New developments in prosthetic arm systems

Long-term functional and clinical outcome of combined targeted muscle reinnervation and osseointegration for functional bionic reconstruction in transhumeral amputees: a case series

OBJECTIVE

To describe and evaluate the combination of osseointegration and nerve transfers in 3 transhumeral amputees.

DESIGN

Case series.

PATIENTS

Three male patients with a unilateral traumatic transhumeral amputation.

METHODS

Patients received a combination of osseointegration and targeted muscle reinnervation surgery. Rehabilitation included graded weight training, range of motion exercises, biofeedback, table-top prosthesis training, and controlling the actual device. The impairment in daily life, health-related quality of life, and pain before and after the intervention was evaluated in these patients. Their shoulder range of motion, prosthesis embodiment, and function were documented at a 2- to 5-year follow-up.

RESULTS

All 3 patients attended rehabilitation and used their myoelectric prosthesis on a daily basis. Two patients had full shoulder range of motion with the prosthesis, while the other patient had 55° of abduction and 45° of anteversion. They became more independent in their daily life activities after the intervention and incorporated their prosthesis into their body scheme to a high extent.

CONCLUSION

These results indicate that patients can benefit from the combined procedure. However, the patients' perspective, risks of the surgical procedures, and the relatively long rehabilitation procedure need to be incorporated in the decision-making.

High Performance Wearable Ultrasound as a Human-Machine Interface for Wrist and Hand Kinematic Tracking

OBJECTIVE

Non-invasive human machine interfaces (HMIs) have high potential in medical, entertainment, and industrial applications. Traditionally, surface electromyography (sEMG) has been used to track muscular activity and infer motor intention. Ultrasound (US) has received increasing attention as an alternative to sEMG-based HMIs. Here, we developed a portable US armband system with 24 channels and a multiple receiver approach, and compared it with existing sEMG- and US-based HMIs on movement intention decoding.

METHODS

US and motion capture data was recorded while participants performed wrist and hand movements of four degrees of freedom (DoFs) and their combinations. A linear regression model was used to offline predict hand kinematics from the US (or sEMG, for comparison) features. The method was further validated in real-time for a 3-DoF target reaching task.

RESULTS

In the offline analysis, the wearable US system achieved an average [Formula: see text] of 0.94 in the prediction of four DoFs of the wrist and hand while sEMG reached a performance of [Formula: see text]= 0.60. In online control, the participants achieved an average 93% completion rate of the targets.

CONCLUSION

When tailored for HMIs, the proposed US A-mode system and processing pipeline can successfully regress hand kinematics both in offline and online settings with performances comparable or superior to previously published interfaces.

SIGNIFICANCE

Wearable US technology may provide a new generation of HMIs that use muscular deformation to estimate limb movements. The wearable US system allowed for robust proportional and simultaneous control over multiple DoFs in both offline and online settings.

Instance-based learning with prototype reduction for real-time proportional myocontrol: a randomized user study demonstrating accuracy-preserving data reduction for prosthetic embedded systems

This work presents the design, implementation and validation of learning techniques based on the kNN scheme for gesture detection in prosthetic control. To cope with high computational demands in instance-based prediction, methods of dataset reduction are evaluated considering real-time determinism to allow for the reliable integration into battery-powered portable devices. The influence of parameterization and varying proportionality schemes is analyzed, utilizing an eight-channel-sEMG armband. Besides offline cross-validation accuracy, success rates in real-time pilot experiments (online target achievement tests) are determined. Based on the assessment of specific dataset reduction techniques' adequacy for embedded control applications regarding accuracy and timing behaviour, decision surface mapping (DSM) proves itself promising when applying kNN on the reduced set. A randomized, double-blind user study was conducted to evaluate the respective methods (kNN and kNN with DSM-reduction) against ridge regression (RR) and RR with random Fourier features (RR-RFF). The kNN-based methods performed significantly better ([Formula: see text]) than the regression techniques. Between DSM-kNN and kNN, there was no statistically significant difference (significance level 0.05). This is remarkable in consideration of only one sample per class in the reduced set, thus yielding a reduction rate of over 99% while preserving success rate. The same behaviour could be confirmed in an extended user study. With [Formula: see text], which turned out to be an excellent choice, the runtime complexity of both kNN (in every prediction step) as well as DSM-kNN (in the training phase) becomes linear concerning the number of original samples, favouring dependable wearable prosthesis applications.

What do users and their aiding professionals want from future devices in upper limb prosthetics? A focus group study

BACKGROUND

High rejection rates of upper limb prosthetics indicate that current prosthetic devices only partially meet user demands. This study therefore investigated the benefits and challenges with current prostheses, associated services and potential areas for improvement from the perspective of upper limb prosthesis users and various professionals working in the field of upper limb and hand prosthetics.

METHODS AND FINDINGS

Seven different focus group discussions were conducted with 32 participants. Participants were grouped by prosthesis type, if they were prosthesis users, or professionals. All focus group discussions were transcribed verbatim, and a summarizing content analysis was performed. Three main topic areas to be addressed emerged from the interviews: 1. a properly functioning prosthesis, 2. the infrastructure, and 3. users' psychological and physical prerequisites. The interaction between a well-functioning prosthesis and a well-developed infrastructure was shown to be important for successful use.

CONCLUSIONS

Our study raises many of the same issues that have been reported in previous qualitative studies, dating back over several decades. This study underlines the need to include users and professionals in the future development of prosthetic devices.

Review and critique of current testing protocols for upper-limb prostheses: a call for standardization amidst rapid technological advancements

This article provides a comprehensive narrative review of physical task-based assessments used to evaluate the multi-grasp dexterity and functional impact of varying control systems in pediatric and adult upper-limb prostheses. Our search returned 1,442 research articles from online databases, of which 25 tests-selected for their scientific rigor, evaluation metrics, and psychometric properties-met our review criteria. We observed that despite significant advancements in the mechatronics of upper-limb prostheses, these 25 assessments are the only validated evaluation methods that have emerged since the first measure in 1948. This not only underscores the lack of a consistently updated, standardized assessment protocol for new innovations, but also reveals an unsettling trend: as technology outpaces standardized evaluation measures, developers will often support their novel devices through custom, study-specific tests. These boutique assessments can potentially introduce bias and jeopardize validity. Furthermore, our analysis revealed that current validated evaluation methods often overlook the influence of competing interests on test success. Clinical settings and research laboratories differ in their time constraints, access to specialized equipment, and testing objectives, all of which significantly influence assessment selection and consistent use. Therefore, we propose a dual testing approach to address the varied demands of these distinct environments. Additionally, we found that almost all existing task-based assessments lack an integrated mechanism for collecting patient feedback, which we assert is essential for a holistic evaluation of upper-limb prostheses. Our review underscores the pressing need for a standardized evaluation protocol capable of objectively assessing the rapidly advancing prosthetic technologies across all testing domains.

Continuous joint velocity estimation using CNN-based deep learning for multi-DoF prosthetic wrist for activities of daily living

Introduction

Myoelectric control of prostheses is a long-established technique, using surface electromyography (sEMG) to detect user intention and perform subsequent mechanical actions. Most machine learning models utilized in control systems are trained using isolated movements that do not reflect the natural movements occurring during daily activities. Moreover, movements are often affected by arm postures, the duration of activities, and personal habits. It is crucial to have a control system for multi-degree-of-freedom (DoF) prosthetic arms that is trained using sEMG data collected from activities of daily living (ADL) tasks.

Method

This work focuses on two major functional wrist movements: pronation-supination and dart-throwing movement (DTM), and introduces a new wrist control system that directly maps sEMG signals to the joint velocities of the multi-DoF wrist. Additionally, a specific training strategy (Quick training) is proposed that enables the controller to be applied to new subjects and handle situations where sensors may displace during daily living, muscles can become fatigued, or sensors can become contaminated (e.g., due to sweat). The prosthetic wrist controller is designed based on data from 24 participants and its performance is evaluated using the Root Mean Square Error (RMSE) and Pearson Correlation.

Result

The results are found to depend on the characteristics of the tasks. For example, tasks with dart-throwing motion show smaller RSME values (Hammer: 6.68 deg/s and Cup: 7.92 deg/s) compared to tasks with pronation-supination (Bulb: 43.98 deg/s and Screw: 53.64 deg/s). The proposed control technique utilizing Quick training demonstrates a decrease in the average root mean square error (RMSE) value by 35% and an increase in the average Pearson correlation value by 40% across all four ADL tasks.

[Targeted muscle reinnervation: a surgical technique of human-machine interface for intelligent prosthesis]

Objective

To review targeted muscle reinnervation (TMR) surgery for the construction of intelligent prosthetic human-machine interface, thus providing a new clinical intervention paradigm for the functional reconstruction of residual limbs in amputees.

Methods

Extensively consulted relevant literature domestically and abroad and systematically expounded the surgical requirements of intelligent prosthetics, TMR operation plan, target population, prognosis, as well as the development and future of TMR.

Results

TMR facilitates intuitive control of intelligent prostheses in amputees by reconstructing the "brain-spinal cord-peripheral nerve-skeletal muscle" neurotransmission pathway and increasing the surface electromyographic signals required for pattern recognition. TMR surgery for different purposes is suitable for different target populations.

Conclusion

TMR surgery has been certified abroad as a transformative technology for improving prosthetic manipulation, and is expected to become a new clinical paradigm for 2 million amputees in China.

Toward higher-performance bionic limbs for wider clinical use

Most prosthetic limbs can autonomously move with dexterity, yet they are not perceived by the user as belonging to their own body. Robotic limbs can convey information about the environment with higher precision than biological limbs, but their actual performance is substantially limited by current technologies for the interfacing of the robotic devices with the body and for transferring motor and sensory information bidirectionally between the prosthesis and the user. In this Perspective, we argue that direct skeletal attachment of bionic devices via osseointegration, the amplification of neural signals by targeted muscle innervation, improved prosthesis control via implanted muscle sensors and advanced algorithms, and the provision of sensory feedback by means of electrodes implanted in peripheral nerves, should all be leveraged towards the creation of a new generation of high-performance bionic limbs. These technologies have been clinically tested in humans, and alongside mechanical redesigns and adequate rehabilitation training should facilitate the wider clinical use of bionic limbs.

Ascertaining the optimal myoelectric signal recording duration for pattern recognition based prostheses control

Introduction

Electromyogram-based pattern recognition (EMG-PR) has been widely considered an essentially intuitive control method for multifunctional upper limb prostheses. A crucial aspect of the scheme is the EMG signal recording duration (SRD) from which requisite motor tasks are characterized per time, impacting the system's overall performance. For instance, lengthy SRD inevitably introduces fatigue (that alters the muscle contraction patterns of specific limb motions) and may incur high computational costs in building the motion intent decoder, resulting in inadequate prosthetic control and controller delay in practical usage. Conversely, relatively shorter SRD may lead to reduced data collection durations that, among other advantages, allow for more convenient prosthesis recalibration protocols. Therefore, determining the optimal SRD required to characterize limb motion intents adequately that will aid intuitive PR-based control remains an open research question.

Method

This study systematically investigated the impact and generalizability of varying lengths of myoelectric SRD on the characterization of multiple classes of finger gestures. The investigation involved characterizing fifteen classes of finger gestures performed by eight normally limb subjects using various groups of EMG SRD including 1, 5, 10, 15, and 20 s. Two different training strategies including Between SRD and Within-SRD were implemented across three popular machine learning classifiers and three time-domain features to investigate the impact of SRD on EMG-PR motion intent decoder.

Result

The between-SRD strategy results which is a reflection of the practical scenario showed that an SRD greater than 5 s but less than or equal to 10 s (>5 and < = 10 s) would be required to achieve decent average finger gesture decoding accuracy for all feature-classifier combinations. Notably, lengthier SRD would incur more acquisition and implementation time and vice-versa. In inclusion, the study's findings provide insight and guidance into selecting appropriate SRD that would aid inadequate characterization of multiple classes of limb motion tasks in PR-based control schemes for multifunctional prostheses.

A multiarticulate pediatric prosthetic hand for clinical and research applications

Although beginning to emerge, multiarticulate upper limb prostheses for children remain sparse despite the continued advancement of mechatronic technologies that have benefited adults with upper limb amputations. Upper limb prosthesis research is primarily focused on adults, even though rates of pediatric prosthetic abandonment far surpass those seen in adults. The implicit goal of a prosthesis is to provide effective functionality while promoting healthy social interaction. Yet most current pediatric devices offer a single degree of freedom open/close grasping function, a stark departure from the multiple grasp configurations provided in advanced adult devices. Although comparable child-sized devices are on the clinical horizon, understanding how to effectively translate these technologies to the pediatric population is vital. This includes exploring grasping movements that may provide the most functional benefits and techniques to control the newly available dexterity. Currently, no dexterous pediatric research platforms exist that offer open access to hardware and programming to facilitate the investigation and provision of multi-grasp function. Our objective was to deliver a child-sized multi-grasp prosthesis that may serve as a robust research platform. In anticipation of an open-source release, we performed a comprehensive set of benchtop and functional tests with common household objects to quantify the performance of our device. This work discusses and evaluates our pediatric-sized multiarticulate prosthetic hand that provides 6 degrees of actuation, weighs 177 g and was designed specifically for ease of implementation in a research or clinical-research setting. Through the benchtop and validated functional tests, the pediatric hand produced grasping forces ranging from 0.424–7.216 N and was found to be comparable to the functional capabilities of similar adult devices. As mechatronic technologies advance and multiarticulate prostheses continue to evolve, translating many of these emerging technologies may help provide children with more useful and functional prosthesis options. Effective translation will inevitably require a solid scientific foundation to inform how best to prescribe advanced prosthetic devices and control systems for children. This work begins addressing these current gaps by providing a much-needed research platform with supporting data to facilitate its use in laboratory and clinical research settings.

Neurorobotic approaches to emulate human motor control with the integration of artificial synapse

The advancement of electronic devices has enabled researchers to successfully emulate human synapses, thereby promoting the development of the research field of artificial synapse integrated soft robots. This paper proposes an artificial reciprocal inhibition system that can successfully emulate the human motor control mechanism through the integration of artificial synapses. The proposed system is composed of artificial synapses, load transistors, voltage/current amplifiers, and a soft actuator to demonstrate the muscle movement. The speed, range, and direction of the soft actuator movement can be precisely controlled via the preset input voltages with different amplitudes, numbers, and signs (positive or negative). The artificial reciprocal inhibition system can impart lifelike motion to soft robots and is a promising tool to enable the successful integration of soft robots or prostheses in a living body.

Reimagining Prosthetic Control: A Novel Body-Powered Prosthetic System for Simultaneous Control and Actuation

Globally, the most popular upper-limb prostheses are powered by the human body. For body-powered (BP) upper-limb prostheses, control is provided by changing the tension of (Bowden) cables to open or close the terminal device. This technology has been around for centuries, and very few BP alternatives have been presented since. This paper introduces a new BP paradigm that can overcome certain limitations of the current cabled systems, such as a restricted operation space and user discomfort caused by the harness to which the cables are attached. A new breathing-powered system is introduced to give the user full control of the hand motion anywhere in space. Users can regulate their breathing, and this controllable airflow is then used to power a small Tesla turbine that can accurately control the prosthetic finger movements. The breathing-powered device provides a novel prosthetic option that can be used without limiting any of the user’s body movements. Here we prove that it is feasible to produce a functional breathing-powered prosthetic hand and show the models behind it along with a preliminary demonstration. This work creates a step-change in the potential BP options available to patients in the future.

Does Trans-radial Longitudinal Compression Influence Myoelectric Control?

BACKGROUND

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

METHODOLOGY

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

FINDINGS

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

CONCLUSION

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

Explainable Deep Learning Model for EMG-Based Finger Angle Estimation Using Attention

Electromyography (EMG) is one of the most common methods to detect muscle activities and intentions. However, it has been difficult to estimate accurate hand motions represented by the finger joint angles using EMG signals. We propose an encoder-decoder network with an attention mechanism, an explainable deep learning model that estimates 14 finger joint angles from forearm EMG signals. This study demonstrates that the model trained by the single-finger motion data can be generalized to estimate complex motions of random fingers. The color map result of the after-training attention matrix shows that the proposed attention algorithm enables the model to learn the nonlinear relationship between the EMG signals and the finger joint angles, which is explainable. The highly activated entries in the color map of the attention matrix derived from model training are consistent with the experimental observations in which certain EMG sensors are highly activated when a particular finger moves. In summary, this study proposes an explainable deep learning model that estimates finger joint angles based on EMG signals of the forearm using the attention mechanism.

Muscle Synergy-driven Motor Unit Clustering for Human-Machine Interfacing

Electromyographic signals (EMGs) can provide information on the overall activity of the innervating motor neuros in any given muscle but also globally reflect the underlying neuromechanics of human movement (e.g., muscle synergies). motor unit(MU) decomposition is a technique based on the deconvolution of high-density EMGs (HD-EMG) in order to derive the activities of the corresponding motor neurons. This powerful yet very sensitive tool has seen some traction in human-machine interfacing (HMI) for rehabilitation. Here, we propose combining the synergy-inspired channel clustering in order to isolate the most prominent regions of EMG activation in each targeted degree of freedom (DoF) and thus cater to decomposition's sensitivity demands. Our assumption is that this will lead to a higher number of extracted MUs and consequently better motion estimation in HMIs. Indeed, in four subjects, we have shown a 69% average increase in the number of MUs when decomposition was done using muscle-synergy channel clustering. Consequently, all three of our kinematic estimators benefited from an increased pool of units, with the linear regressor showing the greatest improvement once compared to, the artificial neural network and the gated recurrent unit, which had the overall best performance. Clinical Relevance- The results demonstrated in this work provide a new perspective on the online EMG-driven HMI systems that can be greatly beneficial in the rehabilitation of motor disorders.

Open-Source 3D Printing in the Prosthetic Field—The Case of Upper Limb Prostheses: A Review

Upper limb loss alters individuals’ private and professional life. Prosthetic devices are thus a solution to supply the missing upper limb segments. Nevertheless, commercial prostheses are often unaffordable, or inaccessible, to underprivileged individuals (e.g., no health insurance, low incomes, warzone). Among potential affordable alternatives, additive manufacturing, commonly “3D printing”, has been increasingly employed. This technology offers higher availability and accessibility, and can produce complex geometrical and highly customized products, which are essential features for prostheses manufacturing. Therefore, this study aims to portray an overview of reliable open-source upper limb 3D-printed prostheses currently available. We thus searched the scientific literature and online repositories hosting 3D-printable designs. We extracted data relative to mechanical and kinematic properties, 3D printing process and efficacy for each device. We found six studies implementing open-source 3DP upper limb prostheses and twenty-five open-source designs from online databases meeting selection criteria. Devices’ technical specifications were not systematically reported. In conclusion, though open-source 3D-printed upper limb prostheses can perform some functional tasks and grasps, and are widely employed to supply limb differences, further research is mandatory to validate their usage and to prove their clinical efficacy. More guidelines are required to unify contributions from private makers and non-governmental organizations with scientific groups.

Limb Prostheses: Industry 1.0 to 4.0: Perspectives on Technological Advances in Prosthetic Care

Technological advances from Industry 1.0 to 4.0, have exercised an increasing influence on prosthetic technology and practices. This paper explores the historical development of the sector within the greater context of industrial revolution. Over the course of the first and up the midpoint of the second industrial revolutions, Industry 1.0 and 2.0, the production and provision of prosthetic devices was an ad hoc process performed by a range of craftspeople. Historical events and technological innovation in the mid-part of Industry 2.0 created an inflection point resulting in the emergence of prosthetists who concentrated solely on hand crafting and fitting artificial limbs as a professional specialty. The third industrial revolution, Industry 3.0, began transforming prosthetic devices themselves. Static or body powered devices began to incorporate digital technology and myoelectric control options and hand carved wood sockets transitioned to laminated designs. Industry 4.0 continued digital advancements and augmenting them with data bases which to which machine learning (M/L) could be applied. This made it possible to use modeling software to better design various elements of prosthetic componentry in conjunction with new materials, additive manufacturing processes and mass customization capabilities. Digitization also began supporting clinical practices, allowing the development of clinical evaluation tools which were becoming a necessity as those paying for devices began requiring objective evidence that the prosthetic technology being paid for was clinically and functionally appropriate and cost effective. Two additional disruptive dynamics emerged. The first was the use of social media tools, allowing amputees to connect directly with engineers and tech developers and become participants in the prosthetic design process. The second was innovation in medical treatments, from diabetes treatments having the potential to reduce the number of lower limb amputations to Osseointegration techniques, which allow for the direct attachment of a prosthesis to a bone anchored implant. Both have the potential to impact prosthetic clinical and business models. Questions remains as to how current prosthetic clinical practitioners will respond and adapt as Industry 4.0 as it continues to shape the sector.

Embedded Machine Learning Using a Multi-Thread Algorithm on a Raspberry Pi Platform to Improve Prosthetic Hand Performance

High accuracy and a real-time system are priorities in the development of a prosthetic hand. This study aimed to develop and evaluate a real-time embedded time-domain feature extraction and machine learning on a system on chip (SoC) Raspberry platform using a multi-thread algorithm to operate a prosthetic hand device. The contribution of this study is that the implementation of the multi-thread in the pattern recognition improves the accuracy and decreases the computation time in the SoC. In this study, ten healthy volunteers were involved. The EMG signal was collected by using two dry electrodes placed on the wrist flexor and wrist extensor muscles. To reduce the complexity, four time-domain features were applied to extract the EMG signal. Furthermore, these features were used as the input of the machine learning. The machine learning evaluated in this study were k-nearest neighbor (k-NN), Naive Bayes (NB), decision tree (DT), and support vector machine (SVM). In the SoC implementation, the data acquisition, feature extraction, machine learning, and motor control process were implemented using a multi-thread algorithm. After the evaluation, the result showed that the pairing of the MAV feature and machine learning DT resulted in higher accuracy among other combinations (98.41%) with a computation time of ~1 ms. The implementation of the multi-thread algorithm in the pattern recognition system resulted in significant impact on the time processing.

Improving Robotic Hand Prosthesis Control With Eye Tracking and Computer Vision: A Multimodal Approach Based on the Visuomotor Behavior of Grasping

The complexity and dexterity of the human hand make the development of natural and robust control of hand prostheses challenging. Although a large number of control approaches were developed and investigated in the last decades, limited robustness in real-life conditions often prevented their application in clinical settings and in commercial products. In this paper, we investigate a multimodal approach that exploits the use of eye-hand coordination to improve the control of myoelectric hand prostheses. The analyzed data are from the publicly available MeganePro Dataset 1, that includes multimodal data from transradial amputees and able-bodied subjects while grasping numerous household objects with ten grasp types. A continuous grasp-type classification based on surface electromyography served as both intent detector and classifier. At the same time, the information provided by eye-hand coordination parameters, gaze data and object recognition in first-person videos allowed to identify the object a person aims to grasp. The results show that the inclusion of visual information significantly increases the average offline classification accuracy by up to 15.61 ± 4.22% for the transradial amputees and of up to 7.37 ± 3.52% for the able-bodied subjects, allowing trans-radial amputees to reach average classification accuracy comparable to intact subjects and suggesting that the robustness of hand prosthesis control based on grasp-type recognition can be significantly improved with the inclusion of visual information extracted by leveraging natural eye-hand coordination behavior and without placing additional cognitive burden on the user.

Simultaneous control of natural and extra degrees of freedom by isometric force and electromyographic activity in the muscle-to-force null space

OBJECTIVE

Muscle activation patterns in the muscle-to-force null space, i.e., patterns that do not generate task-relevant forces, may provide an opportunity for motor augmentation by allowing to control additional end-effectors simultaneously to natural limbs. Here we tested the feasibility of muscular null space control for augmentation by assessing simultaneous control of natural and extra degrees of freedom.

APPROACH

We instructed eight participants to control translation and rotation of a virtual 3D end-effector by simultaneous generation of isometric force at the hand and null space activity extracted in real-time from the electromyographic signals recorded from 15 shoulder and arm muscles. First, we identified the null space components that each participant could control more naturally by voluntary co-contraction. Then, participants performed several blocks of a reaching and holding task. They displaced an ellipsoidal cursor to reach one of nine targets by generating force, and simultaneously rotated the cursor to match the target orientation by activating null space components. We developed an information-theoretic metric, an index of difficulty defined as the sum of a spatial and a temporal term, to assess individual null space control ability for both reaching and holding.

MAIN RESULTS

On average, participants could reach the targets in most trials already in the first block (72%) and they improved with practice (maximum 93%) but holding performance remained lower (maximum 43%). As there was a high inter-individual variability in performance, we performed a simulation with different spatial and temporal task conditions to estimate those for which each individual participants would have performed best.

SIGNIFICANCE

Muscular null space control is feasible and may be used to control additional virtual or robotics end-effectors. However, decoding of motor commands must be optimized according to individual null space control ability.

Learning to teleoperate an upper-limb assistive humanoid robot for bimanual daily-living tasks

Objective.Bimanual humanoid platforms for home assistance are nowadays available, both as academic prototypes and commercially. Although they are usually thought of as daily helpers for non-disabled users, their ability to move around, together with their dexterity, makes them ideal assistive devices for upper-limb disabled persons, too. Indeed, teleoperating a bimanual robotic platform via muscle activation could revolutionize the way stroke survivors, amputees and patients with spinal injuries solve their daily home chores. Moreover, with respect to direct prosthetic control, teleoperation has the advantage of freeing the user from the burden of the prosthesis itself, overpassing several limitations regarding size, weight, or integration, and thus enables a much higher level of functionality.Approach.In this study, nine participants, two of whom suffer from severe upper-limb disabilities, teleoperated a humanoid assistive platform, performing complex bimanual tasks requiring high precision and bilateral arm/hand coordination, simulating home/office chores. A wearable body posture tracker was used for position control of the robotic torso and arms, while interactive machine learning applied to electromyography of the forearms helped the robot to build an increasingly accurate model of the participant's intent over time.Main results.All participants, irrespective of their disability, were uniformly able to perform the demanded tasks. Completion times, subjective evaluation scores, as well as energy- and time- efficiency show improvement over time on short and long term.Significance.This is the first time a hybrid setup, involving myoeletric and inertial measurements, is used by disabled people to teleoperate a bimanual humanoid robot. The proposed setup, taking advantage of interactive machine learning, is simple, non-invasive, and offers a new assistive solution for disabled people in their home environment. Additionnally, it has the potential of being used in several other applications in which fine humanoid robot control is required.

The "Federica" Hand

Hand prostheses partially restore hand appearance and functionalities. In particular, 3D printers have provided great opportunities by simplifying the manufacturing process and reducing costs. The "Federica" hand is 3D-printed and equipped with a single servomotor, which synergically actuates its five fingers by inextensible tendons; no springs are used for hand opening. A differential mechanical system simultaneously distributes the motor force on each finger in predefined portions. The proportional control of hand closure/opening is achieved by monitoring muscle contraction by means of a thin force sensor, as an alternative to EMG. The electrical current of the servomotor is monitored to provide sensory feedback of the grip force, through a small vibration motor. A simple Arduino board was adopted as the processing unit. A closed-chain, differential mechanism guarantees efficient transfer of mechanical energy and a secure grasp of any object, regardless of its shape and deformability. The force sensor offers some advantages over the EMG: it does not require any electrical contact or signal processing to monitor muscle contraction intensity. The activation speed (about half a second) is high enough to allow the user to grab objects on the fly. The cost of the device is less then 100 USD. The "Federica" hand has proved to be a lightweight, low-cost and extremely efficient prosthesis. It is now available as an open-source project (CAD files and software can be downloaded from a public repository), thus allowing everyone to use the "Federica" hand and customize or improve it.

Flexible Dry Electrodes for EMG Acquisition within Lower Extremity Prosthetic Sockets

Acquisition of surface electromyography (sEMG) from a person with an amputated lower extremity (LE) during prosthesis-assisted walking remains a significant challenge due to the dynamic nature of the gait cycle. Current solutions to sEMG-based neural control of active LE prostheses involve a combination of customized electrodes, prosthetic sockets, and liners. These technologies are generally: (i) incompatible with a subject's existing prosthetic socket and liners; (ii) uncomfortable to use; and (iii) expensive. This paper presents a flexible dry electrode design for sEMG acquisition within LE prosthetic sockets which seeks to address these issues. Design criteria and corresponding design decisions are explained and a proposed flexible electrode prototype is presented. Performances of the proposed electrode and commercial Ag/AgCl electrodes are compared in seated subjects without amputations. Quantitative analyses suggest comparable signal qualities for the proposed novel electrode and commercial electrodes. The proposed electrode is demonstrated in a subject with a unilateral transtibial amputation wearing her own liner, socket, and the portable sEMG processing platform in a preliminary standing and level ground walking study. Qualitative analyses suggest the feasibility of real-time sEMG data collection from load-bearing, ambulatory subjects.

A novel framework for designing a multi-DoF prosthetic wrist control using machine learning

Prosthetic arms can significantly increase the upper limb function of individuals with upper limb loss, however despite the development of various multi-DoF prosthetic arms the rate of prosthesis abandonment is still high. One of the major challenges is to design a multi-DoF controller that has high precision, robustness, and intuitiveness for daily use. The present study demonstrates a novel framework for developing a controller leveraging machine learning algorithms and movement synergies to implement natural control of a 2-DoF prosthetic wrist for activities of daily living (ADL). The data was collected during ADL tasks of ten individuals with a wrist brace emulating the absence of wrist function. Using this data, the neural network classifies the movement and then random forest regression computes the desired velocity of the prosthetic wrist. The models were trained/tested with ADLs where their robustness was tested using cross-validation and holdout data sets. The proposed framework demonstrated high accuracy (F-1 score of 99% for the classifier and Pearson's correlation of 0.98 for the regression). Additionally, the interpretable nature of random forest regression was used to verify the targeted movement synergies. The present work provides a novel and effective framework to develop an intuitive control for multi-DoF prosthetic devices.

Interaction in Assistive Robotics: A Radical Constructivist Design Framework

Despite decades of research, muscle-based control of assistive devices (myocontrol) is still unreliable; for instance upper-limb prostheses, each year more and more dexterous and human-like, still provide hardly enough functionality to justify their cost and the effort required to use them. In order to try and close this gap, we propose to shift the goal of myocontrol from guessing intended movements to creating new circular reactions in the constructivist sense defined by Piaget. To this aim, the myocontrol system must be able to acquire new knowledge and forget past one, and knowledge acquisition/forgetting must happen on demand, requested either by the user or by the system itself. We propose a unifying framework based upon Radical Constructivism for the design of such a myocontrol system, including its user interface and user-device interaction strategy.

Hybrid Tongue - Myoelectric Control Improves Functional Use of a Robotic Hand Prosthesis

OBJECTIVE

This study aims at investigating the functional performance of a novel prosthesis control scheme integrating an inductive tongue interface and myoelectric control. The tongue interface allowed direct selection of the desired grasp while myoelectric signals were used to open and close the robotic hand.

METHODS

The novel method was compared to a conventional sequential on/off myoelectric control scheme using functional tasks defined by Assistive Hand Assessment protocol. Ten able-bodied participants were fitted with the SmartHand on their left forearm. They used both the conventional myoelectric control and the Tongue and Myoelectric Hybrid interface (TMH) to accomplish two activities of daily living (i.e., preparing a sandwich and gift wrapping). Sessions were video recorded and the outcome measure was the completion time for the subtasks as well as the full tasks.

RESULTS

The sandwich task was completed significantly faster, with 19% decrease in the completion time, using the TMH when compared to the conventional sequential on/off myoelectric control scheme (p < 0.05).

CONCLUSION

The results indicate that the TMH control scheme facilitates the active use of the prosthetic device by simplifying grasp selection, leading thereby to faster completion of challenging and relevant tasks involving bimanual activities.

Minimum Mapping from EMG Signals at Human Elbow and Shoulder Movements into Two DoF Upper-Limb Robot with Machine Learning

This research focuses on the minimum process of classifying three upper arm movements (elbow extension, shoulder extension, combined shoulder and elbow extension) of humans with three electromyography (EMG) signals, to control a 2-degrees of freedom (DoF) robotic arm. The proposed minimum process consists of four parts: time divisions of data, Teager–Kaiser energy operator (TKEO), the conventional EMG feature extraction (i.e., the mean absolute value (MAV), zero crossings (ZC), slope-sign changes (SSC), and waveform length (WL)), and eight major machine learning models (i.e., decision tree (medium), decision tree (fine), k-Nearest Neighbor (KNN) (weighted KNN, KNN (fine), Support Vector Machine (SVM) (cubic and fine Gaussian SVM), Ensemble (bagged trees and subspace KNN). Then, we compare and investigate 48 classification models (i.e., 47 models are proposed, and 1 model is the conventional) based on five healthy subjects. The results showed that all the classification models achieved accuracies ranging between 74–98%, and the processing speed is below 40 ms and indicated acceptable controller delay for robotic arm control. Moreover, we confirmed that the classification model with no time division, with TKEO, and with ensemble (subspace KNN) had the best performance in accuracy rates at 96.67, recall rates at 99.66, and precision rates at 96.99. In short, the combination of the proposed TKEO and ensemble (subspace KNN) plays an important role to achieve the EMG classification.

Online Closed-Loop Control Using Tactile Feedback Delivered Through Surface and Subdermal Electrotactile Stimulation

Aim

Limb loss is a dramatic event with a devastating impact on a person’s quality of life. Prostheses have been used to restore lost motor abilities and cosmetic appearance. Closing the loop between the prosthesis and the amputee by providing somatosensory feedback to the user might improve the performance, confidence of the amputee, and embodiment of the prosthesis. Recently, a minimally invasive method, in which the electrodes are placed subdermally, was presented and psychometrically evaluated. The present study aimed to assess the quality of online control with subdermal stimulation and compare it to that achieved using surface stimulation (common benchmark) as well as to investigate the impact of training on the two modalities.

Methods

Ten able-bodied subjects performed a PC-based compensatory tracking task. The subjects employed a joystick to track a predefined pseudorandom trajectory using feedback on the momentary tracking error, which was conveyed via surface and subdermal electrotactile stimulation. The tracking performance was evaluated using the correlation coefficient (CORR), root mean square error (RMSE), and time delay between reference and generated trajectories.

Results

Both stimulation modalities resulted in good closed-loop control, and surface stimulation outperformed the subdermal approach. There was significant difference in CORR (86 vs 77%) and RMSE (0.23 vs 0.31) between surface and subdermal stimulation (all p < 0.05). The RMSE of the subdermal stimulation decreased significantly in the first few trials.

Conclusion

Subdermal stimulation is a viable method to provide tactile feedback. The quality of online control is, however, somewhat worse compared to that achieved using surface stimulation. Nevertheless, due to minimal invasiveness, compactness, and power efficiency, the subdermal interface could be an attractive solution for the functional application in sensate prostheses.

Immersive augmented reality system for the training of pattern classification control with a myoelectric prosthesis

BACKGROUND

Hand amputation can have a truly debilitating impact on the life of the affected person. A multifunctional myoelectric prosthesis controlled using pattern classification can be used to restore some of the lost motor abilities. However, learning to control an advanced prosthesis can be a challenging task, but virtual and augmented reality (AR) provide means to create an engaging and motivating training.

METHODS

In this study, we present a novel training framework that integrates virtual elements within a real scene (AR) while allowing the view from the first-person perspective. The framework was evaluated in 13 able-bodied subjects and a limb-deficient person divided into intervention (IG) and control (CG) groups. The IG received training by performing simulated clothespin task and both groups conducted a pre- and posttest with a real prosthesis. When training with the AR, the subjects received visual feedback on the generated grasping force. The main outcome measure was the number of pins that were successfully transferred within 20 min (task duration), while the number of dropped and broken pins were also registered. The participants were asked to score the difficulty of the real task (posttest), fun-factor and motivation, as well as the utility of the feedback.

RESULTS

The performance (median/interquartile range) consistently increased during the training sessions (4/3 to 22/4). While the results were similar for the two groups in the pretest, the performance improved in the posttest only in IG. In addition, the subjects in IG transferred significantly more pins (28/10.5 versus 14.5/11), and dropped (1/2.5 versus 3.5/2) and broke (5/3.8 versus 14.5/9) significantly fewer pins in the posttest compared to CG. The participants in IG assigned (mean ± std) significantly lower scores to the difficulty compared to CG (5.2 ± 1.9 versus 7.1 ± 0.9), and they highly rated the fun factor (8.7 ± 1.3) and usefulness of feedback (8.5 ± 1.7).

CONCLUSION

The results demonstrated that the proposed AR system allows for the transfer of skills from the simulated to the real task while providing a positive user experience. The present study demonstrates the effectiveness and flexibility of the proposed AR framework. Importantly, the developed system is open source and available for download and further development.

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.

Myoelectric digit action decoding with multi-output, multi-class classification: an offline analysis

The ultimate goal of machine learning-based myoelectric control is simultaneous and independent control of multiple degrees of freedom (DOFs), including wrist and digit artificial joints. For prosthetic finger control, regression-based methods are typically used to reconstruct position/velocity trajectories from surface electromyogram (EMG) signals. Unfortunately, such methods have thus far met with limited success. In this work, we propose action decoding, a paradigm-shifting approach for independent, multi-digit movement intent prediction based on multi-output, multi-class classification. At each moment in time, our algorithm decodes movement intent for each available DOF into one of three classes: open, close, or stall (i.e., no movement). Despite using a classifier as the decoder, arbitrary hand postures are possible with our approach. We analyse a public dataset previously recorded and published by us, comprising measurements from 10 able-bodied and two transradial amputee participants. We demonstrate the feasibility of using our proposed action decoding paradigm to predict movement action for all five digits as well as rotation of the thumb. We perform a systematic offline analysis by investigating the effect of various algorithmic parameters on decoding performance, such as feature selection and choice of classification algorithm and multi-output strategy. The outcomes of the offline analysis presented in this study will be used to inform the real-time implementation of our algorithm. In the future, we will further evaluate its efficacy with real-time control experiments involving upper-limb amputees.

The Interaction Between Feedback Type and Learning in Routine Grasping With Myoelectric Prostheses

While prosthetic fitting after upper-limb loss allows for restoration of motor functions, it deprives the amputee of tactile sensations that are essential for grasp control in able-bodied subjects. Therefore, it is commonly assumed that restoring the force feedback would improve the control of prosthesis grasping force. However, the literature regarding the benefit of feedback is controversial. Here, we investigated how the type of feedback affects learning and steady-state performance of routine grasping with a prosthesis. The experimental task was to grasp an object using a prosthesis and generate a low or high target-force range (TFR), both initially unknown, in three feedback conditions: basic auditory feedback on task outcome, and additional visual or vibratory feedback on the force magnitude. The results demonstrated that the performance was rather good and stable for the low TFR, whereas it was substantially worse for the high TFR with a pronounced training effect. Surprisingly, learning curve and steady-state performance did not depend on the feedback condition. Hence, in the specific context of routing grasping with a prosthesis controlled via surface EMG, the basic feedback on task outcome was not outperformed by force-related end-of-trial feedback and hence seemed to be sufficient for accomplishing the task.This conclusion applies to the context of routine grasping using a myoelectric prosthesis with surface EMG electrodes, which means that the control signals are variable and the feedback is perceived and processed at the end of the trial (motor adaption).

The Merits of Dynamic Data Acquisition for Realistic Myocontrol

Natural myocontrol is the intuitive control of a prosthetic limb via the user's voluntary muscular activations. This type of control is usually implemented by means of pattern recognition, which uses a set of training data to create a model that can decipher these muscular activations. A consequence of this approach is that the reliability of a myocontrol system depends on how representative this training data is for all types of signal variability that may be encountered when the amputee puts the prosthesis into real use. Myoelectric signals are indeed known to vary according to the position and orientation of the limb, among other factors, which is why it has become common practice to take this variability into account by acquiring training data in multiple body postures. To shed further light on this problem, we compare two ways of collecting data: while the subjects hold their limb statically in several positions one at a time, which is the traditional way, or while they dynamically move their limb at a constant pace through those same positions. Since our interest is to investigate any differences when controlling an actual prosthetic device, we defined an evaluation protocol that consisted of a series of complex, bimanual daily-living tasks. Fourteen intact participants performed these tasks while wearing prosthetic hands mounted on splints, which were controlled via either a statically or dynamically built myocontrol model. In both cases all subjects managed to complete all tasks and participants without previous experience in myoelectric control manifested a significant learning effect; moreover, there was no significant difference in the task completion times achieved with either model. When evaluated in a simulated scenario with traditional offline performance evaluation, on the other hand, the dynamically-trained system showed significantly better accuracy. Regardless of the setting, the dynamic data acquisition was faster, less tiresome, and better accepted by the users. We conclude that dynamic data acquisition is advantageous and confirm the limited relevance of offline analyses for online myocontrol performance.

Gaze, visual, myoelectric, and inertial data of grasps for intelligent prosthetics

A hand amputation is a highly disabling event, having severe physical and psychological repercussions on a person's life. Despite extensive efforts devoted to restoring the missing functionality via dexterous myoelectric hand prostheses, natural and robust control usable in everyday life is still challenging. Novel techniques have been proposed to overcome the current limitations, among them the fusion of surface electromyography with other sources of contextual information. We present a dataset to investigate the inclusion of eye tracking and first person video to provide more stable intent recognition for prosthetic control. This multimodal dataset contains surface electromyography and accelerometry of the forearm, and gaze, first person video, and inertial measurements of the head recorded from 15 transradial amputees and 30 able-bodied subjects performing grasping tasks. Besides the intended application for upper-limb prosthetics, we also foresee uses for this dataset to study eye-hand coordination in the context of psychophysics, neuroscience, and assistive robotics.

Closed-Loop Multi-Amplitude Control for Robust and Dexterous Performance of Myoelectric Prosthesis

In the case of a hand amputation, the affected person can use a myoelectric prosthesis to substitute the missing limb and regain motor functions. Unfortunately, commercial methods for myoelectric control, although robust and simple, are unintuitive and cognitively taxing when applied to an advanced multi-functional prosthesis. The state-of-the-art methods developed in academia are based on machine learning and therefore require long training and suffer from a lack of robustness. This work presents a novel closed-loop multi-level amplitude controller (CMAC), which aims at overcoming these drawbacks. The CMAC implements three degrees-of-freedom (DoF) control by thresholding the muscle contraction intensity during wrist flexion and extension movements. Unique features of the controller are the vibrotactile feedback that communicates the state of the controller to the user and a scheme for proportional control. These components allow exploiting the full dexterity of the prosthesis using a simple two-channel myoelectric interface. The CMAC was compared to a commonly implemented pattern-recognition method (linear discriminant analysis - LDA) using clinically relevant tests in 12 able-bodied and 2 amputee subjects. The experimental assessment demonstrated that CMAC was similarly fast as LDA in dexterous tests (clothespin and cube manipulation), while it was somewhat slower than LDA during a simple, single DoF task (box and blocks). In addition, in all the tasks, LDA and CMAC resulted in a similarly low error rate. On the other hand, to an amputee that could not generate six distinguishable classes using LDA, the CMAC still enabled the control of all the prosthesis DoFs. Importantly, the overall setup and training time in CMAC were significantly lower compared to LDA. In conclusion, the novel method is convenient for clinical applications, and allows substantially higher control dexterity compared to what can be normally achieved using conventional two channel EMG. Therefore, CMAC provides performance comparable to advanced machine-learning algorithms and the robustness and ease of use that is characteristic for the simple two-channel myoelectric interface.

Psychometric characterization of incidental feedback sources during grasping with a hand prosthesis

Background

A prosthetic system should ideally reinstate the bidirectional communication between the user’s brain and its end effector by restoring both motor and sensory functions lost after an amputation. However, current commercial prostheses generally do not incorporate somatosensory feedback. Even without explicit feedback, grasping using a prosthesis partly relies on sensory information. Indeed, the prosthesis operation is characterized by visual and sound cues that could be exploited by the user to estimate the prosthesis state. However, the quality of this incidental feedback has not been objectively evaluated.

Methods

In this study, the psychometric properties of the auditory and visual feedback of prosthesis motion were assessed and compared to that of a vibro-tactile interface. Twelve able-bodied subjects passively observed prosthesis closing and grasping an object, and they were asked to discriminate (experiment I) or estimate (experiment II) the closing velocity of the prosthesis using visual (VIS), acoustic (SND), or combined (VIS + SND) feedback. In experiment II, the subjects performed the task also with a vibrotactile stimulus (VIB) delivered using a single tactor. The outcome measures for the discrimination and estimation experiments were just noticeable difference (JND) and median absolute estimation error (MAE), respectively.

Results

The results demonstrated that the incidental sources provided a remarkably good discrimination and estimation of the closing velocity, significantly outperforming the vibrotactile feedback. Using incidental sources, the subjects could discriminate almost the minimum possible increment/decrement in velocity that could be commanded to the prosthesis (median JND < 2% for SND and VIS + SND). Similarly, the median MAE in estimating the prosthesis velocity randomly commanded from the full working range was also low, i.e., approximately 5% in SND and VIS + SND.

Conclusions

Since the closing velocity is proportional to grasping force in state-of-the-art myoelectric prostheses, the results of the present study imply that the incidental feedback, when available, could be usefully exploited for grasping force control. Therefore, the impact of incidental feedback needs to be considered when designing a feedback interface in prosthetics, especially since the quality of estimation using supplemental sources (e.g., vibration) can be worse compared to that of the intrinsic cues.

Improving bimanual interaction with a prosthesis using semi-autonomous control

BACKGROUND

The loss of a hand is a traumatic experience that substantially compromises an individual's capability to interact with his environment. The myoelectric prostheses are state-of-the-art (SoA) functional replacements for the lost limbs. Their overall mechanical design and dexterity have improved over the last few decades, but the users have not been able to fully exploit these advances because of the lack of effective and intuitive control. Bimanual tasks are particularly challenging for an amputee since prosthesis control needs to be coordinated with the movement of the sound limb. So far, the bimanual activities have been often neglected by the prosthetic research community.

METHODS

We present a novel method to prosthesis control, which uses a semi-autonomous approach in order to simplify bimanual interactions. The approach supplements the commercial SoA two-channel myoelectric control with two additional sensors. Two inertial measurement units were attached to the prosthesis and the sound hand to detect the movement of both limbs. Once a bimanual interaction is detected, the system mimics the coordination strategies of able-bodied subjects to automatically adjust the prosthesis wrist rotation (pronation, supination) and grip type (lateral, palmar) to assist the sound hand during a bimanual task. The system has been evaluated in eight able-bodied subjects performing functional uni- and bi-manual tasks using the novel method and SoA two-channel myocontrol. The outcome measures were time to accomplish the task, semi-autonomous system misclassification rate, subjective rating of intuitiveness, and perceived workload (NASA TLX).

RESULTS

The results demonstrated that the novel control interface substantially outperformed the SoA myoelectric control. While using the semi-autonomous control the time to accomplish the task and the perceived workload decreased for 25 and 27%, respectively, while the subjects rated the system as more intuitive then SoA myocontrol.

CONCLUSIONS

The novel system uses minimal additional hardware (two inertial sensors) and simple processing and it is therefore convenient for practical implementation. By using the proposed control scheme, the prosthesis assists the user's sound hand in performing bimanual interactions while decreasing cognitive burden.

Myoelectric Control for Upper Limb Prostheses

State-of-the-art high-end prostheses are electro-mechanically able to provide a great variety of movements. Nevertheless, in order to functionally replace a human limb, it is essential that each movement is properly controlled. This is the goal of prosthesis control, which has become a growing research field in the last decades, with the ultimate goal of reproducing biological limb control. Therefore, exploration and development of prosthesis control are crucial to improve many aspects of an amputee’s life. Nowadays, a large divergence between academia and industry has become evident in commercial systems. Although several studies propose more natural control systems with promising results, basic one degree of freedom (DoF), a control switching system is the most widely used option in industry because of simplicity, robustness and inertia. A few classification controlled prostheses have emerged in the last years but they are still a low percentage of the used ones. One of the factors that generate this situation is the lack of robustness of more advanced control algorithms in daily life activities outside of laboratory conditions. Because of this, research has shifted towards more functional prosthesis control. This work reviews the most recent literature in upper limb prosthetic control. It covers commonly used variants of possible biological inputs, its processing and translation to actual control, mostly focusing on electromyograms as well as the problems it will have to overcome in near future.

Motorized Biomechatronic Upper and Lower Limb Prostheses-Clinically Relevant Outcomes

People with major limb amputations are severely impaired when it comes to activity, body structure and function, as well as participation. Demographic statistics predict a dramatic increase of this population and additional challenges with their increasing age and higher levels of amputation. Prosthetic use has been shown to have a positive impact on mobility and depression, thereby affecting the quality of life. Biomechatronic prostheses are at the forefront of prosthetic development. Actively powered designs are now regularly used for upper limb prosthetic fittings, whereas for lower limbs the clinical use of actively powered prostheses has been limited to a very low number of applications. Actively powered prostheses enhance restoration of the lost physical functions of an amputee but are yet to allow intuitive user control. This paper provides a review of the status of biomechatronic developments in upper and lower limb prostheses in the context of the various challenges of amputation and the clinically relevant outcomes. Whereas most of the evidence regarding lower limb prostheses addresses biomechanical issues, the evidence for upper limb prostheses relates to activities of daily living (ADL) and instrumental ADL through diverse outcome measures and tools.

Can Multi-DoF Training Improve Robustness of Muscle Synergy Inspired Myocontrollers?

Non-negative Matrix Factorization (NMF) has been effective in extracting commands from surface electromyography (EMG) for the control of upper-limb prostheses. This approach enables Simultaneous and Proportional Control (SPC) over multiple degrees-of-freedom (DoFs) in a minimally supervised way. Here, like with other myoelectric approaches, robustness remains essential for clinical adoption, with device donning/doffing being a known cause for performance degradation. Previous research has demonstrated that NMF-based myocontrollers, trained on just single-DoF activations, permit a certain degree of user adaptation to a range of disturbances. In this study, we compare this traditional NMF controller with its sparsity constrained variation that allows initialization using both single and combined-DoF activations (NMF-C). The evaluation was done on 12 able bodied participants through a set of online target-reaching tests. Subjects were fitted with an 8-channel bipolar EMG setup, which was shifted by 1cm in both transversal directions throughout the experiments without system retraining. In the baseline condition NMF performed somewhat better than NMFC, but it did suffer more following the electrode repositioning, making the two perform on par. With no significant difference present across the conditions, results suggest that there is no immediate advantage from the naïve inclusion of more comprehensive training sets to the classic synergy-inspired implementation of SPC.

Clinical outcomes of a low-cost single-channel myoelectric-interface three-dimensional hand prosthesis

Background

Prosthetic hands with a myoelectric interface have recently received interest within the broader category of hand prostheses, but their high cost is a major barrier to use. Modern three-dimensional (3D) printing technology has enabled more widespread development and cost-effectiveness in the field of prostheses. The objective of the present study was to evaluate the clinical impact of a low-cost 3D-printed myoelectric-interface prosthetic hand on patients’ daily life.

Methods

A prospective review of all upper-arm transradial amputation amputees who used 3D-printed myoelectric interface prostheses (Mark V) between January 2016 and August 2017 was conducted. The functional outcomes of prosthesis usage over a 3-month follow-up period were measured using a validated method (Orthotics Prosthetics User Survey–Upper Extremity Functional Status [OPUS-UEFS]). In addition, the correlation between the length of the amputated radius and changes in OPUS-UEFS scores was analyzed.

Results

Ten patients were included in the study. After use of the 3D-printed myoelectric single electromyography channel prosthesis for 3 months, the average OPUS-UEFS score significantly increased from 45.50 to 60.10. The Spearman correlation coefficient (r) of the correlation between radius length and OPUS-UEFS at the 3rd month of prosthetic use was 0.815.

Conclusions

This low-cost 3D-printed myoelectric-interface prosthetic hand with a single reliable myoelectrical signal shows the potential to positively impact amputees’ quality of life through daily usage. The emergence of a low-cost 3D-printed myoelectric prosthesis could lead to new market trends, with such a device gaining popularity via reduced production costs and increased market demand.

Natural Myocontrol in a Realistic Setting: a Comparison Between Static and Dynamic Data Acquisition

Natural myocontrol employs pattern recognition to allow users to control a robotic limb intuitively using their own voluntary muscular activations. The reliability of myocontrol strongly depends on the signals initially collected from the users, which must appropriately capture the variability encountered later on during operation. Since myoelectric signals can vary based on the position and orientation of the limb, it has become best practice to gather data in multiple body postures. We hereby concentrate on this acquisition protocol and investigate the relative merits of collecting data either statically or dynamically. In the static case, data for a desired hand configuration is collected while the users keep their hand still in certain positions, whereas in the dynamic case, data is collected while users move their limbs, passing through the required positions with a roughly constant velocity.Fourteen able-bodied subjects were asked to naturally control two dexterous hand prostheses mounted on splints, performing a set of complex, realistic bimanual activities of daily living. We could not find any significant difference between the protocols in terms of the total execution times, although the dynamic data acquisition was faster and less tiring. This would indicate that dynamic data acquisition should be preferred over the static one.

Cross-sectional International Multicenter Study on Quality of Life and Reasons for Abandonment of Upper Limb Prostheses

Background:

This multicenter study aimed to examine the reasons for prosthesis rejection and assess the quality of life (QOL) among patients with upper limb deficiency.

Methods:

Three rehabilitation centers in Japan and 1 academic medical center in the United States participated. Patients between the age of 12 and 75 years with unilateral or bilateral upper limb absence from the level of wrist to shoulder disarticulation were included. Two questionnaires were used, an original questionnaire on prosthesis use and the EQ-5D, which were completed by both the participant and a live-in proxy.

Results:

Of the 367 patients with upper limb loss invited, 174 patients participated in this study. Eighty percent of the study population were male patients. The most common amputation level was transradial. Trauma was the most common cause of limb loss. The prosthesis rejection rate was 9% (n = 16). The most common reason for abandonment was a lack of prosthesis functionality. Ten of 16 prosthesis nonusers (63%) and 59 prosthesis users (38%) were unemployed or students. The mean EQ-5D utility score was significantly higher in prosthesis users than in nonusers (0.762 versus 0.628, P < 0.01). Live-in proxies significantly overestimated QOL in male patients (0.77 versus 0.807, P=0.01).

Conclusions:

The current prosthesis rejection rate is low. QOL was significantly higher in prosthesis users than in nonusers. More prosthesis users were employed compared with nonusers. Care should be taken not to overestimate the QOL of male patients with upper limb loss as their proxies often did.

Directional Forgetting for Stable Co-Adaptation in Myoelectric Control

Conventional myoelectric controllers provide a mapping between electromyographic signals and prosthetic functions. However, due to a number of instabilities continuously challenging this process, an initial mapping may require an extended calibration phase with long periods of user-training in order to ensure satisfactory performance. Recently, studies on co-adaptation have highlighted the benefits of concurrent user learning and machine adaptation where systems can cope with deficiencies in the initial model by learning from newly acquired data. However, the success remains highly dependent on careful weighting of these new data. In this study, we proposed a function driven directional forgetting approach to the recursive least-squares algorithm as opposed to the classic exponential forgetting scheme. By only discounting past information in the same direction of the new data, local corrections to the mapping would induce less distortion to other regions. To validate the approach, subjects performed a set of real-time myoelectric tasks over a range of forgetting factors. Results show that directional forgetting with a forgetting factor of 0.995 outperformed exponential forgetting as well as unassisted user learning. Moreover, myoelectric control remained stable after adaptation with directional forgetting over a range of forgetting factors. These results indicate that a directional approach to discounting past training data can improve performance and alleviate sensitivities to parameter selection in recursive adaptation algorithms.

Predicting wrist kinematics from motor unit discharge timings for the control of active prostheses

BACKGROUND

Current myoelectric control algorithms for active prostheses map time- and frequency-domain features of the interference EMG signal into prosthesis commands. With this approach, only a fraction of the available information content of the EMG is used and the resulting control fails to satisfy the majority of users. In this study, we predict joint angles of the three degrees of freedom of the wrist from motor unit discharge timings identified by decomposition of high-density surface EMG.

METHODS

We recorded wrist kinematics and high-density surface EMG signals from six able-bodied individuals and one patient with limb deficiency while they performed movements of three degrees of freedom of the wrist at three different speeds. We compared the performance of linear regression to predict the observed individual wrist joint angles from, either traditional time domain features of the interference EMG or from motor unit discharge timings (which we termed neural features) obtained by EMG decomposition. In addition, we propose and test a simple model-based dimensionality reduction, based on the physiological notion that the discharge timings of motor units are partly correlated.

RESULTS

The regression approach using neural features outperformed regression on classic global EMG features (average R² for neural features 0.77 and 0.64, for able-bodied subjects and patients, respectively; for time-domain features 0.70 and 0.52).

CONCLUSIONS

These results indicate that the use of neural information extracted from EMG decomposition can advance man-machine interfacing for prosthesis control.

Improving Reliability of Myocontrol Using Formal Verification

In the context of assistive robotics, myocontrol is one of the so-far unsolved problems of upper-limb prosthetics. It consists of swiftly, naturally, and reliably converting biosignals, non-invasively gathered from an upper-limb disabled subject, into control commands for an appropriate self-powered prosthetic device. Despite decades of research, traditional surface electromyography cannot yet detect the subject's intent to an acceptable degree of reliability, that is, enforce an action exactly when the subject wants it to be enforced.. In this paper, we tackle one such kind of mismatch between the subject's intent and the response by the myocontrol system, and show that formal verification can indeed be used to mitigate it. Eighteen intact subjects were engaged in two target achievement control tests in which a standard myocontrol system was compared to two "repaired" ones, one based on a non-formal technique, thus enforcing no guarantee of safety, and the other using the satisfiability modulo theories (SMT) technology to rigorously enforce the desired property. The experimental results indicate that both repaired systems exhibit better reliability than the non-repaired one. The SMT-based system causes only a modest increase in the required computational resources with respect to the non-formal technique; as opposed to this, the non-formal technique can be easily implemented in existing myocontrol systems, potentially increasing their reliability.

Online mapping of EMG signals into kinematics by autoencoding

Background

In this paper, we propose a nonlinear minimally supervised method based on autoencoding (AEN) of EMG for myocontrol. The proposed method was tested against the state-of-the-art (SOA) control scheme using a Fitts’ law approach.

Methods

Seven able-bodied subjects performed a series of target acquisition myoelectric control tasks using the AEN and SOA algorithms for controlling two degrees-of-freedom (radial/ulnar deviation and flexion/extension of the wrist), and their online performance was characterized by six metrics.

Results

Both methods allowed a completion rate close to 100%, however AEN outperformed SOA for all other performance metrics, e.g. it allowed to perform the tasks on average in half the time with respect to SOA. Moreover, the amount of information transferred by the proposed method in bit/s was nearly twice the throughput of SOA.

Conclusions

These results show that autoencoders can map EMG signals into kinematics with the potential of providing intuitive and dexterous control of artificial limbs for amputees.