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Song H, Hsieh TH, Yeon SH, Shu T, Nawrot M, Landis CF, Friedman GN, Israel EA, Gutierrez-Arango S, Carty MJ, Freed LE, Herr HM. Continuous neural control of a bionic limb restores biomimetic gait after amputation. Nat Med 2024; 30:2010-2019. [PMID: 38951635 PMCID: PMC11271427 DOI: 10.1038/s41591-024-02994-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 04/11/2024] [Indexed: 07/03/2024]
Abstract
For centuries scientists and technologists have sought artificial leg replacements that fully capture the versatility of their intact biological counterparts. However, biological gait requires coordinated volitional and reflexive motor control by complex afferent and efferent neural interplay, making its neuroprosthetic emulation challenging after limb amputation. Here we hypothesize that continuous neural control of a bionic limb can restore biomimetic gait after below-knee amputation when residual muscle afferents are augmented. To test this hypothesis, we present a neuroprosthetic interface consisting of surgically connected, agonist-antagonist muscles including muscle-sensing electrodes. In a cohort of seven leg amputees, the interface is shown to augment residual muscle afferents by 18% of biologically intact values. Compared with a matched amputee cohort without the afferent augmentation, the maximum neuroprosthetic walking speed is increased by 41%, enabling equivalent peak speeds to persons without leg amputation. Further, this level of afferent augmentation enables biomimetic adaptation to various walking speeds and real-world environments, including slopes, stairs and obstructed pathways. Our results suggest that even a small augmentation of residual muscle afferents restores biomimetic gait under continuous neuromodulation in individuals with leg amputation.
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Affiliation(s)
- Hyungeun Song
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tsung-Han Hsieh
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Seong Ho Yeon
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tony Shu
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michael Nawrot
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christian F Landis
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Gabriel N Friedman
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erica A Israel
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Samantha Gutierrez-Arango
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Matthew J Carty
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Lisa E Freed
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Hugh M Herr
- K. Lisa Yang Center for Bionics, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Media Arts and Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.
- McGovern Institute, Massachusetts Institute of Technology, Cambridge, MA, USA.
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Xu S, Wang R, Ma S, He B. Interventional effect of core stability training on pain and muscle function of youth with chronic non-specific lower back pain: A randomized controlled trial. Heliyon 2024; 10:e32818. [PMID: 38975134 PMCID: PMC11226851 DOI: 10.1016/j.heliyon.2024.e32818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
Nowadays, due to lifestyle changes, the number of young people suffering from chronic non-specific low back pain (CNLBP) is gradually increasing. The recent guidelines for the treatment of low back pain emphasize that exercise therapy is the preferred treatment method for CNLBP. This study take ordinary college male students with CNLBP as objective of the study, focused into how core stability training affected the pain and muscle function of the CNLBP of youth. Herein, 60 male subjects were randomly divided into a control group and an experimental group, and conducted a randomized control trial in the Sports Rehabilitation Laboratory of Guangxi Normal University from September to October 2023. The control group received traditional waist strength training, while the experimental group received core stability training. VAS scores, pain symptoms scores and clinical efficacy grades were evaluated. Waist muscles fitness was evaluated, including back muscle strength, the prone upper body up's static holding time, 1-min modified sit-ups' pcs, the supine abdominal curling's static holding time and the supine leg raising's static holding time. Waist movement function was also evaluated using oswestry disability index (ODI) questionnaire. Surface electromyographic (EMG) signals were collected from rectus abdominis, erector spinae and multifidus. The independent sample t-test was used to compare groups, and the paired sample t-test was used for the data comparison before and post-exercise within the group. The results of the study found that CNLBP was improved in both the experimental and control groups in the post-exercise. Compared to pre-exercise, there are significant decrease in the VAS scores (95%CI: 2.51 to 6.51, p = 0.000), pain symptoms scores (95%CI: 2.95 to 3.55, p = 0.000), waist movement function's evaluation scores for ODI (95%CI: 2.23 to 4.31, p = 0.000), rectus abdominis' IEMG values (95%CI: 2.29 to 4.39, p = 0.000), erector spinae and multifidus' IEMG values (95%CI: 2.18 to 4.45, p = 0.000) of experimental group in the post-exercise. Compared to pre-exercise, there are significant improvement in the back muscle strength (95%CI: 12.85 to 19.49, p = 0.000), the prone upper body up's static holding time (95%CI: 9.67 to 19.17, p = 0.000), the 1-min modified sit-ups' pcs (95%CI: 8.56 to 18.12, p = 0.000), the supine abdominal curling's static holding time (95%CI: 6.73 to 19.14, p = 0.000), and the supine leg raising's static holding time (95%CI: 8.21 to 18.35, p = 0.000) of experimental group in the post-exercise. In the post-exercise,there are significant lower in the VAS scores (95%CI: 1.41 to 4.98, p = 0.000), pain symptoms scores (95%CI: 1.14 to 1.79, p = 0.011), waist movement function's evaluation scores for ODI (95%CI: 1.13 to 2.25, p = 0.000), rectus abdominis' IEMG values (95%CI: 2.36 to 4.47, p = 0.000), erector spinae and multifidus' IEMG values (95%CI: 2.24 to 4.23, p = 0.017) of experimental group than those of control group. In the post-exercise, there are significant higher in the recovery rate (p = 0.000), the prone upper body up's static holding time (95%CI: 4.16 to 8.32, p = 0.008), and the supine abdominal curling's static holding time (95%CI: 3.89 to 7.44, p = 0.000) of experimental group than those of control group. Therefore, it can be concluded that core stability training is significantly effective in treating CNLBP in youth, enhancing lower back muscle function. This therapeutic effect is primarily attributed to the improvement in muscle function.
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Affiliation(s)
- Simao Xu
- College of Sports Medicine and Health, Chengdu Sports University, Chengdu 61004, China
| | - Rui Wang
- College of Physical Education and Health, Guilin Institute of Information Technology, Guilin 541004, China
| | - Shuzhen Ma
- School of Public Administration, Guilin University of Technology, Guilin 541004, China
| | - Benxiang He
- College of Sports Medicine and Health, Chengdu Sports University, Chengdu 61004, China
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Voß M, Koelewijn AD, Beckerle P. Intuitive and versatile bionic legs: a perspective on volitional control. Front Neurorobot 2024; 18:1410760. [PMID: 38974662 PMCID: PMC11225306 DOI: 10.3389/fnbot.2024.1410760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Active lower limb prostheses show large potential to offer energetic, balance, and versatility improvements to users when compared to passive and semi-active devices. Still, their control remains a major development challenge, with many different approaches existing. This perspective aims at illustrating a future leg prosthesis control approach to improve the everyday life of prosthesis users, while providing a research road map for getting there. Reviewing research on the needs and challenges faced by prosthesis users, we argue for the development of versatile control architectures for lower limb prosthetic devices that grant the wearer full volitional control at all times. To this end, existing control approaches for active lower limb prostheses are divided based on their consideration of volitional user input. The presented methods are discussed in regard to their suitability for universal everyday control involving user volition. Novel combinations of established methods are proposed. This involves the combination of feed-forward motor control signals with simulated feedback loops in prosthesis control, as well as online optimization techniques to individualize the system parameters. To provide more context, developments related to volitional control design are touched on.
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Affiliation(s)
- Matthias Voß
- Chair of Autonomous Systems and Mechatronics, Department Electrical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anne D. Koelewijn
- Chair of Autonomous Systems and Mechatronics, Department Electrical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Beckerle
- Chair of Autonomous Systems and Mechatronics, Department Electrical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Teater RH, Zelik KE, McDonald KA. Biomechanical effects of adding an articulating toe joint to a passive foot prosthesis for incline and decline walking. PLoS One 2024; 19:e0295465. [PMID: 38758923 PMCID: PMC11101096 DOI: 10.1371/journal.pone.0295465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/23/2024] [Indexed: 05/19/2024] Open
Abstract
Walking on sloped surfaces is challenging for many lower limb prosthesis users, in part due to the limited ankle range of motion provided by typical prosthetic ankle-foot devices. Adding a toe joint could potentially benefit users by providing an additional degree of flexibility to adapt to sloped surfaces, but this remains untested. The objective of this study was to characterize the effect of a prosthesis with an articulating toe joint on the preferences and gait biomechanics of individuals with unilateral below-knee limb loss walking on slopes. Nine active prosthesis users walked on an instrumented treadmill at a +5° incline and -5° decline while wearing an experimental foot prosthesis in two configurations: a Flexible toe joint and a Locked-out toe joint. Three participants preferred the Flexible toe joint over the Locked-out toe joint for incline and decline walking. Eight of nine participants went on to participate in a biomechanical data collection. The Flexible toe joint decreased prosthesis Push-off work by 2 Joules during both incline (p = 0.008; g = -0.63) and decline (p = 0.008; g = -0.65) walking. During incline walking, prosthetic limb knee flexion at toe-off was 3° greater in the Flexible configuration compared to the Locked (p = 0.008; g = 0.42). Overall, these results indicate that adding a toe joint to a passive foot prosthesis has relatively small effects on joint kinematics and kinetics during sloped walking. This study is part of a larger body of work that also assessed the impact of a prosthetic toe joint for level and uneven terrain walking and stair ascent/descent. Collectively, toe joints do not appear to substantially or consistently alter lower limb mechanics for active unilateral below-knee prosthesis users. Our findings also demonstrate that user preference for passive prosthetic technology may be both subject-specific and task-specific. Future work could investigate the inter-individual preferences and potential benefits of a prosthetic toe joint for lower-mobility individuals.
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Affiliation(s)
- Rachel H. Teater
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, United States of America
| | - Karl E. Zelik
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, United States of America
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States of America
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN, United States of America
| | - Kirsty A. McDonald
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
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Moisan G, Zong-Hao Ma C. Advances in prosthetics and orthotics. BMC Musculoskelet Disord 2024; 25:135. [PMID: 38347514 PMCID: PMC10860223 DOI: 10.1186/s12891-024-07246-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
Over the past years, the field of prosthetics and orthotics has seen incredible innovations that used to be perceived as science fiction. This editorial aims to shed light on such exciting developments, exploring how they are addressing the challenges faced by individuals with limb impairments and musculoskeletal conditions.
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Affiliation(s)
- Gabriel Moisan
- Department of Human Kinetics, University du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, Québec, G8Z 4M3, Canada.
- Research Group on Neuromusculoskeletal Affections (GRAN), Trois-Rivières, G9A5H7, Canada.
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