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Galviati R, Boccardo N, Canepa M, Di Domenico D, Marinelli A, Frigo CA, Laffranchi M, de Michieli L. IMU Sensors Measurements Towards the Development of Novel Prosthetic Arm Control Strategies. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941218 DOI: 10.1109/icorr58425.2023.10304730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The complexity of the human upper limb makes replicating it in a prosthetic device a significant challenge. With advancements in mechatronic developments involving the addition of a large number of degrees of freedom, novel control strategies are required. To accommodate this need, this study aims at developing an IMU-based control for the HannesARM upper-limb prosthetic device, as a proof-of-concept for new control strategies integrating data-fusion approaches. The natural human control of the upper-limb is based on different inputs that allow adaptive control. To mimic this in prostheses, the implementation of IMUs provides kinematic information of both the stump and the prosthesis to enrich the EMG control. The principle of operation is to decode upper limb movements by using a custom-made system and to replicate them in prosthetic arms improving the control algorithms. To evaluate the system's effectiveness, the custom algorithm's motion extraction was compared to a motion capture system using fifteen able-bodied subjects. The results showed that this system scored 0.16 ± 0.04 and 0.81 ± 0.12 in Root Mean Squared Error and Cross-Correlation compared to the motion capture system. Experimental results demonstrate how this work can extract valuable kinematic information necessary for new and improved control strategies, such as intention detection or pattern recognition, to allow users to perform a broader range of tasks and enhancing in turn their quality of life.
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2
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Wilson L, Dohan D, Garibaldi M, Szeto D, Timmerman M, Matheny J. Prosthesis preferences for those with upper limb loss: Discrete choice study of PULLTY® for use in regulatory decisions. J Rehabil Assist Technol Eng 2023; 10:20556683231152418. [PMID: 36698551 PMCID: PMC9869218 DOI: 10.1177/20556683231152418] [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] [Indexed: 01/21/2023] Open
Abstract
Introduction The patient's voice in shared decision-making has progressed from physician's office to regulatory decision-making for medical devices with FDA's Patient Preference Initiative. A discrete-choice preference measure for upper limb prosthetic devices was developed to investigate patient's risk/benefit preference choices for regulatory decision making. Methods Rapid ethnographic procedures were used to design a discrete-choice measure describing risk and benefits of osseointegration with myoelectric control and test in a pilot preference study in adults with upper limb loss. Primary outcome is utility of each choice based conjoint (CBC) attribute using mixed-effects regression. Utilities with and without video, and between genders were compared. Results Strongest negative preference was for avoiding infection risk (B = -1.77, p < 0.001) and chance of daily pain (B = -1.22, p, 0.001). Strongest positive preference was for attaining complete independence when cooking dinner (B = 1.62, p < 0.001) and smooth grip patterns at all levels (B = 1.62, B = 1.28, B = 1.26, p < 0.001). Trade-offs showed a 1% increase in risk of serious/treatable infection resulted in a 1.77 decrease in relative preference. There were gender differences, and where video was used, preferences were stronger. Conclusions Strongest preferences were for attributes of functionality and independence versus connectedness and sensation but showed willingness to make risk-benefit trade-offs. Findings provide valuable information for regulatory benefit-risk decisions for prosthetic device innovations. Trial Registration This study is not a clinical trial reporting results of a health care intervention so is not registered.
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Affiliation(s)
- Leslie Wilson
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA,Leslie Wilson, Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, 480 16th street Office 32f, Box 0613, San Francisco, CA 94143-3402, USA.
| | - Dan Dohan
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Garibaldi
- Director, Orthotics Prosthetics, University of California San Francisco, San Francisco, CA, USA
| | - David Szeto
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA
| | - Molly Timmerman
- General Physical Medicine & Rehabilitation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Johnny Matheny
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA
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3
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Hansen TC, Citterman AR, Stone ES, Tully TN, Baschuk CM, Duncan CC, George JA. A Multi-User Transradial Functional-Test Socket for Validation of New Myoelectric Prosthetic Control Strategies. Front Neurorobot 2022; 16:872791. [PMID: 35783364 PMCID: PMC9247306 DOI: 10.3389/fnbot.2022.872791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/16/2022] [Indexed: 01/09/2023] Open
Abstract
The validation of myoelectric prosthetic control strategies for individuals experiencing upper-limb loss is hindered by the time and cost affiliated with traditional custom-fabricated sockets. Consequently, researchers often rely upon virtual reality or robotic arms to validate novel control strategies, which limits end-user involvement. Prosthetists fabricate diagnostic check sockets to assess and refine socket fit, but these clinical techniques are not readily available to researchers and are not intended to assess functionality for control strategies. Here we present a multi-user, low-cost, transradial, functional-test socket for short-term research use that can be custom-fit and donned rapidly, used in conjunction with various electromyography configurations, and adapted for use with various residual limbs and terminal devices. In this study, participants with upper-limb amputation completed functional tasks in physical and virtual environments both with and without the socket, and they reported on their perceived comfort level over time. The functional-test socket was fabricated prior to participants' arrival, iteratively fitted by the researchers within 10 mins, and donned in under 1 min (excluding electrode placement, which will vary for different use cases). It accommodated multiple individuals and terminal devices and had a total cost of materials under $10 USD. Across all participants, the socket did not significantly impede functional task performance or reduce the electromyography signal-to-noise ratio. The socket was rated as comfortable enough for at least 2 h of use, though it was expectedly perceived as less comfortable than a clinically-prescribed daily-use socket. The development of this multi-user, transradial, functional-test socket constitutes an important step toward increased end-user participation in advanced myoelectric prosthetic research. The socket design has been open-sourced and is available for other researchers.
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Affiliation(s)
- Taylor C. Hansen
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Abigail R. Citterman
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Handspring, Salt Lake City, UT, United States
| | - Eric S. Stone
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Troy N. Tully
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | | | - Christopher C. Duncan
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, United States
| | - Jacob A. George
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, United States
- Departments of Electrical and Computer Engineering and Mechanical Engineering, University of Utah, Salt Lake City, UT, United States
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4
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Rekant J, Fisher LE, Boninger M, Gaunt RA, Collinger JL. Amputee, clinician, and regulator perspectives on current and prospective upper extremity prosthetic technologies. Assist Technol 2022:1-13. [PMID: 34982647 DOI: 10.1080/10400435.2021.2020935] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Existing prosthetic technologies for people with upper limb amputation are being adopted at moderate rates. Once fitted for these devices, many upper limb amputees report not using them regularly or at all. The primary aim of this study was to solicit feedback about prosthetic technology and important device design criteria from amputees, clinicians, and device regulators. We compare these perspectives to identify common or divergent priorities. Twenty-one adults with upper limb loss, 35 clinicians, and 3 regulators completed a survey on existing prosthetic technologies and a conceptual sensorimotor prosthesis driven by implanted myoelectric electrodes with sensory feedback via spinal root stimulation. The survey included questions from the Trinity Amputation and Prosthesis Experience Scale, the Disabilities of the Arm, Shoulder, and Hand, and novel questions about technology acceptance and neuroprosthetic design. User and clinician ratings of satisfaction with existing devices were similar. Amputees were most accepting of the proposed sensorimotor prosthesis (75.5% vs clinicians(68.8%), regulators(67.8%)). Stakeholders valued user-centered outcomes like individualized task goals, improved quality of life, device reliability, and user safety; regulators emphasized these last two. The results of this study provide insight into amputee, clinician, and regulator priorities to inform future upper-limb prosthetic design and clinical trial protocol development.
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Affiliation(s)
- Julie Rekant
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Michael Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.,Human Engineering Research Labs, VA Center of Excellence, Department of Veteran Affairs, Pittsburgh, PA, USA
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Neural Basis of Cognition, Pittsburgh, PA, USA.,Human Engineering Research Labs, VA Center of Excellence, Department of Veteran Affairs, Pittsburgh, PA, USA
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5
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Gates DH, Engdahl SM, Davis A. Recommendations for the Successful Implementation of Upper Limb Prosthetic Technology. Hand Clin 2021; 37:457-466. [PMID: 34253318 DOI: 10.1016/j.hcl.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite the numerous prosthetic hand designs that are commercially available, people with upper limb loss still frequently report dissatisfaction and abandonment. Over the past decade there have been numerous advances in prosthetic design, control, sensation, and device attachment. Each offers the potential to enhance function and satisfaction, but most come at high costs and involve surgical risks. Here, we discuss potential barriers and solutions to promote the widespread use of novel prosthetic technology. With appropriate reimbursement, multidisciplinary care teams, device-specific rehabilitation, and patient and clinician education, such technology has the potential to revolutionize the field and improve patient outcomes.
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Affiliation(s)
- Deanna H Gates
- School of Kinesiology, University of Michigan, 830 N. University Avenue, Ann Arbor, MI 48109, USA.
| | - Susannah M Engdahl
- Department of Bioengineering, George Mason University, 4400 University Drive, MS 1J7, Fairfax, VA 22030, USA
| | - Alicia Davis
- University of Michigan Orthotics and Prosthetics Center, 2850 South Industrial Highway, Suite 400, Ann Arbor, MI 48104, USA
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6
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Karczewski AM, Dingle AM, Poore SO. The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements. Front Neurorobot 2021; 15:711028. [PMID: 34366820 PMCID: PMC8334559 DOI: 10.3389/fnbot.2021.711028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022] Open
Abstract
Over the last few decades there has been a push to enhance the use of advanced prosthetics within the fields of biomedical engineering, neuroscience, and surgery. Through the development of peripheral neural interfaces and invasive electrodes, an individual's own nervous system can be used to control a prosthesis. With novel improvements in neural recording and signal decoding, this intimate communication has paved the way for bidirectional and intuitive control of prostheses. While various collaborations between engineers and surgeons have led to considerable success with motor control and pain management, it has been significantly more challenging to restore sensation. Many of the existing peripheral neural interfaces have demonstrated success in one of these modalities; however, none are currently able to fully restore limb function. Though this is in part due to the complexity of the human somatosensory system and stability of bioelectronics, the fragmentary and as-yet uncoordinated nature of the neuroprosthetic industry further complicates this advancement. In this review, we provide a comprehensive overview of the current field of neuroprosthetics and explore potential strategies to address its unique challenges. These include exploration of electrodes, surgical techniques, control methods, and prosthetic technology. Additionally, we propose a new approach to optimizing prosthetic limb function and facilitating clinical application by capitalizing on available resources. It is incumbent upon academia and industry to encourage collaboration and utilization of different peripheral neural interfaces in combination with each other to create versatile limbs that not only improve function but quality of life. Despite the rapidly evolving technology, if the field continues to work in divided "silos," we will delay achieving the critical, valuable outcome: creating a prosthetic limb that is right for the patient and positively affects their life.
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Affiliation(s)
| | - Aaron M. Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin–Madison, Madison, WI, United States
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7
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Jones H, Dupan S, Dyson M, Krasoulis A, Kenney LPJ, Donovan-Hall M, Memarzadeh K, Day S, Coutinho M, Nazarpour K. Co-creation and User Perspectives for Upper Limb Prosthetics. Front Neurorobot 2021; 15:689717. [PMID: 34305564 PMCID: PMC8299561 DOI: 10.3389/fnbot.2021.689717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
People who either use an upper limb prosthesis and/or have used services provided by a prosthetic rehabilitation centre, experience limitations of currently available prosthetic devices. Collaboration between academia and a broad range of stakeholders, can lead to the development of solutions that address peoples' needs. By doing so, the rate of prosthetic device abandonment can decrease. Co-creation is an approach that can enable collaboration of this nature to occur throughout the research process. We present findings of a co-creation project that gained user perspectives from a user survey, and a subsequent workshop involving: people who use an upper limb prosthesis and/or have experienced care services (users), academics, industry experts, charity executives, and clinicians. The survey invited users to prioritise six themes, which academia, clinicians, and industry should focus on over the next decade. The prioritisation of the themes concluded in the following order, with the first as the most important: function, psychology, aesthetics, clinical service, collaboration, and media. Within five multi-stakeholder groups, the workshop participants discussed challenges and collaborative opportunities for each theme. Workshop groups prioritised the themes based on their discussions, to highlight opportunities for further development. Two groups chose function, one group chose clinical service, one group chose collaboration, and another group chose media. The identified opportunities are presented within the context of the prioritised themes, including the importance of transparent information flow between all stakeholders; user involvement throughout research studies; and routes to informing healthcare policy through collaboration. As the field of upper limb prosthetics moves toward in-home research, we present co-creation as an approach that can facilitate user involvement throughout the duration of such studies.
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Affiliation(s)
- Hannah Jones
- Edinburgh Neuroprosthetics Laboratory, School of Informatics, University of Edinburgh, Edinburgh, United Kingdom.,Intelligent Sensing Laboratory, School of Engineering, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sigrid Dupan
- Edinburgh Neuroprosthetics Laboratory, School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthew Dyson
- Intelligent Sensing Laboratory, School of Engineering, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Agamemnon Krasoulis
- Intelligent Sensing Laboratory, School of Engineering, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Laurence P J Kenney
- School of Health and Society, University of Salford, Manchester, United Kingdom
| | | | | | - Sarah Day
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Maxford Coutinho
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Kianoush Nazarpour
- Edinburgh Neuroprosthetics Laboratory, School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
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8
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Abstract
People who either use an upper limb prosthesis and/or have used services provided by a prosthetic rehabilitation centre, hereafter called users, are yet to benefit from the fast-paced growth in academic knowledge within the field of upper limb prosthetics. Crucially over the past decade, research has acknowledged the limitations of conducting laboratory-based studies for clinical translation. This has led to an increase, albeit rather small, in trials that gather real-world user data. Multi-stakeholder collaboration is critical within such trials, especially between researchers, users, and clinicians, as well as policy makers, charity representatives, and industry specialists. This paper presents a co-creation model that enables researchers to collaborate with multiple stakeholders, including users, throughout the duration of a study. This approach can lead to a transition in defining the roles of stakeholders, such as users, from participants to co-researchers. This presents a scenario whereby the boundaries between research and participation become blurred and ethical considerations may become complex. However, the time and resources that are required to conduct co-creation within academia can lead to greater impact and benefit the people that the research aims to serve.
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9
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Page DM, George JA, Wendelken SM, Davis TS, Kluger DT, Hutchinson DT, Clark GA. Discriminability of multiple cutaneous and proprioceptive hand percepts evoked by intraneural stimulation with Utah slanted electrode arrays in human amputees. J Neuroeng Rehabil 2021; 18:12. [PMID: 33478534 PMCID: PMC7819250 DOI: 10.1186/s12984-021-00808-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electrical stimulation of residual afferent nerve fibers can evoke sensations from a missing limb after amputation, and bionic arms endowed with artificial sensory feedback have been shown to confer functional and psychological benefits. Here we explore the extent to which artificial sensations can be discriminated based on location, quality, and intensity. METHODS We implanted Utah Slanted Electrode Arrays (USEAs) in the arm nerves of three transradial amputees and delivered electrical stimulation via different electrodes and frequencies to produce sensations on the missing hand with various locations, qualities, and intensities. Participants performed blind discrimination trials to discriminate among these artificial sensations. RESULTS Participants successfully discriminated cutaneous and proprioceptive sensations ranging in location, quality and intensity. Performance was significantly greater than chance for all discrimination tasks, including discrimination among up to ten different cutaneous location-intensity combinations (15/30 successes, p < 0.0001) and seven different proprioceptive location-intensity combinations (21/40 successes, p < 0.0001). Variations in the site of stimulation within the nerve, via electrode selection, enabled discrimination among up to five locations and qualities (35/35 successes, p < 0.0001). Variations in the stimulation frequency enabled discrimination among four different intensities at the same location (13/20 successes, p < 0.0005). One participant also discriminated among individual stimulation of two different USEA electrodes, simultaneous stimulation on both electrodes, and interleaved stimulation on both electrodes (20/24 successes, p < 0.0001). CONCLUSION Electrode location, stimulation frequency, and stimulation pattern can be modulated to evoke functionally discriminable sensations with a range of locations, qualities, and intensities. This rich source of artificial sensory feedback may enhance functional performance and embodiment of bionic arms endowed with a sense of touch.
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Affiliation(s)
| | - Jacob A George
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, 84112, USA.
| | - Suzanne M Wendelken
- Department of Anesthesiology, Maine Medical Center, Portland, ME, 04102, USA
| | - Tyler S Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, 84112, USA
| | | | | | - Gregory A Clark
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, 84112, USA
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10
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Kelley MA, Benz H, Engdahl S, Bridges JFP. Identifying the benefits and risks of emerging integration methods for upper limb prosthetic devices in the United States: an environmental scan. Expert Rev Med Devices 2019; 16:631-641. [DOI: 10.1080/17434440.2019.1626231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Marcella A Kelley
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center of Excellence in Regulatory Science and Innovation, Baltimore, MD, USA
| | - Heather Benz
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Susannah Engdahl
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - John F P Bridges
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center of Excellence in Regulatory Science and Innovation, Baltimore, MD, USA
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11
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Resnik L, Benz H, Borgia M, Clark MA. Patient perspectives on benefits and risks of implantable interfaces for upper limb prostheses: a national survey. Expert Rev Med Devices 2019; 16:515-540. [DOI: 10.1080/17434440.2019.1619453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Linda Resnik
- Research Department, Providence VA Medical Center, Providence, RI, USA
- Health Services, Policy and Practice, Brown University, Providence, RI, USA
| | - Heather Benz
- Center for Devices and Radiological Health, US Food & Drug Administration, Silver Spring, MD, USA
| | - Matthew Borgia
- Research Department, Providence VA Medical Center, Providence, RI, USA
| | - Melissa A. Clark
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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12
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Resnik L, Benz H, Borgia M, Clark MA. Patient Perspectives on Osseointegration: A National Survey of Veterans with Upper Limb Amputation. PM R 2019; 11:1261-1271. [DOI: 10.1002/pmrj.12147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Linda Resnik
- Research DepartmentProvidence VA Medical Center Providence RI
- Health Services, Policy and PracticeBrown University, Health Services, Policy and Practice Brown University Providence RI
| | - Heather Benz
- Center for Devices and Radiological Health, US Food & Drug Administration Silver Spring MD
- Department of Quantitative Health SciencesUniversity of Massachusetts Medical School Worcester MA
| | - Matthew Borgia
- Research DepartmentProvidence VA Medical Center Providence RI
| | - Melissa A. Clark
- Department of Quantitative Health SciencesUniversity of Massachusetts Medical School Worcester MA
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13
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Major MJ. Fall Prevalence and Contributors to the Likelihood of Falling in Persons With Upper Limb Loss. Phys Ther 2019; 99:377-387. [PMID: 30561742 PMCID: PMC6684228 DOI: 10.1093/ptj/pzy156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Arms are important for locomotor stability and preventing falls by controlling whole-body angular momentum, redirecting the body's center of mass, and providing support to arrest descent. Hence, upper limb loss (ULL) can increase fall risk. However, the prevalence of falls and factors that influence fall risk have not previously been reported for people with ULL. OBJECTIVE This study quantified fall prevalence in persons with ULL at or proximal to the wrist and identified clinical factors that contributed to the likelihood of falling. DESIGN This was a cross-sectional study. METHODS Factors including body and health characteristics, activity level, fall history, prosthesis use, and balance confidence were determined for persons with ULL proximal to the wrist using an online survey. Logistic regression analyses assessed the contribution of these factors to the classification of fallers (≥2 falls in previous year) and nonfallers. RESULTS A percentage (28.6%) of participants (n = 105) reported experiencing 2 or more falls in the past year. The regression model (R2 = 0.473) correctly classified 84.5% of cases and indicated that increased likelihood of falling was significantly influenced by reduced balance confidence, use of upper limb prostheses, and reduced physical capabilities. LIMITATIONS Data were collected online from a convenience sample, and fall classification was based on retrospective data. CONCLUSIONS Falls in persons with ULL are prevalent, suggesting that clinicians should use screening methods to identify at-risk individuals. Balance confidence, use of upper limb prostheses, and perceived physical capabilities could be useful screening metrics. Research is warranted to better understand the factors that underlie fall risk in persons with ULL and the efficacy of therapeutic interventions capable of mitigating fall risk.
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Affiliation(s)
- Matthew J Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, 680 N Lake Shore Dr, Suite 1100, Chicago, IL 60611 (USA); and Jesse Brown VA Medical Center, Chicago, Illinois
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14
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Zheng JY, Kalpakjian C, Larrága-Martínez M, Chestek CA, Gates DH. Priorities for the design and control of upper limb prostheses: A focus group study. Disabil Health J 2019; 12:706-711. [PMID: 30952491 DOI: 10.1016/j.dhjo.2019.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/24/2019] [Accepted: 03/19/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Common prosthetic options do not allow for enough independent control signals to control all the movements of the arm. Invasive approaches to obtain prosthetic control signals are being developed to provide people with upper limb loss improved prosthetic control and feedback. OBJECTIVE/HYPOTHESIS This study explored the prosthetic qualities that are important to users and examined the factors that play into the decision to consider invasive prosthetic interfaces that allow for enhanced prosthetic control. METHODS Individuals participated in semi-structured focus groups or in individual semi-structured interviews (N = 11). A semi-structured interview guide containing open-ended questions was used to learn about ideal prosthesis qualities and interest in prosthetic technology interfaces including targeted muscle reinnervation, peripheral nerve interface, and cortical interface. Qualitative content analysis with an inductive approach was used for transcript analysis. RESULTS Participants were most interested in improving the dexterity and durability of prosthetic options. Recovery time, anticipated risk, medical co-morbidities, and baseline functional status influenced willingness to consider invasive prosthetic interfaces. Participants were interested in learning more about all three invasive interfaces but had the most concerns about cortical interfaces. CONCLUSIONS Attitudes toward invasive control interfaces vary. Further education on invasive control interfaces and additional conversations between prosthetic developers and people with limb loss will help to develop effective prosthetic devices that potential consumers will use.
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Affiliation(s)
- Jasmine Y Zheng
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 East Eisenhower Parkway, Ann Arbor, MI, 48108, USA; Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard St, 1st Floor, Philadelphia, PA, 19146, USA.
| | - Claire Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, 325 East Eisenhower Parkway, Ann Arbor, MI, 48108, USA
| | - María Larrága-Martínez
- Department of Biomedical Engineering, University of Michigan, 2200 Bonnisteel Blvd, Ann Arbor, MI, 48109, USA
| | - Cynthia A Chestek
- Department of Biomedical Engineering, University of Michigan, 2200 Bonnisteel Blvd, Ann Arbor, MI, 48109, USA
| | - Deanna H Gates
- Department of Biomedical Engineering, University of Michigan, 2200 Bonnisteel Blvd, Ann Arbor, MI, 48109, USA; School of Kinesiology, University of Michigan, 1402 Washington Heights, Ann Arbor, MI, 48109, USA
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15
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Graczyk EL, Gill A, Tyler DJ, Resnik LJ. The benefits of sensation on the experience of a hand: A qualitative case series. PLoS One 2019; 14:e0211469. [PMID: 30703163 PMCID: PMC6355013 DOI: 10.1371/journal.pone.0211469] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/15/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The experience of upper limb loss involves loss of both functional capabilities and the sensory connection of a hand. Research studies to restore sensation to persons with upper limb loss with neural interfaces typically measure outcomes through standardized functional tests or quantitative surveys. However, these types of metrics cannot fully capture the personal experience of living with limb loss or the impact of sensory restoration on this experience. Qualitative studies can demonstrate the viewpoints and priorities of specific persons or groups and reveal the underlying conceptual structure of various aspects of their experiences. METHODS AND FINDINGS Following a home use trial of a neural-connected, sensory-enabled prosthesis, two persons with upper limb loss were interviewed about their experiences using the sensory restoration system in unsupervised, unconstrained settings. We used grounded theory methodology to examine their experiences, perspectives, and opinions about the sensory restoration system. We then developed a model to describe the impact of sensation on the experience of a hand for persons with upper limb loss. CONCLUSIONS The experience of sensation was complex and included concepts such as the naturalness of the experience, sensation modality, and the usefulness of the sensory information. Sensation was critical for outcome acceptance, and contributed to prosthesis embodiment, confidence, reduced focus and attention for using the prosthesis, and social interactions. Embodiment, confidence, and social interactions were also key determinants of outcome acceptance. This model provides a unified framework to study and understand the impact of sensation on the experience of limb loss and to understand outcome acceptance following upper limb loss more broadly.
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Affiliation(s)
- Emily L. Graczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Anisha Gill
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, United States of America
| | - Dustin J. Tyler
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Linda J. Resnik
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, United States of America
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, United States of America
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Page DM, George JA, Kluger DT, Duncan C, Wendelken S, Davis T, Hutchinson DT, Clark GA. Motor Control and Sensory Feedback Enhance Prosthesis Embodiment and Reduce Phantom Pain After Long-Term Hand Amputation. Front Hum Neurosci 2018; 12:352. [PMID: 30319374 PMCID: PMC6166773 DOI: 10.3389/fnhum.2018.00352] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/17/2018] [Indexed: 12/29/2022] Open
Abstract
We quantified prosthesis embodiment and phantom pain reduction associated with motor control and sensory feedback from a prosthetic hand in one human with a long-term transradial amputation. Microelectrode arrays were implanted in the residual median and ulnar arm nerves and intramuscular electromyography recording leads were implanted in residual limb muscles to enable sensory feedback and motor control. Objective measures (proprioceptive drift) and subjective measures (survey answers) were used to assess prosthesis embodiment. For both measures, there was a significant level of embodiment of the physical prosthetic limb after open-loop motor control of the prosthesis (i.e., without sensory feedback), open-loop sensation from the prosthesis (i.e., without motor control), and closed-loop control of the prosthesis (i.e., motor control with sensory feedback). There was also a statistically significant reduction in reported phantom pain after experimental sessions that included open-loop nerve microstimulation, open-loop prosthesis motor control, or closed-loop prosthesis motor control. The closed-loop condition provided no additional significant improvements in phantom pain reduction or prosthesis embodiment relative to the open-loop sensory condition or the open-loop motor condition. This study represents the first long-term (14-month), systematic report of phantom pain reduction and prosthesis embodiment in a human amputee across a variety of prosthesis use cases.
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Affiliation(s)
- David M. Page
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States
| | - Jacob A. George
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States
| | - David T. Kluger
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States
| | - Christopher Duncan
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, United States
| | - Suzanne Wendelken
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States
| | - Tyler Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States
| | | | - Gregory A. Clark
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States
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Hope J, Vanholsbeeck F, McDaid A. A model of electrical impedance tomography implemented in nerve-cuff for neural-prosthetics control. Physiol Meas 2018; 39:044002. [DOI: 10.1088/1361-6579/aab73a] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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