Voluntary Control of Residual Antagonistic Muscles in Transtibial Amputees: Feedforward Ballistic Contractions and Implications for Direct Neural Control of Powered Lower Limb Prostheses

Intuitive and versatile bionic legs: a perspective on volitional control

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.

Biosignal-integrated robotic systems with emerging trends in visual interfaces: A systematic review

Human-machine interfaces (HMI) are currently a trendy and rapidly expanding area of research. Interestingly, the human user does not readily observe the interface between humans and machines. Instead, interactions between the machine and electrical signals from the user's body are obscured by complex control algorithms. The result is effectively a one-way street, wherein data is only transmitted from human to machine. Thus, a gap remains in the literature: how can information be effectively conveyed to the user to enable mutual understanding between humans and machines? Here, this paper reviews recent advancements in biosignal-integrated wearable robotics, with a particular emphasis on "visualization"-the presentation of relevant data, statistics, and visual feedback to the user. This review article covers various signals of interest, such as electroencephalograms and electromyograms, and explores novel sensor architectures and key materials. Recent developments in wearable robotics are examined from control and mechanical design perspectives. Additionally, we discuss current visualization methods and outline the field's future direction. While much of the HMI field focuses on biomedical and healthcare applications, such as rehabilitation of spinal cord injury and stroke patients, this paper also covers less common applications in manufacturing, defense, and other domains.

Modified motor unit properties in residual muscle following transtibial amputation

Objective.Neural signals in residual muscles of amputated limbs are frequently decoded to control powered prostheses. Yet myoelectric controllers assume muscle activities of residual muscles are similar to that of intact muscles. This study sought to understand potential changes to motor unit (MU) properties after limb amputation.Approach.Six people with unilateral transtibial amputation were recruited. Surface electromyogram (EMG) of residual and intacttibialis anterior(TA) andgastrocnemius(GA) muscles were recorded while subjects traced profiles targeting up to 20% and 35% of maximum activation for each muscle (isometric for intact limbs). EMG was decomposed into groups of MU spike trains. MU recruitment thresholds, action potential amplitudes (MU size), and firing rates were correlated to model Henneman's size principle, the onion-skin phenomenon, and rate-size associations. Organization (correlation) and modulation (rates of change) of relations were compared between intact and residual muscles.Main results.The residual TA exhibited significantly lower correlation and flatter slopes in the size principle and onion-skin, and each outcome covaried between the MU relations. The residual GA was unaffected for most subjects. Subjects trained prior with myoelectric prostheses had minimally affected slopes in the TA. Rate-size association correlations were preserved, but both residual muscles exhibited flatter decay rates.Significance.We showed peripheral neuromuscular damage also leads to spinal-level functional reorganizations. Our findings suggest models of MU recruitment and discharge patterns for residual muscle EMG generation need reparameterization to account for disturbances observed. In the future, tracking MU pool adaptations may also provide a biomarker of neuromuscular control to aid training with myoelectric prostheses.

Neural prosthesis control restores near-normative neuromechanics in standing postural control

Current lower-limb prostheses do not provide active assistance in postural control tasks to maintain the user's balance, particularly in situations of perturbation. In this study, we aimed to address this missing function by enabling neural control of robotic lower-limb prostheses. Specifically, electromyographic (EMG) signals (amplified neural control signals) recorded from antagonistic residual ankle muscles were used to drive a robotic prosthetic ankle directly and continuously. Participants with transtibial amputation were recruited and trained in using the EMG-driven robotic ankle. We studied how using the EMG-controlled ankle affected the participants' anticipatory and compensatory postural control strategies and stability under expected perturbations compared with using their daily passive devices. We investigated the similarity of neuromuscular coordination (by analyzing motor modules) of the participants, using either device in a postural sway task, to that of able-bodied controls. Results showed that, compared with their passive prosthesis, the EMG-controlled prosthesis enabled participants to use near-normative postural control strategies, as evidenced by improved between-limb symmetry in intact-prosthetic center-of-pressure and joint angle excursions. Participants substantially improved postural stability, as evidenced by a reduction in steps or falls using the EMG-controlled prosthetic ankle. Furthermore, after relearning to use residual ankle muscles to drive the robotic ankle in postural control, nearly all participants' motor module structure shifted toward that observed in individuals without limb amputations. Here, we have demonstrated the potential benefit of direct EMG control of robotic lower limb prostheses to restore normative postural control strategies (both neural and biomechanical) toward enhancing standing postural stability in amputee users.

A Scientometric Analysis and Visualization of Prosthetic Foot Research Work: 2000 to 2022

This study aims to highlight recent research work on topics around prosthetic feet through a scientometric analysis and historical review. The most cited publications from the Clarivate Analytics Web of Science Core Collection database were identified and analyzed from 1 January 2000 to 31 October 2022. Original articles, reviews with full manuscripts, conference proceedings, early access documents, and meeting abstracts were included. A scientometric visualization analysis of the bibliometric information related to the publications, including the countries, institutions, journals, references, and keywords, was conducted. A total of 1827 publications met the search criteria in this study. The related publications grouped by year show an overall trend of increase during the two decades from 2000 to 2022. The United States is ranked first in terms of overall influence in this field (n = 774). The Northwestern University has published the most papers on prosthetic feet (n = 84). Prosthetics and Orthotics International has published the largest number of studies on prosthetic feet (n = 151). During recent years, a number of studies with citation bursts and burst keywords (e.g., diabetes, gait, pain, and sensor) have provided clues on the hotspots of prosthetic feet and prosthetic foot trends. The findings of this study are based on a comprehensive analysis of the literature and highlight the research topics on prosthetic feet that have been primarily explored. The data provide guidance to clinicians and researchers to further studies in this field.

Direct continuous electromyographic control of a powered prosthetic ankle for improved postural control after guided physical training: A case study

Despite the promise of powered lower limb prostheses, existing controllers do not assist many daily activities that require continuous control of prosthetic joints according to human states and environments. The objective of this case study was to investigate the feasibility of direct, continuous electromyographic (dEMG) control of a powered ankle prosthesis, combined with physical therapist-guided training, for improved standing postural control in an individual with transtibial amputation. Specifically, EMG signals of the residual antagonistic muscles (i.e. lateral gastrocnemius and tibialis anterior) were used to proportionally drive pneumatical artificial muscles to move a prosthetic ankle. Clinical-based activities were used in the training and evaluation protocol of the control paradigm. We quantified the EMG signals in the bilateral shank muscles as well as measures of postural control and stability. Compared to the participant's daily passive prosthesis, the dEMG-controlled ankle, combined with the training, yielded improved clinical balance scores and reduced compensation from intact joints. Cross-correlation coefficient of bilateral center of pressure excursions, a metric for quantifying standing postural control, increased to .83(±.07) when using dEMG ankle control (passive device: .39(±.29)). We observed synchronized activation of homologous muscles, rapid improvement in performance on the first day of the training for load transfer tasks, and further improvement in performance across training days (p = .006). This case study showed the feasibility of this dEMG control paradigm of a powered prosthetic ankle to assist postural control. This study lays the foundation for future study to extend these results through the inclusion of more participants and activities.

Acquisition of Surface EMG Using Flexible and Low-Profile Electrodes for Lower Extremity Neuroprosthetic Control

For persons with lower extremity (LE) amputation, acquisition of surface electromyography (sEMG) from within the prosthetic socket remains a significant challenge due to the dynamic loads experienced during the gait cycle. However, these signals are critical for both understanding the clinical effects of LE amputation and determining the desired control trajectories of active LE prostheses. Current solutions for collecting within-socket sEMG are generally (i) incompatible with a subject's prescribed prosthetic socket and liners, (ii) uncomfortable, and (iii) expensive. This study presents an alternative within-socket sEMG acquisition paradigm using a novel flexible and low-profile electrode. First, the practical performance of this Sub-Liner Interface for Prosthetics (SLIP) electrode is compared to that of commercial Ag/AgCl electrodes within a cohort of subjects without amputation. Then, the corresponding SLIP electrode sEMG acquisition paradigm is implemented in a single subject with unilateral transtibial amputation performing unconstrained movements and walking on level ground. Finally, a quantitative questionnaire characterizes subjective comfort for SLIP electrode and commercial Ag/AgCl electrode instrumentation setups. Quantitative analyses suggest comparable signal qualities between SLIP and Ag/AgCl electrodes while qualitative analyses suggest the feasibility of using the SLIP electrode for real-time sEMG data collection from load-bearing, ambulatory subjects with LE amputation.

Myoelectric control of robotic lower limb prostheses: a review of electromyography interfaces, control paradigms, challenges and future directions

Objective.Advanced robotic lower limb prostheses are mainly controlled autonomously. Although the existing control can assist cyclic movements during locomotion of amputee users, the function of these modern devices is still limited due to the lack of neuromuscular control (i.e. control based on human efferent neural signals from the central nervous system to peripheral muscles for movement production). Neuromuscular control signals can be recorded from muscles, called electromyographic (EMG) or myoelectric signals. In fact, using EMG signals for robotic lower limb prostheses control has been an emerging research topic in the field for the past decade to address novel prosthesis functionality and adaptability to different environments and task contexts. The objective of this paper is to review robotic lower limb Prosthesis control via EMG signals recorded from residual muscles in individuals with lower limb amputations.Approach.We performed a literature review on surgical techniques for enhanced EMG interfaces, EMG sensors, decoding algorithms, and control paradigms for robotic lower limb prostheses.Main results.This review highlights the promise of EMG control for enabling new functionalities in robotic lower limb prostheses, as well as the existing challenges, knowledge gaps, and opportunities on this research topic from human motor control and clinical practice perspectives.Significance.This review may guide the future collaborations among researchers in neuromechanics, neural engineering, assistive technologies, and amputee clinics in order to build and translate true bionic lower limbs to individuals with lower limb amputations for improved motor function.

Investigation of EMG parameter for transtibial prosthetic user with flexion and extension of the knee and normal walking gait: A preliminary study

Electromyography signal has been used widely as input for prosthetic's leg movements. C-Leg, for example, is among the prosthetics devices that use electromyography as the main input. The main challenge facing the industrial party is the position of the electromyography sensor as it is fixed inside the socket. The study aims to investigate the best positional parameter of electromyography for transtibial prosthetic users for the device to be effective in multiple movement activities and compare with normal human muscle's activities. DELSYS Trigno wireless electromyography instrument was used in this study to achieve this aim. Ten non-amputee subjects and two transtibial amputees were involved in this study. The surface electromyography signals were recorded from two anterior and posterior below the knee muscles and above the knee muscles, respectively: tibial anterior and gastrocnemius lateral head as well as rectus femoris and biceps femoris during two activities (flexion and extension of knee joint and gait cycle for normal walking). The result during flexion and extension activities for gastrocnemius lateral head and biceps femoris muscles was found to be more useful for the control subjects, while the tibial anterior and also gastrocnemius lateral head are more active for amputee subjects. Also, during normal walking activity for biceps femoris and gastrocnemius lateral head, it was more useful for the control subjects, while for transtibial amputee subject-1, the rectus femoris was the highest signal of the average normal walking activity (0.0001 V) compared to biceps femoris (0.00007 V), as for transtibial amputee subject-2, the biceps femoris was the highest signals of the average normal walking activity (0.0001 V) compared to rectus femoris (0.00004 V). So, it is difficult to rely entirely on the static positioning of the electromyography sensor within the socket as there is a possibility of the sensor to contact with inactive muscle, which will be a gap in the control, leading to a decrease in the functional efficiency of the powered prostheses.

IMU-Based Locomotion Mode Identification for Transtibial Prostheses, Orthoses, and Exoskeletons

Active transtibial prostheses, orthoses, and exoskeletons hold the promise of improving the mobility of lower-limb impaired or amputated individuals. Locomotion mode identification (LMI) is essential for these devices precisely reproducing the required function in different terrains. In this study, a terrain geometry-based LMI algorithm is proposed. The environment should be built according to the inclination grade of the ground. For example, when the inclination angle is between 7 degrees and 15 degrees, the environment should be a ramp. If the inclination angle is around 30 degrees, the environment is preferred to be equipped with stairs. Given that, the locomotion mode/terrain can be classified by the inclination grade. Besides, human feet always move along the surface of terrain to minimize the energy expenditure for transporting lower limbs and get the required foot clearance. Hence, the foot trajectory estimated by an IMU was used to derive the inclination grade of the terrain that we traverse to identify the locomotion mode. In addition, a novel trigger condition (an elliptical boundary) is proposed to activate the decision-making of the LMI algorithm before the next foot strike thus leaving enough time for performing preparatory work in the swing phase. When the estimated foot trajectory goes across the elliptical boundary, the decision-making will be executed. Experimental results show that the average accuracy for three healthy subjects and three below-knee amputees is 98.5% in five locomotion modes: level-ground walking, up slope, down slope, stair descent, and stair ascent. Besides, all the locomotion modes can be identified before the next foot strike.

Proportional Myoelectric Control of a Powered Ankle Prosthesis for Postural Control under Expected Perturbation: A Pilot Study

In this study we aimed to investigate the potential for antagonistic residual muscles to generate anticipatory and compensatory postural adjustments and their benefit to postural control with proportional myoelectric control of a powered ankle prosthesis. We conducted this investigation using a predictable pendulum drop task with a single transtibial amputee. In two individual testing sessions the participant used his prescribed passive device and a powered device with pneumatic artificial muscles actuated proportionally to the activation of residual Tibialis Anterior (TA) and Lateral Gastrocnemius (GAS) muscles. Results demonstrated the transtibial amputee generated activations from the residual TA significantly earlier in the powered condition $(p=\theta.\theta\theta 7)$. In the powered condition anticipatory center of pressure excursions were significantly higher $(p=\theta.\theta 17)$, and peak center of mass excursions were reduced $(p=\theta.\theta 21)$. Peak medio-lateral center of pressure excursions were also significantly less in the direction of the intact limb for the powered condition $(p\ =\ \theta.\theta\theta 3)$. The results from this pilot study demonstrate the promise for transtibial amputees to generate anticipatory postural adjustments as well as the potential improvement of stability under expected perturbations. This pilot study provides an initial basis for future study using proportional myoelectric control via antagonistic residual muscles for the control of posture under expected perturbations.

Proportional Myoelectric Control of a Virtual Inverted Pendulum Using Residual Antagonistic Muscles: Toward Voluntary Postural Control

This paper aims to investigate whether transtibial amputees are capable of coordinating the descending neural commands to antagonistic residual ankle muscles for performing dynamic tasks that require continuous, precise control. To achieve this goal, we developed a virtual inverted pendulum that was inherently unstable and mimicked human-like dynamics in a standing posture. Balancing this dynamic system requires continuous inputs, proportional to electromyography (EMG) magnitudes recorded from (residual) tibialis anterior (TA) and lateral gastrocnemius muscles (GAS), respectively. The six able-bodied and six transtibial amputees were recruited and asked to balance the inverted pendulum for ten 90-s trials. The results showed that the amputees were capable of controlling this unstable dynamic system with a proportional myoelectric control; however, they underperformed the able-bodied subjects, who maintained the pendulum closer to center ( p = 0.041 ). Compared to the performance in the initial two trials, amputees improved the performance by significantly reducing the number of pendulum falls ( p = 0.0329 ) and sway size ( p = 0.048 ) in the final two trials. However, the amount of improvement varied across amputee subjects. Amputee subjects demonstrated different task adaptation strategies, including reduction of erroneous residual muscle contractions, development of an appropriate state-action (pendulum state-EMG activation) relationship for the task, and/or reduction of muscle control variability with the improved task performance efficiency (i.e., increased inactivity and sway minimization). The results suggest that after the training of transtibial amputees in coordinating antagonistic residual muscles in dynamic systems, it may be feasible to implement the proportional myoelectric control of the powered ankle prostheses in order to assist the postural control mechanisms, such as anticipatory and compensatory postural adjustments.

Voluntary Control of Residual Antagonistic Muscles in Transtibial Amputees: Reciprocal Activation, Coactivation, and Implications for Direct Neural Control of Powered Lower Limb Prostheses

Residual ankle muscles (i.e., previously antagonistic ankle muscles) of transtibial amputees are a potential source for continuous feedforward control of powered ankle prostheses using proportional myoelectric control. The ability for transtibial amputees to use their residual ankle muscles for two control input degrees of freedom (i.e., two independent myoelectric control input sources) for direct neural control depends on the ability for amputees to generate varying magnitudes of reciprocal activation and coactivation using their residual ankle muscles, which is not well understood. In this paper, we aimed to fill this knowledge gap. We asked 12 transtibial amputees to control the 2-D movement of a computer cursor using continuous proportional myoelectric control via their residual plantar flexor and residual dorsiflexor muscles to define their reachable 2-D control input space. The x-y position of the computer cursor was directly proportional to the independent continuous myoelectric control signals from the residual lateral gastrocnemius (x-axis) and the residual tibialis anterior (y-axis) where the limits of each axis were 0%-100% maximum voluntary activation of the corresponding residual muscle. Our results show that the reachable control input space varied widely across amputee subjects ranging from 38% to 81% of the maximum possible control input space. The cumulative time for the amputee subjects to saturate their reachable control input space ranged from 1.95 to 6.85 min. The amputee subjects used different residual muscle activation patterns and coordination strategies to expand their reachable control input space depending on their ability to perform coactivation and reciprocal activation using their residual plantar flexor and dorsiflexor muscles. The future development of powered lower limb prostheses using direct continuous proportional myoelectric control via residual muscles (e.g., for direct voluntary control of prosthesis joint impedance) should consider how an amputee user's immediately accessible residual muscle activation patterns and reachable 2-D control input space may affect their learning and performance.