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

Effect on signal-to-noise ratio of splitting the continuous contacts of cuff electrodes into smaller recording areas.

BackgroundCuff electrodes have been widely used chronically in different clinical applications. This neural interface has been dominantly used for nerve stimulation while interfering noise is the major issue when employed for recording purposes. Advancements have been made in rejecting extra-neural interference by using continuous ring contacts in tripolar topologies. Ring contacts provide an average of the neural activity, and thus reduce the information retrieved. Splitting these contacts into smaller recording areas could potentially increase the information content. In this study, we investigate the impact of such discretization on the Signal-to-Noise Ratio (SNR). The effect of contacts positioning and an additional short circuited pair of electrodes were also addressed.MethodsDifferent recording configurations using ring, dot, and a mixed of both contacts were studied in vitro in a frog model. An interfering signal was induced in the medium to simulate myoelectric noise. The experimental setup was design in such a way that the only difference between recordings was the configuration used. The inter-session experimental differences were taken care of by a common configuration that allowed normalization between electrode designs.ResultsIt was found that splitting all contacts into small recording areas had negative effects on noise rejection. However, if this is only applied to the central contact creating a mixed tripole configuration, a considerable and statistically significant improvement was observed. Moreover, the signal to noise ratio was equal or larger than what can be achieved with the best known configuration, namely the short circuited tripole. This suggests that for recording purposes, any tripole topology would benefit from splitting the central contact into one or more discrete contacts.ConclusionsOur results showed that a mixed tripole configuration performs better than the configuration including only ring contacts. Therefore, splitting the central ring contact of a cuff electrode into a number of dot contacts not only provides additional information but also an improved SNR. In addition, the effect of an additional pair of short circuited electrodes and the "end effect" observed with the presented method are in line with previous findings by other authors

Neuromusculoskeletal Arm Prostheses: Personal and Social Implications of Living With an Intimately Integrated Bionic Arm

People with limb loss are for the first time living chronically and uninterruptedly with intimately integrated neuromusculoskeletal prostheses. This new generation of artificial limbs are fixated to the skeleton and operated by bidirectionally transferred neural information. This unprecedented level of human–machine integration is bound to have profound psychosocial effects on the individuals living with these prostheses. Here, we examined the psychosociological impact on people as they integrate neuromusculoskeletal prostheses into their bodies and lives. Three people with transhumeral amputations participated in this study, all of whom had been living with neuromusculoskeletal prostheses in their daily lives between 2 and 6 years at the time of the interview. Direct neural sensory feedback had been enabled for 6 months to 2 years. Participants were interviewed about their experiences living with the neuromusculoskeletal prostheses in their home and professional daily lives. We analyzed these interviews to elucidate themes using an interpretive phenomenological approach that regards participants’ own experiences as forms of expertise and knowledge-making. Our participant-generated results indicate that people adapted and integrated the technology into functional and social arenas of daily living, with positive psychosocial effects on self-esteem, self-image, and social relations intimately linked to improved trust of the prostheses. Participants expressed enhanced prosthetic function, increased and more diverse prosthesis use in tasks of daily living, and improved relationships between their prosthesis and phantom limb. Our interviews with patients also generated critiques of the language commonly used to describe human-prosthetic relations, including terms such as “embodiment,” and the need for specificity surrounding the term “natural” with regard to control versus sensory feedback. Experiences living with neuromusculoskeletal prostheses were complex and subject-dependent, and therefore future research should consider human–machine interaction as a relationship that is constantly enacted, negotiated, and deeply contextualized

Alpha Oscillation in Phantom Limb Pain Patients: A Neuropathic Pain Signature

People with acquired amputation face oftentimes the onset of chronic pain, which develops as either residual limb pain, neuroma or nociceptive phantom limb pain (PLP), or neuropathic PLP.\ua0 To date, the pathophysiology giving raise to PLP is still object of debate, with previous literature mainly focusingon whether and how reorganization takes place in the primary somatosensory and motor cortices. Striving to understand how changes in somatotopy and mototopy relate to PLP, brain imaging studies have traditionally been conducted with a task-based fMRI approaches which measure the neuralactivity in an indirect way. Yet, little is known about the effect of amputation on the global brain organization and electrophysiological techniques, such as EEG, have not been taken fully advantage of. In this study we analyse the power of spontaneous and ongoing EEG activity as a function offrequency. The rationale for this choice stems from the assumption that brain at rest, in opposition to task-based paradigms, allows to capture dynamics related to the processing of pain which would otherwise be masked by other sensory or cognitive functions processes

Stationary Wavelet Processing and Data Imputing in Myoelectric Pattern Recognition on a Low-Cost Embedded System

Pattern recognition-based decoding of surface electromyography allows for intuitive and flexible control of prostheses but comes at the cost of sensitivity to in-band noise and sensor faults. System robustness can be improved with wavelet-based signal processing and data imputing, but no attempt has been made to implement such algorithms on real-time, portable systems. The aim of this work was to investigate the feasibility of low-latency, wavelet-based processing and data imputing on an embedded device capable of controlling upper-arm prostheses. Nine able-bodied subjects performed Motion Tests while inducing transient disturbances. Additional investigation was performed on pre-recorded Motion Tests from 15 able-bodied subjects with simulated disturbances. Results from real-time tests were inconclusive, likely due to the low number of disturbance episodes, but simulated tests showed significant improvements in most metrics for both algorithms. However, both algorithms also showed reduced responsiveness during disturbance episodes. These results suggest wavelet-based processing and data imputing can be implemented in portable, real-time systems to potentially improve robustness to signal distortion in prosthetic devices with the caveat of reduced responsiveness for the typically short duration of signal disturbances. The trade-off between large-scale signal corruption robustness and system responsiveness warrants further studies in daily life activities

Evaluation of computer-based target achievement tests for myoelectric control

Real-Time evaluation of novel prosthetic control schemes is critical for translational research on artificial limbs. Recently, two computer-based, real-Time evaluation tools, the target achievement control (TAC) test and the Fitts' law test (FLT), have been proposed to assess real-Time controllability. Whereas TAC tests provides an anthropomorphic visual representation of the limb at the cost of confusing visual feedback, FLT clarifies the current and target locations by simplified non-Anthropomorphic representations. Here, we investigated these two approaches and quantified differences in common performance metrics that can result from the chosen method of visual feedback. Ten able-bodied and one amputee subject performed target achievement tasks corresponding to the FLT and TAC test with equivalent indices of difficulty. Ablebodied subjects exhibited significantly (p <0.05) better completion rate, path efficiency, and overshoot when performing the FLT, although no significant difference was seen in throughput performance. The amputee subject showed significantly better performance in overshoot at the FLT, but showed no significant difference in completion rate, path efficiency, and throughput. Results from the FLT showed a strong linear relationship between the movement time and the index of difficulty (R2 D 0:96), whereas TAC test results showed no apparent linear relationship (R2 D 0:19). These results suggest that in relatively similar conditions, the confusing location of virtual limb representation used in the TAC test contributed to poorer performance. Establishing an understanding of the biases of various evaluation protocols is critical to the translation of research into clinical practice

Stationary wavelet processing and data imputing in myoelectric pattern recognition on a low-cost embedded system

Pattern recognition-based decoding of surface electromyography allows for intuitive and flexible control of prostheses but comes at the cost of sensitivity to in-band noise and sensor faults. System robustness can be improved with wavelet-based signal processing and data imputing, but no attempt has been made to implement such algorithms on real-time, portable systems. The aim of this work was to investigate the feasibility of low-latency, wavelet-based processing and data imputing on an embedded device capable of controlling upper-arm prostheses. Nine able-bodied subjects performed Motion Tests while inducing transient disturbances. Additional investigation was performed on pre-recorded Motion Tests from 15 able-bodied subjects with simulated disturbances. Results from real-time tests were inconclusive, likely due to the low number of disturbance episodes, but simulated tests showed significant improvements in most metrics for both algorithms. However, both algorithms also showed reduced responsiveness during disturbance episodes. These results suggest wavelet-based processing and data imputing can be implemented in portable, real-time systems to potentially improve robustness to signal distortion in prosthetic devices with the caveat of reduced responsiveness for the typically short duration of signal disturbances. The trade-off between large-scale signal corruption robustness and system responsiveness warrants further studies in daily life activities

A multi-dimensional framework for prosthetic embodiment: a perspective for translational research

The concept of embodiment has gained widespread popularity within prosthetics research. Embodiment has been claimed to be an indicator of the efficacy of sensory feedback and control strategies. Moreover, it has even been claimed to be necessary for prosthesis acceptance, albeit unfoundedly. Despite the popularity of the term, an actual consensus on how prosthetic embodiment should be used in an experimental framework has yet to be reached. The lack of consensus is in part due to terminological ambiguity and the lack of an exact definition of prosthetic embodiment itself. In a review published parallel to this article, we summarized the definitions of embodiment used in prosthetics literature and concluded that treating prosthetic embodiment as a combination of ownership and agency allows for embodiment to be quantified, and thus useful in translational research. Here, we review the potential mechanisms that give rise to ownership and agency considering temporal, spatial, and anatomical constraints. We then use this to propose a multi-dimensional framework where prosthetic embodiment arises within a spectrum dependent on the integration of volition and multi-sensory information as demanded by the degree of interaction with the environment. This framework allows for the different experimental paradigms on sensory feedback and prosthetic control to be placed in a common perspective. By considering that embodiment lays along a spectrum tied to the interactions with the environment, one can conclude that the embodiment of prosthetic devices should be assessed while operating in environments as close to daily life as possible for it to become relevant