A case study of technology transfer: Rehabilitative engineering at Rancho Los Amigos Hospital

The transfer of NASA technolgy to rehabilitative applications of artificial limbs is studied. Human factors engineering activities range from orthotic manipulators to tiny dc motors and transducers to detect and transmit voluntary control signals. It is found that bicarbon implant devices are suitable for medical equipment and artificial limbs because of their biological compatibility with human body fluids and tissues

Towards Natural Control of Artificial Limbs

The use of implantable electrodes has been long thought as the solution for a more natural control of artificial limbs, as these offer access to long-term stable and physiologically appropriate sources of control, as well as the possibility to elicit appropriate sensory feedback via neurostimulation. Although these ideas have been explored since the 1960’s, the lack of a long-term stable human-machine interface has prevented the utilization of even the simplest implanted electrodes in clinically viable limb prostheses.In this thesis, a novel human-machine interface for bidirectional communication between implanted electrodes and the artificial limb was developed and clinically implemented. The long-term stability was achieved via osseointegration, which has been shown to provide stable skeletal attachment. By enhancing this technology as a communication gateway, the longest clinical implementation of prosthetic control sourced by implanted electrodes has been achieved, as well as the first in modern times. The first recipient has used it uninterruptedly in daily and professional activities for over one year. Prosthetic control was found to improve in resolution while requiring less muscular effort, as well as to be resilient to motion artifacts, limb position, and environmental conditions.In order to support this work, the literature was reviewed in search of reliable and safe neuromuscular electrodes that could be immediately used in humans. Additional work was conducted to improve the signal-to-noise ratio and increase the amount of information retrievable from extraneural recordings. Different signal processing and pattern recognition algorithms were investigated and further developed towards real-time and simultaneous prediction of limb movements. These algorithms were used to demonstrate that higher functionality could be restored by intuitive control of distal joints, and that such control remains viable over time when using epimysial electrodes. Lastly, the long-term viability of direct nerve stimulation to produce intuitive sensory feedback was also demonstrated.The possibility to permanently and reliably access implanted electrodes, thus making them viable for prosthetic control, is potentially the main contribution of this work. Furthermore, the opportunity to chronically record and stimulate the neuromuscular system offers new venues for the prediction of complex limb motions and increased understanding of somatosensory perception. Therefore, the technology developed here, combining stable attachment with permanent and reliable human-machine communication, is considered by the author as a critical step towards more functional artificial limbs

Prosthetics Outreach Foundation

Prosthetics Outreach Foundation (POF) is a non profit medical service organization that provides urgently needed high quality prostheses (artificial limbs) to amputees in developing countries and in the United States. Since 1988, the staff and volunteers have fitted over 10,000 children and adults with new prostheses, enabling each amputee to walk again with dignity. POF helps communities to meet the needs of their own amputees by establishing clinics to create and fit artificial limbs and workshops to manufacture prosthetic components with local materials

Temporal-Difference Learning to Assist Human Decision Making during the Control of an Artificial Limb

In this work we explore the use of reinforcement learning (RL) to help with human decision making, combining state-of-the-art RL algorithms with an application to prosthetics. Managing human-machine interaction is a problem of considerable scope, and the simplification of human-robot interfaces is especially important in the domains of biomedical technology and rehabilitation medicine. For example, amputees who control artificial limbs are often required to quickly switch between a number of control actions or modes of operation in order to operate their devices. We suggest that by learning to anticipate (predict) a user's behaviour, artificial limbs could take on an active role in a human's control decisions so as to reduce the burden on their users. Recently, we showed that RL in the form of general value functions (GVFs) could be used to accurately detect a user's control intent prior to their explicit control choices. In the present work, we explore the use of temporal-difference learning and GVFs to predict when users will switch their control influence between the different motor functions of a robot arm. Experiments were performed using a multi-function robot arm that was controlled by muscle signals from a user's body (similar to conventional artificial limb control). Our approach was able to acquire and maintain forecasts about a user's switching decisions in real time. It also provides an intuitive and reward-free way for users to correct or reinforce the decisions made by the machine learning system. We expect that when a system is certain enough about its predictions, it can begin to take over switching decisions from the user to streamline control and potentially decrease the time and effort needed to complete tasks. This preliminary study therefore suggests a way to naturally integrate human- and machine-based decision making systems.Comment: 5 pages, 4 figures, This version to appear at The 1st Multidisciplinary Conference on Reinforcement Learning and Decision Making, Princeton, NJ, USA, Oct. 25-27, 201

‘A plentiful crop of cripples made by all this progress’: Disability, Artificial Limbs and Working-Class Mutualism in the South Wales Coalfield, 1890-1948’

Historians of orthopaedics, artificial limbs and disability have devoted a great deal of attention to children and soldiers but have neglected to give sufficient space in their studies to industrial workers, the other patient group that has been identified as crucial to the development of these areas. Furthermore, this attention has led to an imbalanced focus on charitable and philanthropic activities as the main means of assistance and the neglect of a significant part of the voluntary sphere, the labour movement. This article, focusing on industrial south Wales, examines the efforts of workingclass organisations to provide artificial limbs and a range of other surgical appliances to workers and their family members in the late nineteenth and early twentieth centuries. It finds that a distinctive, labourist conception of disability existed which envisaged disabled workers as an important priority and one to which significant time, effort and resources were devoted.Wellcome Trus

Osseointegrated prostheses for rehabilitation following amputation : The pioneering Swedish model.

The direct attachment of osseointegrated (OI) prostheses to the skeleton avoids the inherent problems of socket suspension. It also provides physiological weight bearing, improved range of motion in the proximal joint, as well as osseoperceptive sensory feedback, enabling better control of the artificial limbs by amputees. The present article briefly reviews the pioneering efforts on extremity osseointegration surgeries in Sweden and the development of the OPRA (Osseointegrated Prostheses for the Rehabilitation of Amputees) program. The standard implant design of the OPRA system and surgical techniques are described as well as the special rehabilitation protocols based on surgical sites. The results of long-term follow-up for transradial, transhumeral, and thumb amputee operations are briefly reported including the prospective study of transfemoral amputees according to OPRA protocol. The importance of refinement on implant designs and surgical techniques based on the biomechanical analysis and early clinical trials is emphasized. Future aspects on osseointegration surgery are briefly described, including novel treatment options using implanted electrodes