Neuromuscular adaptations and sensorimotor integration following a unilateral transfemoral amputation

Background Following an amputation, the human postural control system develops neuromuscular adaptations to regain an effective postural control. We investigated the compensatory mechanisms behind these adaptations and how sensorimotor integration is affected after a lower-limb transfemoral amputation. Methods Center of pressure (CoP) data of 12 unilateral transfemoral amputees and 12 age-matched able-bodied subjects were recorded during quiet standing with eyes open (EO) and closed (EC). CoP adjustments under each leg were recorded to study their contribution to posture control. The spatial structure of the CoP displacements was characterized by measuring the mean distance, the mean velocity of the CoP adjustments, and the sway area. The Entropic Half-Life (EnHL) quantifies the temporal structure of the CoP adjustments and was used to infer disrupted sensory feedback loops in amputees. We expanded the analysis with measures of weight-bearing imbalance and asymmetry, and with two standardized balance assessments, the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG). Results There was no difference in the EnHL values of amputees and controls when combining the contributions of both limbs (p = 0.754). However, amputees presented significant differences between the EnHL values of the intact and prosthetic limb (p <  0.001). Suppressing vision reduced the EnHL values of the intact (p = 0.001) and both legs (p = 0.028), but not in controls. Vision feedback in amputees also had a significant effect (increase) on the mean CoP distance (p <  0.001), CoP velocity (p <  0.001) and sway area (p = 0.007). Amputees presented an asymmetrical stance. The EnHL values of the intact limb in amputees were positively correlated to the BBS scores (EO: ρ = 0.43, EC: ρ = 0.44) and negatively correlated to the TUG times (EO: ρ = − 0.59, EC: ρ = − 0.69). Conclusion These results suggest that besides the asymmetry in load distribution, there exist neuromuscular adaptations after an amputation, possibly related to the loss of sensory feedback and an altered sensorimotor integration. The EnHL values suggest that the somatosensory system predominates in the control of the intact leg. Further, suppressing the visual system caused instability in amputees, but had a minimal impact on the CoP dynamics of controls. These findings points toward the importance of providing somatosensory feedback in lower-limb prosthesis to reestablish a normal postural control

Multilevel control of an anthropomorphic prosthetic hand for grasp and slip prevention

The success of grasping and manipulation tasks of commercial prosthetic hands is mainly related to amputee visual feedback since they are not provided either with tactile sensors or with sophisticated control. As a consequence, slippage and object falls often occur. This article wants to address the specific issue of enhancing grasping and manipulation capabilities of existing prosthetic hands, by changing the control strategy. For this purpose, it proposes a multilevel control based on two distinct levels consisting of (1) a policy search learning algorithm combined with central pattern generators in the higher level and (2) a parallel force/position control managing slippage events in the lower level. The control has been tested on an anthropomorphic robotic hand with prosthetic features (the IH2 hand) equipped with force sensors. Bi-digital and tri-digital grasping tasks with and without slip information have been carried out. The KUKA-LWR has been employed to perturb the grasp stability inducing controlled slip events. The acquired data demonstrate that the proposed control has the potential to adapt to changes in the environment and guarantees grasp stability, by avoiding object fall thanks to prompt slippage event detection

Internet of Things: An Opportunity for Advancing Universal Access

IoT enables the worldwide connection of heterogeneous things or objects, which can hence interact with each other and cooperate with their neighbors to reach common goals, by using different communication technologies and communication protocol standards. IoT and related technologies can increase or reduce the gap among people. In this respect, this chapter aims to highlight the virtuose use of the IoT paradigm by providing examples of its application for enhancing universal access in different fields