children (TD).

METHODS

Five children with ULD (3 boys, 2 girls, 8.76 ± 3.37 years of age) and five age- and sex-matched TD children (3 boys, 2 girls, 8.96 ± 3.23 years of age) performed a gross manual dexterity task (Box and Block Test) while measuring brain activity (functional near-infrared spectroscopy; fNIRS).

RESULTS

There were no significant differences (p = 0.948) in gross dexterity performance between the ULD group with prosthesis (7.23 ± 3.37 blocks per minute) and TD group with the prosthetic simulator (7.63 ± 5.61 blocks per minute). However, there was a significant (p = 0.001) difference in Laterality Index (LI) between the ULD group with prosthesis (LI = - 0.2888 ± 0.0205) and TD group with simulator (LI = 0.0504 ± 0.0296) showing in a significant ipsilateral control for the ULD group. Thus, the major finding of the present investigation was that children with ULD, unlike the control group, showed significant activation in the ipsilateral motor cortex on the non-preferred side using a prosthesis during a gross manual dexterity task.

CONCLUSIONS

This ipsilateral response may be a compensation strategy in which the existing cortical representations of the non-affected (preferred) side are been used by the affected (non-preferred) side to operate the prosthesis. This study is the first to report altered lateralization in children with ULD while using a prosthesis. Trial registration The clinical trial (ClinicalTrial.gov ID: NCT04110730 and unique protocol ID: IRB # 614-16-FB) was registered on October 1, 2019 ( https://clinicaltrials.gov/ct2/show/NCT04110730 ) and posted on October 1, 2019. The study start date was January 10, 2020. The first participant was enrolled on January 14, 2020, and the trial is scheduled to be completed by August 23, 2023. The trial was updated January 18, 2020 and is currently recruiting.

Relationship of prosthesis ownership and phantom limb pain: results of a survey in 2383 limb amputees

ABSTRACT

Phantom limb pain (PLP) accounts for a significant reduction in quality of life and is difficult to treat. Prosthesis use has been shown to negatively covary with PLP. Recent research on body perception in amputees suggest that prosthesis ownership, defined as the extent to which a prosthesis is experienced as being part of the body rather than an artificial device foreign to the body, might interact with PLP. We used survey data from 2383 unilateral prosthesis-using upper-limb or lower-limb amputees and performed regression analyses to determine the relationship between prosthesis ownership and PLP. To test for specificity, we examined the role of prosthesis ownership also for residual limb pain (RLP) and nonpainful phantom limb sensations (npPLS). Prosthesis ownership was reduced in older participants and higher in lower-limb compared to upper-limb amputees. A longer residual limb and more frequent prosthesis use as well as a longer time since amputation also yielded higher values. Prostheses based on natural principles were associated with higher prosthesis ownership. Phantom limb pain and RLP were lower with higher prosthesis ownership, and RLP but not PLP was lower when prosthesis use was frequent. There were no significant associations for npPLS. The regression results differ in some aspects from those revealed by univariate analyses, emphasizing the importance of multivariate statistical approaches. Our findings provide insights into the interplay of body- and pain-related sensations after amputation, and could help to develop new treatment approaches for both PLP and RLP.

Embodied cognition: So flexible as to be "disembodied"?

This review aims to explore what I call the "Embodiment Cost Hypothesis" (ECH), according to which, when humans "embody" a part of the world other than their bodies, a measurable cost is detectable on their real bodies. The review analyzes experimental evidence in favor of the ECH by examining studies from different research fields, including studies of action observation (2), tool-use (3), rubber hand illusion (4), and full-body illusions (5). In light of this literature, this review argues that embodiment effects can profitably be seen as phenomena associated with both benefits (resulting from the embodiment of external objects/bodies) and costs (resulting from the disembodiment at various levels of the subject's own body). Implications are discussed in relation to the ongoing debate on the embodied cognition (EC) approach.

Grasping performance depends upon the richness of hand feedback

Although visual feedback of the hand allows fast and accurate grasping actions, little is known about whether the nature of feedback of the hand affects performance. We investigated kinematics during precision grasping (with the index finger and thumb) when participants received different levels of hand feedback, with or without visual feedback of the target. Specifically, we compared performance when participants saw (1) no hand feedback; (2) only the two critical points on the index finger and thumb tips; (3) 21 points on all digit tips and hand joints; (4) 21 points connected by a "skeleton", or (5) full feedback of the hand wearing a glove. When less hand feedback was available, participants took longer to execute the movement because they allowed more time to slow the reach and close the hand. When target feedback was unavailable, participants took longer to plan the movement and reached with higher velocity. We were particularly interested in investigating maximum grip aperture (MGA), which can reflect the margin of error that participants allow to compensate for uncertainty. A trend suggested that MGA was smallest when ample feedback was available (skeleton and full hand feedback, regardless of target feedback) and when only essential information about hand and target was provided (2-point hand feedback + target feedback) but increased when non-essential points were included (21-point feedback). These results suggest that visual feedback of the hand affects grasping performance and that, while more feedback is usually beneficial, this is not necessarily always the case.

Prosthesis embodiment and attenuation of prosthetic touch in upper limb amputees - A proof-of-concept study

Sensory attenuation of self-touch, that is, the perceptual reduction of self-generated tactile stimuli, is considered a neurocognitive basis for self-other distinction. However, whether this effect can also be found in upper limb amputees using a prosthesis is unknown. Thirteen participants were asked to touch their foot sole with a) their intact hand (self-touch), b) their prosthesis (prosthesis-touch), or c) let it be touched by another person (other-touch). Intensity of touch was assessed with a questionnaire. In addition, prosthesis embodiment was assessed in nine participants. Self-touch as well as prosthesis-touch was characterized by significant perceptual attenuation compared to other-touch, while self- and prosthesis-touch did not differ. The more embodied the prosthesis was, the more similar was its elicited touch perception to actual self-touch. These findings - although preliminary - suggest that perceptually embodied prostheses can be represented as an actual limb by the users' sensorimotor system.

Talking with Your (Artificial) Hands: Communicative Hand Gestures as an Implicit Measure of Embodiment

When people talk, they move their hands to enhance meaning. Using accelerometry, we measured whether people spontaneously use their artificial limbs (prostheses) to gesture, and whether this behavior relates to everyday prosthesis use and perceived embodiment. Perhaps surprisingly, one- and two-handed participants did not differ in the number of gestures they produced in gesture-facilitating tasks. However, they did differ in their gesture profile. One-handers performed more, and bigger, gesture movements with their intact hand relative to their prosthesis. Importantly, one-handers who gestured more similarly to their two-handed counterparts also used their prosthesis more in everyday life. Although collectively one-handers only marginally agreed that their prosthesis feels like a body part, one-handers who reported they embody their prosthesis also showed greater prosthesis use for communication and daily function. Our findings provide the first empirical link between everyday prosthesis use habits and perceived embodiment and a novel means for implicitly indexing embodiment.

Brain (re)organisation following amputation: Implications for phantom limb pain

Following arm amputation the region that represented the missing hand in primary somatosensory cortex (S1) becomes deprived of its primary input, resulting in changed boundaries of the S1 body map. This remapping process has been termed 'reorganisation' and has been attributed to multiple mechanisms, including increased expression of previously masked inputs. In a maladaptive plasticity model, such reorganisation has been associated with phantom limb pain (PLP). Brain activity associated with phantom hand movements is also correlated with PLP, suggesting that preserved limb functional representation may serve as a complementary process. Here we review some of the most recent evidence for the potential drivers and consequences of brain (re)organisation following amputation, based on human neuroimaging. We emphasise other perceptual and behavioural factors consequential to arm amputation, such as non-painful phantom sensations, perceived limb ownership, intact hand compensatory behaviour or prosthesis use, which have also been related to both cortical changes and PLP. We also discuss new findings based on interventions designed to alter the brain representation of the phantom limb, including augmented/virtual reality applications and brain computer interfaces. These studies point to a close interaction of sensory changes and alterations in brain regions involved in body representation, pain processing and motor control. Finally, we review recent evidence based on methodological advances such as high field neuroimaging and multivariate techniques that provide new opportunities to interrogate somatosensory representations in the missing hand cortical territory. Collectively, this research highlights the need to consider potential contributions of additional brain mechanisms, beyond S1 remapping, and the dynamic interplay of contextual factors with brain changes for understanding and alleviating PLP.

Perceptual correlates of successful body-prosthesis interaction in lower limb amputees: psychometric characterisation and development of the Prosthesis Embodiment Scale

Prostheses are used to at least partly restore the body after limb amputation. Making the user accepting the prosthetic device as part of his or her body, i.e., inducing prosthesis embodiment, has been identified as major aim of prosthetic treatment. However, up to now, there is no consensus about the psychometric nature of prosthesis embodiment in limb amputees. In the present study, 118 unilateral lower limb amputees using a prosthesis were asked to complete an online questionnaire targeting prosthesis embodiment. Principal axis factoring revealed the factor structure of prosthesis embodiment, i.e., Ownership/Integrity, Agency, and Anatomical Plausibility, which resembles the embodiment structure previously identified for normally-limbed participants. The majority of amputees achieved prosthesis embodiment as assessed with the final version of the newly developed Prosthesis Embodiment Scale. Internal consistency was excellent, and test–retest reliability was satisfying, while the instrument was also sensitive for new prosthetic equipment. Validation on the basis of relationships to prosthesis satisfaction and adjustment to prosthesis use was performed. The Prosthesis Embodiment Scale could be a valuable tool for the assessment of perceptual correlates of successful body–prosthesis interaction in rehabilitative and research contexts, the latter which might further benefit from the comparability of psychometrically evaluated data.

Cortical plasticity after hand prostheses use: Is the hypothesis of deafferented cortex "invasion" always true?

OBJECTIVE

To study motor cortex plasticity after a period of training with a new prototype of bidirectional hand prosthesis in three left trans-radial amputees, correlating these changes with the modification of Phantom Limb Pain (PLP) in the same period.

METHODS

Each subject underwent a brain motor mapping with Transcranial Magnetic Stimulation (TMS) and PLP evaluation with questionnaires during a six-month training with a prototype of bidirectional hand prosthesis.

RESULTS

The baseline motor maps showed in all three amputees a smaller area of muscles representation of the amputated side compared to the intact limb. After training, there was a partial reversal of the baseline asymmetry. The two subjects affected by PLP experienced a statistically significant reduction of pain.

CONCLUSIONS

Two apparently opposite findings, the invasion of the "deafferented" cortex by neighbouring areas and the "persistence" of neural structures after amputation, could vary according to different target used for measurement. Our results do not support a correlation between PLP and motor cortical changes.

SIGNIFICANCE

The selection of the target and of the task is essential for studies investigating motor brain plasticity. This study boosts against a direct and unique role of motor cortical changes on PLP genesis.

Is an artificial limb embodied as a hand? Brain decoding in prosthetic limb users

The potential ability of the human brain to represent an artificial limb as a body part (embodiment) has been inspiring engineers, clinicians, and scientists as a means to optimise human-machine interfaces. Using functional MRI (fMRI), we studied whether neural embodiment actually occurs in prosthesis users' occipitotemporal cortex (OTC). Compared with controls, different prostheses types were visually represented more similarly to each other, relative to hands and tools, indicating the emergence of a dissociated prosthesis categorisation. Greater daily life prosthesis usage correlated positively with greater prosthesis categorisation. Moreover, when comparing prosthesis users' representation of their own prosthesis to controls' representation of a similar looking prosthesis, prosthesis users represented their own prosthesis more dissimilarly to hands, challenging current views of visual prosthesis embodiment. Our results reveal a use-dependent neural correlate for wearable technology adoption, demonstrating adaptive use-related plasticity within the OTC. Because these neural correlates were independent of the prostheses' appearance and control, our findings offer new opportunities for prosthesis design by lifting restrictions imposed by the embodiment theory for artificial limbs.

Motor control drives visual bodily judgements

The 'embodied cognition' framework proposes that our motor repertoire shapes visual perception and cognition. But recent studies showing normal visual body representation in individuals born without hands challenges the contribution of motor control on visual body representation. Here, we studied hand laterality judgements in three groups with fundamentally different visual and motor hand experiences: two-handed controls, one-handers born without a hand (congenital one-handers) and one-handers with an acquired amputation (amputees). Congenital one-handers, lacking both motor and first-person visual information of their missing hand, diverged in their performance from the other groups, exhibiting more errors for their intact hand and slower reaction-times for challenging hand postures. Amputees, who have lingering non-visual motor control of their missing (phantom) hand, performed the task similarly to controls. Amputees' reaction-times for visual laterality judgements correlated positively with their phantom hand's motor control, such that deteriorated motor control associated with slower visual laterality judgements. Finally, we have implemented a computational simulation to describe how a mechanism that utilises a single hand representation in congenital one-handers as opposed to two in controls, could replicate our empirical results. Together, our findings demonstrate that motor control is a driver in making visual bodily judgments.

Toward Enhanced Teleoperation Through Embodiment

Telerobotics aims to transfer human manipulation skills and dexterity over an arbitrary distance and at an arbitrary scale to a remote workplace. A telerobotic system that is transparent enables a natural and intuitive interaction. We postulate that embodiment (with three sub-components: sense of ownership, agency, and self-location) of the robotic system leads to optimal perceptual transparency and increases task performance. However, this has not yet been investigated directly. We reason along four premises and present findings from the literature that substantiate each of them: (1) the brain can embody non-bodily objects (e.g., robotic hands), (2) embodiment can be elicited with mediated sensorimotor interaction, (3) embodiment is robust against inconsistencies between the robotic system and the operator's body, and (4) embodiment positively correlates to dexterous task performance. We use the predictive encoding theory as a framework to interpret and discuss the results reported in the literature. Numerous previous studies have shown that it is possible to induce embodiment over a wide range of virtual and real extracorporeal objects (including artificial limbs, avatars, and android robots) through mediated sensorimotor interaction. Also, embodiment can occur for non-human morphologies including for elongated arms and a tail. In accordance with the predictive encoding theory, none of the sensory modalities is critical in establishing ownership, and discrepancies in multisensory signals do not necessarily lead to loss of embodiment. However, large discrepancies in terms of multisensory synchrony or visual likeness can prohibit embodiment from occurring. The literature provides less extensive support for the link between embodiment and (dexterous) task performance. However, data gathered with prosthetic hands do indicate a positive correlation. We conclude that all four premises are supported by direct or indirect evidence in the literature, suggesting that embodiment of a remote manipulator may improve dexterous performance in telerobotics. This warrants further implementation testing of embodiment in telerobotics. We formulate a first set of guidelines to apply embodiment in telerobotics and identify some important research topics.

Weakening the subjective sensation of own hand ownership does not interfere with rapid finger movements

When we perform a movement we generally have a clear distinction between which parts of the world constitute our body and which parts do not. However, how the sense of ownership over our body supports movement is not yet fully understood. We aimed to see whether a sense of ownership over the hand supports the performance of rapid hand movements. In three experiments (n = 48, n = 30, n = 24), we presented participants with congruent and incongruent visuotactile and visuoproprioceptive information regarding their own hand. In keeping with previous experiments, multisensory disintegration resulted in a reduction in the subjective sensation of ownership over the hand, as reflected in questionnaire responses. Following sensory stimulation, participants were required to rapidly abduct their index finger whilst the movement was tracked. We examined the hypothesis that, should a sense of ownership over the limb be necessary for generating rapid movements with that limb, reaction time would increase when hand ownership was reduced, whilst the acceleration and velocity of the movement would decrease. We observed that reductions in own hand ownership did not interfere with rapid index finger abduction, suggesting that the motor system may not be reliant on a subjective sense of ownership over the body in order to generate movement.

Large-Scale Organization of the Hand Action Observation Network in Individuals Born Without Hands

The human high-level visual cortex comprises regions specialized for the processing of distinct types of stimuli, such as objects, animals, and human actions. How does this specialization emerge? Here, we investigated the role of effector-specific visuomotor coupling experience in shaping the organization of the action observation network (AON) as a window on this question. Observed body movements are frequently coupled with corresponding motor codes, e.g., during monitoring one’s own movements and imitation, resulting in bidirectionally connected circuits between areas involved in body movements observation (e.g., of the hand) and the motor codes involved in their execution. If the organization of the AON is shaped by this effector-specific visuomotor coupling, then, it should not form for body movements that do not belong to individuals’ motor repertoire. To test this prediction, we used fMRI to investigate the spatial arrangement and functional properties of the hand and foot action observation circuits in individuals born without upper limbs. Multivoxel pattern decoding, pattern similarity, and univariate analyses revealed an intact hand AON in the individuals born without upper limbs. This suggests that the organization of the AON does not require effector-specific visuomotor coupling.

Reaffirming the link between chronic phantom limb pain and maintained missing hand representation

Phantom limb pain (PLP) is commonly considered to be a result of maladaptive brain plasticity. This model proposes that PLP is mainly caused by reorganisation in the primary somatosensory cortex, presumably characterised by functional degradation of the missing hand representation and remapping of other body part representations. In the current study, we replicate our previous results by showing that chronic PLP correlates with maintained representation of the missing hand in the primary sensorimotor missing hand cortex. We asked unilateral upper-limb amputees to move their phantom hand, lips or other body parts and measured the associated neural responses using functional magnetic resonance imaging (fMRI). We confirm that amputees suffering from worse chronic PLP have stronger activity in the primary sensorimotor missing hand cortex while performing phantom hand movements. We find no evidence of lip representation remapping into the missing hand territory, as assessed by measuring activity in the primary sensorimotor missing hand cortex during lip movements. We further show that the correlation between chronic PLP and maintained representation of the missing hand cannot be explained by the experience of chronic non-painful phantom sensations or compensatory usage of the residual arm or an artificial arm (prosthesis). Together, our results reaffirm a likely relationship between persistent peripheral inputs pertaining to the missing hand representation and chronic PLP. Our findings emphasise a need to further study the role of peripheral inputs from the residual nerves to better understand the mechanisms underlying chronic PLP.