New developments in prosthetic arm systems

Absence of an upper limb leads to severe impairments in everyday life, which can further influence the social and mental state. For these reasons, early developments in cosmetic and body-driven prostheses date some centuries ago, and they have been evolving ever since. Following the end of the Second World War, rapid developments in technology resulted in powered myoelectric hand prosthetics. In the years to come, these devices were common on the market, though they still suffered high user abandonment rates. The reasons for rejection were trifold - insufficient functionality of the hardware, fragile design, and cumbersome control. In the last decade, both academia and industry have reached major improvements concerning technical features of upper limb prosthetics and methods for their interfacing and control. Advanced robotic hands are offered by several vendors and research groups, with a variety of active and passive wrist options that can be articulated across several degrees of freedom. Nowadays, elbow joint designs include active solutions with different weight and power options. Control features are getting progressively more sophisticated, offering options for multiple sensor integration and multi-joint articulation. Latest developments in socket designs are capable of facilitating implantable and multiple surface electromyography sensors in both traditional and osseointegration-based systems. Novel surgical techniques in combination with modern, sophisticated hardware are enabling restoration of dexterous upper limb functionality. This article is aimed at reviewing the latest state of the upper limb prosthetic market, offering insights on the accompanying technologies and techniques. We also examine the capabilities and features of some of academia’s flagship solutions and methods

Optimal Motor Unit Subset Selection for Accurate Motor Intention Decoding: Towards Dexterous Real-Time Interfacing

Objective: Motor unit (MU) discharge timings encode human motor intentions to the finest degree. Whilst tapping into such information can bring significant gains to a range of applications, current approaches to MU decoding from surface signals do not scale well with the demands of dexterous human-machine interfacing (HMI). To optimize the forward estimation accuracy and time-efficiency of such systems, we propose the inclusion of task-wise initialization and MU subset selection. Methods: Offline analyses were conducted on data recorded from 11 non-disabled subjects. Task-wise decomposition was applied to identify MUs from high-density surface electromyography (HD-sEMG) pertaining to 18 wrist/forearm motor tasks. The activities of a selected subset of MUs were extracted from test data and used for forward estimation of intended motor tasks and joint kinematics. To that end, various combinations of subset selection and estimation algorithms (both regression and classification-based) were tested for a range of subset sizes. Results: The mutual information-based minimum Redundancy Maximum Relevance (mRMR-MI) criterion retained MUs with the highest predicative power. When the portion of tracked MUs was reduced down to 25%, the regression performance decreased only by 3% (R2=0.79) while classification accuracy dropped by 2.7% (accuracy = 74%) when kernel-based estimators were considered. Conclusion and Significance: Careful selection of tracked MUs can optimize the efficiency of MU-driven interfacing. In particular, prioritization of MUs exhibiting strong nonlinear relationships with target motions is best leveraged by kernel-based estimators. Hence, this frees resources for more robust and adaptive MU decoding techniques to be implemented in future

Semi-Automated Identification of Motor Units Concurrently Recorded in High-Density Surface and Intramuscular Electromyography

: An increasing focus on extending automated surface electromyography (EMG) decomposition algorithms to operate under non-stationary conditions requires rigorous and robust validation. However, relevant benchmarks derived manually from iEMG are laborsome to obtain and this is further exacerbated by the need to consider multiple contraction conditions. This work demonstrates a semi-automatic technique for extracting motor units (MUs) whose activities are present in concurrently recorded high-density surface EMG (HD-sEMG) and intramuscular EMG (iEMG) during isometric contractions. We leverage existing automatic surface decomposition algorithms for initial identification of active MUs. Resulting spike times are then used to identify (trigger) the sources that are concurrently detectable in iEMG. We demonstrate this technique on recordings targeting the extensor carpi radialis brevis in five human subjects. This dataset consists of 117 trials across different force levels and wrist angles, from which the presented method yielded a set of 367 high-confidence decompositions. Thus, our approach effectively alleviates the overhead of manual decomposition as it efficiently produces reliable benchmarks under different conditions.Clinical Relevance- We present an efficient method for obtaining high-quality in-vivo decomposition particularly useful in the verification of new surface decomposition approaches

Far-field electric potentials provide access to the output from the spinal cord from wrist-mounted sensors

OBJECTIVE: Neural interfaces need to become more unobtrusive and socially acceptable to appeal to general consumers outside rehabilitation settings. APPROACH: We developed a non-invasive neural interface that provides access to spinal motor neuron activities from the wrist, which is the preferred location for a wearable. The interface decodes far-field potentials present at the tendon endings of the forearm muscles using blind source separation. First, we evaluated the reliability of the interface to detect motor neuron firings based on far-field potentials, and thereafter we used the decoded motor neuron activity for the prediction of finger contractions in offline and real-time conditions. MAIN RESULTS: The results showed that motor neuron activity decoded from the far-field potentials at the wrist accurately predicted individual and combined finger commands and therefore allowed for highly accurate real-time task classification. SIGNIFICANCE: These findings demonstrate the feasibility of a non-invasive, neural interface at the wrist for precise real-time control based on the output of the spinal cord

Longitudinal high-density EMG classification: Case study in a glenohumeral TMR subject.

Targeted muscle reinnervation (TMR) represents a breakthrough interface for prosthetic control in high-level upper-limb amputees. However, clinically, it is still limited to the direct motion-wise control restricted by the number of reinnervation sites. Pattern recognition may overcome this limitation. Previous studies on EMG classification in TMR patients experienced with myocontrol have shown greater accuracy when using high-density (HD) recordings compared to conventional single-channel derivations. This case study investigates the potential of HD-EMG classification longitudinally over a period of 17 months post-surgery in a glenohumeral amputee. Five experimental sessions, separated by approximately 3 months, were performed. They were timed during a standard rehabilitation protocol that included intensive physio- and occupational therapy, myosignal training, and routine use of the final myoprosthesis. The EMG signals recorded by HD-EMG grids were classified into 12 classes. The first sign of EMG activity was observed in the second experimental session. The classification accuracy over 12 classes was 76% in the third session and ∼95% in the last two sessions. When using training and testing sets that were acquired with a 1-h time interval in between, a much lower accuracy (32%, Session 4) was obtained, which improved upon prosthesis usage (Session 5, 67%). The results document the improvement in EMG classification accuracy throughout the TMR-rehabilitation process

Motor unit characteristics after targeted muscle reinnervation

Targeted muscle reinnervation (TMR) is a surgical procedure used to redirect nerves originally controlling muscles of the amputated limb into remaining muscles above the amputation, to treat phantom limb pain and facilitate prosthetic control. While this procedure effectively establishes robust prosthetic control, there is little knowledge on the behavior and characteristics of the reinnervated motor units. In this study we compared the m. pectoralis of five TMR patients to nine able-bodied controls with respect to motor unit action potential (MUAP) characteristics. We recorded and decomposed high-density surface EMG signals into individual spike trains of motor unit action potentials. In the TMR patients the MUAP surface area normalized to the electrode grid surface (0.25 ± 0.17 and 0.81 ± 0.46, p < 0.001) and the MUAP duration (10.92 ± 3.89 ms and 14.03 ± 3.91 ms, p < 0.01) were smaller for the TMR group than for the controls. The mean MUAP amplitude (0.19 ± 0.11 mV and 0.14 ± 0.06 mV, p = 0.07) was not significantly different between the two groups. Finally, we observed that MUAP surface representation in TMR generally overlapped, and the surface occupied by motor units corresponding to only one motor task was on average smaller than 12% of the electrode surface. These results suggest that smaller MUAP surface areas in TMR patients do not necessarily facilitate prosthetic control due to a high degree of overlap between these areas, and a neural information—based control could lead to improved performance. Based on the results we also infer that the size of the motor units after reinnervation is influenced by the size of the innervating motor neuron

Biomechanical analysis of body movements of myoelectric prosthesis users during standardized clinical tests

Objective: The objective clinical evaluation of user's capabilities to handle their prosthesis is done using various tests which primarily focus on the task completion speed and do not explicitly account for the potential presence of compensatory motions. Given that the excessive body compensation is a common indicator of inadequate prosthesis control, tests which include subjective observations on the quality of performed motions have been introduced. However, these metrics are then influenced by the examiner's opinions, skills, and training making them harder to standardize across patient pools and compare across different prosthetic technologies. Here we aim to objectively quantify the severity of body compensations present in myoelectric prosthetic hand users and evaluate the extent to which traditional objective clinical scores are still able to capture them. Methods: We have instructed 9 below-elbow prosthesis users and 9 able-bodied participants to complete three established objective clinical tests: Box-and-Blocks-Test, Clothespin-Relocation-Test, and Southampton-Hand-Assessment-Procedure. During all tests, upper-body kinematics has been recorded. Results: While the analysis showed that there are some correlations between the achieved clinical scores and the individual body segment travel distances and average speeds, there were only weak correlations between the clinical scores and the observed ranges of motion. At the same time, the compensations were observed in all prosthesis users and, for the most part, they were substantial across the tests. Conclusion: The sole reliance on the currently available objective clinical assessment methods seems inadequate as the compensatory movements are prominent in prosthesis users and yet not sufficiently accounted for

Undergraduate medical research: the student perspective

Background: Research training is essential in a modern undergraduate medical curriculum. Our evaluation aimed to (a) gauge students&#x2019; awareness of research activities, (b) compare students&#x2019; perceptions of their transferable and research-specific skills competencies, (c) determine students&#x2019; motivation for research and (d) obtain students&#x2019; personal views on doing research. Methods: Undergraduate medical students (N=317) completed a research skills questionnaire developed by the Centre for Excellence in Teaching and Learning in Applied Undergraduate Research Skills (CETL-AURS) at Reading University. The questionnaire assessed students&#x2019; transferable skills, research-specific skills (e.g., study design, data collection and data analysis), research experience and attitude and motivation towards doing research. Results: The majority of students are motivated to pursue research. Graduate entrants and male students appear to be the most confident regarding their research skills competencies. Although all students recognise the role of research in medical practice, many are unaware of the medical research activities or successes within their university. Of those who report no interest in a career incorporating research, a common perception was that researchers are isolated from patients and clinical practice. Discussion: Students have a narrow definition of research and what it entails. An explanation for why research competence does not align more closely with research motivation is derived from students&#x2019; lack of understanding of the concept of translational research, as well as a lack of awareness of the research activity being undertaken by their teachers and mentors. We plan to address this with specific research awareness initiatives