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BACKGROUND: Numerous military soldiers have lost limbs as a result of the Syrian War. While there are variations between trauma-related amputations in military and civilian populations, both scenarios result in life-changing injuries. OBJECTIVE: To explore the relationship between body image, self-esteem, and quality of life (QOL) domains following trauma-related major amputation. It will be the first study in Syria on the correlation between self-esteem and body image. It will help improve our quality of care to meet patient needs and increase well-being, which in turn will help to address body image, self-esteem, and QOL. METHOD: A cross-sectional study that recruited 235 soldiers with amputations in two centers and two military hospitals in Latakia and Tartous. Patients were given an 81-item questionnaire that included the Amputee Body-Image Scale (ABIS), the Rosenberg Self-esteem (RSE) scale, the WHOQOL-BREF questionnaire, and unidimensional pain measures. The ANOVA test, a student's t-test, multiple linear regression, internal consistency, and test-retest reliability were utilized for statistical analysis. RESULTS: There was a strong relationship between body image, self-esteem, and QOL, with the presence of body image concerns significantly associated with lower self-esteem scores and lower QOL scores (p=0.001). Patients with phantom pain sensation had significantly reduced self-esteem (p =0.001), greater body image concerns (p =0.001), and lower scores in all domains of QOL. We found that body image and self-esteem impacted the psychological, social, and environmental domains. After controlling for pain level and number of co-morbid conditions, body image and self-esteem did not predict WHOQOL-BREF scores, with the exception of the environmental domain, where no pain and low self-esteem predicted better environmental domain scores. CONCLUSION: Patients' body image and self-esteem were greatly impacted by lower-limb amputations. Additionally, phantom pain further impacted self-esteem, body image, and QOL. The image of the body had a profound effect on psychological, social, and environmental domains, and self-esteem was influenced by almost all aspects of QOL.
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Imagen Corporal , Calidad de Vida , Autoimagen , Humanos , Imagen Corporal/psicología , Calidad de Vida/psicología , Masculino , Estudios Transversales , Adulto , Siria , Femenino , Encuestas y Cuestionarios , Amputados/psicología , Personal Militar/psicologíaRESUMEN
Skin identity is controlled by intrinsic features of the epidermis and dermis and their interactions. Modifying skin identity has clinical potential, such as the conversion of residual limb and stump (nonvolar) skin of amputees to pressure-responsive palmoplantar (volar) skin to enhance prosthesis use and minimize skin breakdown. Greater keratin 9 (KRT9) expression, higher epidermal thickness, keratinocyte cytoplasmic size, collagen length, and elastin are markers of volar skin and likely contribute to volar skin resiliency. Given fibroblasts' capacity to modify keratinocyte differentiation, we hypothesized that volar fibroblasts influence these features. Bioprinted skin constructs confirmed the capacity of volar fibroblasts to induce volar keratinocyte features. A clinical trial of healthy volunteers demonstrated that injecting volar fibroblasts into nonvolar skin increased volar features that lasted up to 5 months, highlighting a potential cellular therapy.
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Refuerzo Biomédico , Bioimpresión , Dermis , Epidermis , Fibroblastos , Queratinocitos , Adulto , Femenino , Humanos , Masculino , Amputados , Diferenciación Celular , Colágeno/metabolismo , Dermis/citología , Dermis/metabolismo , Elastina/metabolismo , Epidermis/metabolismo , Fibroblastos/citología , Fibroblastos/trasplante , Mano , Queratina-9/metabolismo , Queratinocitos/citología , Queratinocitos/metabolismo , Refuerzo Biomédico/métodosRESUMEN
The loss of a hand disrupts the sophisticated neural pathways between the brain and the hand, severely affecting the level of independence of the patient and the ability to carry out daily work and social activities. Recent years have witnessed a rapid evolution of surgical techniques and technologies aimed at restoring dexterous motor functions akin to those of the human hand through bionic solutions, mainly relying on probing of electrical signals from the residual nerves and muscles. Here, we report the clinical implementation of an interface aimed at achieving this goal by exploiting muscle deformation, sensed through passive magnetic implants: the myokinetic interface. One participant with a transradial amputation received an implantation of six permanent magnets in three muscles of the residual limb. A truly self-contained myokinetic prosthetic arm embedding all hardware components and the battery within the prosthetic socket was developed. By retrieving muscle deformation caused by voluntary contraction through magnet localization, we were able to control in real time a dexterous robotic hand following both a direct control strategy and a pattern recognition approach. In just 6 weeks, the participant successfully completed a series of functional tests, achieving scores similar to those achieved when using myoelectric controllers, a standard-of-care solution, with comparable physical and mental workloads. This experience raised conceptual and technical limits of the interface, which nevertheless pave the way for further investigations in a partially unexplored field. This study also demonstrates a viable possibility for intuitively interfacing humans with robotic technologies.
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Amputados , Miembros Artificiales , Fuerza de la Mano , Imanes , Diseño de Prótesis , Robótica , Humanos , Amputados/rehabilitación , Fuerza de la Mano/fisiología , Robótica/instrumentación , Masculino , Músculo Esquelético/fisiología , Extremidad Superior , Mano/fisiología , Adulto , Electromiografía , Muñones de Amputación/fisiopatología , Contracción Muscular/fisiología , Implantación de PrótesisRESUMEN
BACKGROUND: Commercially available osseointegrated devices for transfemoral amputees are limited in size and thus fail to meet the significant anatomical variability in the femoral medullary canal. This study aimed to develop a customized osseointegrated stem to better accommodate a variety of femoral anatomies in transfemoral amputees than off-the-shelf stems. Customization is expected to enhance cortical bone preservation and increase the stem-bone contact area, which are critical for the long-term stability and success of implants. METHODS: A customized stem (OsteoCustom) was designed based on the statistical shape variability of the medullary canal. The implantability of the OsteoCustom stem was tested via 70 computed tomography (CT) images of human femurs and compared to that of a commercial device (OFI-C) for two different resection levels. The evaluations included the volume of cortical bone removed and the percentage of stem-bone contact area for both resection levels. Statistical significance was analyzed using paired and unpaired t tests. RESULTS: The OsteoCustom stem could be virtually implanted in all 70 femurs, while the OFI-C was unsuitable in 19 cases due to insufficient cortical thickness after implantation, further emphasizing its adaptability to varying anatomical conditions. The OsteoCustom stem preserved a greater volume of cortical bone than did the OFI-C. In fact, 42% less bone was removed at the proximal resection level (3.15 cm³ vs. 5.42 cm³, p ≤ 0.0001), and 33% less at the distal resection level (2.25 cm³ vs. 3.39 cm³, p = 0.003). The stem-bone contact area was also greater for the OsteoCustom stem, particularly at the distal resection level, showing a 20% increase in contact area (52.3% vs. 32.2%, p = 0.002) compared to that of the OFI-C. CONCLUSIONS: The OsteoCustom stem performed better than the commercial stem by preserving more cortical bone and achieving a greater stem-bone contact area, especially at distal resection levels where the shape of the medullary canal exhibits more inter-subject variability. Optimal fit in the distal region is of paramount importance for ensuring the stability of osseointegrated implants. This study highlights the potential benefits of customized osseointegrated stems in accommodating a broader range of femoral anatomies, with enhanced fit in the medullary canal.
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Amputados , Prótesis Anclada al Hueso , Fémur , Oseointegración , Diseño de Prótesis , Humanos , Fémur/cirugía , Fémur/diagnóstico por imagen , Masculino , Oseointegración/fisiología , Femenino , Persona de Mediana Edad , Adulto , Anciano , Miembros Artificiales , Tomografía Computarizada por Rayos X , Implantación de Prótesis/métodos , Adulto JovenRESUMEN
BACKGROUND: Eye tracking technology not only reveals the acquisition of visual information at fixation but also has the potential to unveil underlying cognitive processes involved in learning to use a multifunction prosthetic hand. It also reveals gaze behaviours observed during standardized tasks and self-chosen tasks. The aim of the study was to explore the use of eye tracking to track learning progress of multifunction hands at two different time points in prosthetic rehabilitation. METHODS: Three amputees received control training of a multifunction hand with new control strategy. Detailed description of control training was collected first. They wore Tobii Pro2 eye-tracking glasses and performed a set of standardized tasks (required to switch to different grips for each task) after one day of training and at one-year-follow-up (missing data for Subject 3 at the follow up due to socket problem). They also performed a self-chosen task (free to use any grip for any object) and were instructed to perform the task in a way how they would normally do at home. The gaze-overlaid videos were analysed using the Tobii Pro Lab and the following metrics were extracted: fixation duration, saccade amplitude, eye-hand latency, fixation count and time to first fixation. RESULTS: During control training, the subjects learned 3 to 4 grips. Some grips were easier, and others were more difficult because they forgot or were confused with the switching strategies. At the one-year-follow-up, a decrease in performance time, fixation duration, eye-hand latency, and fixation count was observed in Subject 1 and 2, indicating an improvement in the ability to control the multifunction hand and a reduction of cognitive load. An increase in saccade amplitude was observed in both subjects, suggesting a decrease in difficulty to control the prosthetic hand. During the standardized tasks, the first fixation of all three subjects were on the multifunction hand in all objects. During the self-chosen tasks, the first fixations were mostly on the objects first. CONCLUSION: The qualitative data from control training and the quantitative eye tracking data from clinical standardized tasks provided a rich exploration of cognitive processing in learning to control a multifunction hand. Many prosthesis users prefer multifunction hands and with this study we have demonstrated that a targeted prosthetic training protocol with reliable assessment methods will help to lay the foundation for measuring functional benefits of multifunction hands.
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Miembros Artificiales , Tecnología de Seguimiento Ocular , Mano , Aprendizaje , Humanos , Masculino , Mano/fisiología , Adulto , Amputados/rehabilitación , Persona de Mediana Edad , Femenino , Fijación Ocular/fisiología , Desempeño Psicomotor/fisiologíaRESUMEN
Motion analysis has played a crucial role in providing gait analysis for prosthetic users. Understanding kinematics in motion analysis allows for the evaluation of the effects of prostheses and the development of a prosthetic component design that aids in walking within the community. However, there are currently limited open datasets available to study the locomotion of individuals using transtibial prostheses, and most research studies involve a limited number of participants. This dataset shows 30 transtibial prosthesis users walking comfortably on a 10-meter walkway inside a laboratory. We offer a set of joint ankles obtained from the inertial measurement unit (IMU) signals in CSV file format. We also provide the optical motion capture (OMC) system's raw trajectory marker data in C3D file format and joint angle in CSV file format. This open dataset will provide resources for professionals interested in amputee gait for research in amputee gait detection and tracking algorithms. Moreover, the data will be the control data for comparison in developing advanced prosthetic components.
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Miembros Artificiales , Marcha , Humanos , Fenómenos Biomecánicos , Amputados , Caminata , MasculinoRESUMEN
OBJECTIVE: To explore cognitive load in people with transfemoral amputations fitted with socket or bone-anchored prostheses by describing activity in the left and right dorsolateral prefrontal cortices during single- and dual-task walking. DESIGN: Cross-sectional pilot study. PATIENTS: 8 socket prosthesis users and 8 bone-anchored prosthesis users. All were fitted with microprocessor-controlled prosthetic knees. METHODS: Participants answered self-report questionnaires and performed gait tests during 1 single-task walking condition and 2 dual-task walking conditions. While walking, activity in the dorsolateral prefrontal cortex was measured using functional near-infrared spectroscopy. Cognitive load was investigated for each participant by exploring the relative concentration of oxygenated haemoglobin in the left and right dorsolateral prefrontal cortex. Symmetry of brain activity was investigated by calculating a laterality index. RESULTS: Self-report measures and basic gait variables did not show differences between the groups. No obvious between-group differences were observed in the relative concentration of oxygenated haemoglobin for any walking condition. There was a tendency towards more right-side brain activity for participants using a socket prosthesis during dual-task conditions. CONCLUSIONS: This pilot study did not identify substantial differences in cognitive load or lateralization between socket prosthesis users and bone-anchored prosthesis users.
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Miembros Artificiales , Cognición , Caminata , Humanos , Proyectos Piloto , Masculino , Persona de Mediana Edad , Estudios Transversales , Femenino , Caminata/fisiología , Cognición/fisiología , Adulto , Anciano , Fémur/cirugía , Amputación Quirúrgica/rehabilitación , Diseño de Prótesis , Prótesis Anclada al Hueso , Corteza Prefrontal/fisiopatología , Amputados/rehabilitación , Amputados/psicología , Espectroscopía Infrarroja Corta , Marcha/fisiologíaRESUMEN
Individuals with transtibial amputation can activate residual limb muscles to volitionally control robotic ankle prostheses for walking and postural control. Most continuous myoelectric ankle prostheses have used a tethered, pneumatic device. The Open Source Leg allows for myoelectric control on an untethered electromechanically actuated ankle. To evaluate continuous proportional myoelectric control on the Open Source Ankle, we recruited five individuals with transtibial amputation. Participants walked over ground with an experimental powered prosthesis and their prescribed passive prosthesis before and after multiple powered device practice sessions. Participants averaged five hours of total walking time. After the final testing session, participants indicated their prosthesis preference via questionnaire. Participants tended to increase peak ankle power after practice (powered 0.80 ± 1.02 W/kg and passive 0.39 ± 0.31 W/kg). Additionally, participants tended to generate greater ankle work with the powered prosthesis compared to their passive device ( 0.13 ± .15 J/kg increase). Although work and peak power generation were not statistically different between the two prostheses, participants preferred walking with the prosthesis under myoelectric control compared to the passive prosthesis. These results indicate individuals with transtibial amputation learned to walk with an untethered powered prosthesis under continuous myoelectric control. Four out 5 participants generated larger magnitudes in peak power compared to their passive prosthesis after practice sessions. An additional important finding was participants chose to walk with peak ankle powers about half of what the powered prosthesis was capable of based on mechanical testing.
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Amputación Quirúrgica , Miembros Artificiales , Biónica , Electromiografía , Diseño de Prótesis , Caminata , Humanos , Masculino , Caminata/fisiología , Femenino , Fenómenos Biomecánicos , Adulto , Persona de Mediana Edad , Amputación Quirúrgica/rehabilitación , Tobillo , Tibia/cirugía , Robótica , Amputados/rehabilitación , Articulación del TobilloRESUMEN
Most of current prostheses can offer motor function restoration for limb amputees but usually lack natural and intuitive sensory feedback. Many studies have demonstrated that Transcutaneous Electrical Nerve Stimulation (TENS) is promising in non-invasive sensation evoking for amputees. However, the objective evaluation and mechanism analysis on sensation feedback are still limited. This work utilized multi-channel TENS with diverse stimulus patterns to evoke sensations on four non-disabled subjects and two transradial amputees. Meanwhile, electroencephalogram (EEG) was collected to objectively assess the evoked sensations, where event-related potentials (ERPs), brain electrical activity maps (BEAMs), and functional connectivity (FC) were computed. The results show that various sensations could be successfully evoked for both amputees and non-disabled subjects by customizing stimulus parameters. The ERP confirmed the sensation and revealed the sensory-processing-related components like N100 and P200; the BEAMs confirmed the corresponding regions of somatosensory cortex were activated by stimulation; the FC indicated an increase of interactions between the regions of sensorimotor cortex. This study may shed light on how the brain responds to external stimulation as sensory feedback and serve as a pilot for further bidirectional closed-loop prosthetic control.
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Amputados , Electroencefalografía , Corteza Somatosensorial , Estimulación Eléctrica Transcutánea del Nervio , Humanos , Electroencefalografía/métodos , Estimulación Eléctrica Transcutánea del Nervio/métodos , Amputados/rehabilitación , Masculino , Adulto , Corteza Somatosensorial/fisiología , Femenino , Tacto/fisiología , Retroalimentación Sensorial/fisiología , Potenciales Evocados/fisiología , Corteza Sensoriomotora/fisiología , Persona de Mediana Edad , Potenciales Evocados Somatosensoriales/fisiología , Adulto JovenRESUMEN
Upper limb amputation severely affects the quality of life of individuals. Therefore, developing closed-loop upper-limb prostheses would enhance the sensory-motor capabilities of the prosthetic user. Considering design priorities based on user needs, the restoration of sensory feedback is one of the most desired features. This study focuses on employing Transcutaneous Electrical Nerve Stimulation (TENS) as a non-invasive somatotopic stimulation technique for restoring somatic sensations in upper-limb amputees. The aim of this study is to propose two encoding strategies to elicit force and slippage sensations in transradial amputees. The former aims at restoring three different levels of force through a Linear Pulse Amplitude Modulation (LPAM); the latter is devoted to elicit slippage sensations through Apparent Moving Sensation (AMS) by means of three different algorithms, i.e. the Pulse Amplitude Variation (PAV), the Pulse Width Variation (PWV) and Inter-Stimulus Delay Modulation (ISDM). Amputees had to characterize perceived sensations and to perform force and slippage recognition tasks. Results demonstrates that amputees were able to correctly identify low, medium and high levels of force, with an accuracy above the 80% and similarly, to also discriminate the slippage moving direction with a high accuracy above 90%, also highlighting that ISDM would be the most suitable method, among the three AMS strategies to deliver slippage sensations. It was demonstrated for the first time that the developed encoding strategies are effective methods to somatotopically reintroduce in the amputees, by means of TENS, force and slippage sensations.
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Amputados , Miembros Artificiales , Estimulación Eléctrica Transcutánea del Nervio , Humanos , Estimulación Eléctrica Transcutánea del Nervio/métodos , Amputados/rehabilitación , Masculino , Persona de Mediana Edad , Adulto , Algoritmos , Extremidad Superior , Femenino , Retroalimentación Sensorial , Diseño de PrótesisRESUMEN
INTRODUCTION: Approximately 89% of all service members with amputations do not return to duty. Restoring intuitive neural control with somatosensory sensation is a key to improving the safety and efficacy of prosthetic locomotion. However, natural somatosensory feedback from lower-limb prostheses has not yet been incorporated into any commercial prostheses. MATERIALS AND METHODS: We developed a neuroprosthesis with intuitive bidirectional control and somatosensation and evoking phase-dependent locomotor reflexes, we aspire to significantly improve the prosthetic rehabilitation and long-term functional outcomes of U.S. amputees. We implanted the skin and bone integrated pylon with peripheral neural interface pylon into the cat distal tibia, electromyographic electrodes into the residual gastrocnemius muscle, and nerve cuff electrodes on the distal tibial and sciatic nerves. Results. The bidirectional neural interface that was developed was integrated into the existing passive Free-Flow Foot and Ankle prosthesis, WillowWood, Mount Sterling, OH. The Free-Flow Foot was chosen because it had the highest Index of Anthropomorphicity among lower-limb prostheses and was the first anthropomorphic prosthesis brought to market. Conclusion. The cats walked on a treadmill with no cutaneous feedback from the foot in the control condition and with their residual distal tibial nerve stimulated during the stance phase of walking.
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Miembros Artificiales , Diseño de Prótesis , Miembros Artificiales/estadística & datos numéricos , Animales , Diseño de Prótesis/métodos , Gatos , Pie/fisiología , Pie/fisiopatología , Amputados/rehabilitación , Electromiografía/métodos , Electromiografía/instrumentación , Biónica/métodos , Biónica/instrumentación , Caminata/fisiología , Caminata/estadística & datos numéricos , HumanosRESUMEN
Pattern recognition (PR)-based myoelectric control systems can naturally provide multifunctional and intuitive control of upper limb prostheses and restore lost limb function, but understanding their robustness remains an open scientific question. This study investigates how limb positions and electrode shifts-two factors that have been suggested to cause classification deterioration-affect classifiers' performance by quantifying changes in the class distribution using each factor as a class and computing the repeatability and modified separability indices. Ten intact-limb participants took part in the study. Linear discriminant analysis (LDA) was used as the classifier. The results confirmed previous studies that limb positions and electrode shifts deteriorate classification performance (14-21% decrease) with no difference between factors (p > 0.05). When considering limb positions and electrode shifts as classes, we could classify them with an accuracy of 96.13 ± 1.44% and 65.40 ± 8.23% for single and all motions, respectively. Testing on five amputees corroborated the above findings. We have demonstrated that each factor introduces changes in the feature space that are statistically new class instances. Thus, the feature space contains two statistically classifiable clusters when the same motion is collected in two different limb positions or electrode shifts. Our results are a step forward in understanding PR schemes' challenges for myoelectric control of prostheses and further validation needs be conducted on more amputee-related datasets.
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Amputados , Miembros Artificiales , Electrodos , Electromiografía , Reconocimiento de Normas Patrones Automatizadas , Humanos , Electromiografía/métodos , Masculino , Adulto , Reconocimiento de Normas Patrones Automatizadas/métodos , Amputados/rehabilitación , Femenino , Análisis Discriminante , Adulto Joven , Extremidades/fisiologíaRESUMEN
Functional mobility tests, such as the L test of functional mobility, are recommended to provide clinicians with information regarding the mobility progress of lower-limb amputees. Smartphone inertial sensors have been used to perform subtask segmentation on functional mobility tests, providing further clinically useful measures such as fall risk. However, L test subtask segmentation rule-based algorithms developed for able-bodied individuals have not produced sufficiently acceptable results when tested with lower-limb amputee data. In this paper, a random forest machine learning model was trained to segment subtasks of the L test for application to lower-limb amputees. The model was trained with 105 trials completed by able-bodied participants and 25 trials completed by lower-limb amputee participants and tested using a leave-one-out method with lower-limb amputees. This algorithm successfully classified subtasks within a one-foot strike for most lower-limb amputee participants. The algorithm produced acceptable results to enhance clinician understanding of a person's mobility status (>85% accuracy, >75% sensitivity, >95% specificity).
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Amputados , Extremidad Inferior , Aprendizaje Automático , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Amputados/rehabilitación , Extremidad Inferior/cirugía , Extremidad Inferior/fisiopatología , Extremidad Inferior/fisiología , Bosques AleatoriosRESUMEN
Phantom limb pain, a common challenge for amputees, lacks effective treatment options. Vibration therapy is a promising non-pharmacologic intervention for reducing pain intensity, but its efficacy in alleviating phantom limb pain requires further investigation. This study focused on developing prosthesis liners with integrated vibration motors to administer vibration therapy for phantom limb pain. The prototypes developed for this study addressed previous issues with wiring the electronic components. Two transfemoral amputees participated in a four-week at-home trial, during which they used the vibration liner and rated their initial and final pain intensity on a numeric rating scale each time they had phantom pain. Semi-structured interviews were conducted to gather feedback following the at-home trial. Both participants described relaxing and soothing sensations in their residual limb and phantom limb while using vibration therapy. One participant reported a relaxation of his phantom limb sensations, while both participants noted a decrease in the intensity of their phantom limb pain. Participants said the vibration liners were comfortable but suggested that the vibration could be stronger and that aligning the contacts could be easier. The results of this study highlight the potential effectiveness of using vibration therapy to reduce the intensity of phantom limb pain and suggest a vibration liner may be a feasible mode of administering the therapy. Future research should address optimizing the performance of the vibration liners to maximize their therapeutic benefits.
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Amputados , Miembro Fantasma , Robótica , Vibración , Humanos , Miembro Fantasma/terapia , Vibración/uso terapéutico , Amputados/rehabilitación , Masculino , Robótica/métodos , Robótica/instrumentación , Persona de Mediana Edad , Miembros Artificiales , Adulto , FemeninoRESUMEN
The ability of a novel biorealistic hand prosthesis for grasp force control reveals improved neural compatibility between the human-prosthetic interaction. The primary purpose here was to validate a virtual training platform for amputee subjects and evaluate the respective roles of visual and tactile information in fundamental force control tasks. We developed a digital twin of tendon-driven prosthetic hand in the MuJoCo environment. Biorealistic controllers emulated a pair of antagonistic muscles controlling the index finger of the virtual hand by surface electromyographic (sEMG) signals from amputees' residual forearm muscles. Grasp force information was transmitted to amputees through evoked tactile sensation (ETS) feedback. Six forearm amputees participated in force tracking and holding tasks under different feedback conditions or using their intact hands. Test results showed that visual feedback played a predominant role than ETS feedback in force tracking and holding tasks. However, in the absence of visual feedback during the force holding task, ETS feedback significantly enhanced motor performance compared to feedforward control alone. Thus, ETS feedback still supplied reliable sensory information to facilitate amputee's ability of stable grasp force control. The effects of tactile and visual feedback on force control were subject-specific when both types of feedback were provided simultaneously. Amputees were able to integrate visual and tactile information to the biorealistic controllers and achieve a good sensorimotor performance in grasp force regulation. The virtual platform may provide a training paradigm for amputees to adapt the biorealistic hand controller and ETS feedback optimally.
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Amputados , Miembros Artificiales , Electromiografía , Retroalimentación Sensorial , Fuerza de la Mano , Mano , Diseño de Prótesis , Humanos , Retroalimentación Sensorial/fisiología , Masculino , Fuerza de la Mano/fisiología , Mano/fisiología , Adulto , Femenino , Persona de Mediana Edad , Tacto/fisiología , Músculo Esquelético/fisiología , Desempeño Psicomotor/fisiología , Antebrazo/fisiología , Fenómenos Biomecánicos , Tendones/fisiologíaRESUMEN
BACKGROUND: Closing the control loop between users and their prostheses by providing artificial sensory feedback is a fundamental step toward the full restoration of lost sensory-motor functions. METHODS: We propose a novel approach to provide artificial proprioceptive feedback about two degrees of freedom using a single array of 8 vibration motors (compact solution). The performance afforded by the novel method during an online closed-loop control task was compared to that achieved using the conventional approach, in which the same information was conveyed using two arrays of 8 and 4 vibromotors (one array per degree of freedom), respectively. The new method employed Gaussian interpolation to modulate the intensity profile across a single array of vibration motors (compact feedback) to convey wrist rotation and hand aperture by adjusting the mean and standard deviation of the Gaussian, respectively. Ten able-bodied participants and four transradial amputees performed a target achievement control test by utilizing pattern recognition with compact and conventional vibrotactile feedback to control the Hannes prosthetic hand (test conditions). A second group of ten able-bodied participants performed the same experiment in control conditions with visual and auditory feedback as well as no-feedback. RESULTS: Conventional and compact approaches resulted in similar positioning accuracy, time and path efficiency, and total trial time. The comparison with control condition revealed that vibrational feedback was intuitive and useful, but also underlined the power of incidental feedback sources. Notably, amputee participants achieved similar performance to that of able-bodied participants. CONCLUSIONS: The study therefore shows that the novel feedback strategy conveys useful information about prosthesis movements while reducing the number of motors without compromising performance. This is an important step toward the full integration of such an interface into a prosthesis socket for clinical use.
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Miembros Artificiales , Retroalimentación Sensorial , Mano , Propiocepción , Vibración , Muñeca , Humanos , Retroalimentación Sensorial/fisiología , Propiocepción/fisiología , Adulto , Masculino , Muñeca/fisiología , Femenino , Mano/fisiología , Amputados/rehabilitación , Rotación , Adulto Joven , Persona de Mediana Edad , Tacto/fisiologíaRESUMEN
Sensory feedback provides critical interactive information for the effective use of hand prostheses. Non-invasive neural interfaces allow convenient access to the sensory system, but they communicate a limited amount of sensory information. This study examined a novel approach that leverages a direct and natural sensory afferent pathway, and enables an evoked tactile sensation (ETS) of multiple digits in the projected finger map (PFM) of participants with forearm amputation non-invasively. A bidirectional prosthetic interface was constructed by integrating the non-invasive ETS-based feedback system into a commercial prosthetic hand. The pressure information of five fingers was encoded linearly by the pulse width modulation range of the buzz sensation. We showed that simultaneous perception of multiple digits allowed participants with forearm amputation to identify object length and compliance by using information about contact patterns and force intensity. The ETS enhanced the grasp-and-transport performance of participants with and without prior experience of prosthetic use. The functional test of transport-and-identification further revealed improved execution in classifying object size and compliance using ETS-based feedback. Results demonstrated that the ETS is capable of communicating somatotopically compatible information to participants efficiently, and improves sensory discrimination and closed-loop prosthetic control. This non-invasive sensory interface may establish a viable way to restore sensory ability for prosthetic users who experience the phenomenon of PFM.
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Miembros Artificiales , Retroalimentación Sensorial , Dedos , Diseño de Prótesis , Tacto , Estimulación Eléctrica Transcutánea del Nervio , Humanos , Masculino , Estimulación Eléctrica Transcutánea del Nervio/métodos , Adulto , Retroalimentación Sensorial/fisiología , Dedos/fisiología , Dedos/inervación , Femenino , Tacto/fisiología , Fuerza de la Mano/fisiología , Antebrazo/inervación , Amputados , Adulto Joven , Percepción del Tacto/fisiología , Desempeño Psicomotor/fisiología , ManoRESUMEN
Lower limb amputation is a medical intervention which causes motor disability and may compromise quality of life. Several factors determine patients' health outcomes, including an appropriate prosthetic provision and an effective rehabilitation program, necessitating a thorough quantitative observation through different data sources. In this context, the role of interoperability becomes essential, facilitating the reuse of real-world data through the provision of structured and easily accessible databases. This study introduces a comprehensive 10-year dataset encompassing clinical features, mobility measurements, and prosthetic knees of 1006 trans-femoral amputees during 1962 hospital stays for rehabilitation. The dataset is made available in both comma-separated values (CSV) format and HL7 Fast Healthcare Interoperability Resources (FHIR)-based representation, ensuring broad utility and compatibility for researchers and healthcare practitioners. This initiative contributes to advancing community understanding of post-amputation rehabilitation and underscores the significance of interoperability in promoting seamless data sharing for meaningful insights into healthcare outcomes.
Asunto(s)
Amputación Quirúrgica , Humanos , Amputación Quirúrgica/rehabilitación , Miembros Artificiales , Amputados/rehabilitación , Fémur/cirugía , Recolección de DatosRESUMEN
Transfemoral amputation is a debilitating condition that leads to long-term mobility restriction and secondary disorders that negatively affect the quality of life of millions of individuals worldwide. Currently available prostheses are not able to restore energetically efficient and functional gait, thus, recently, the alternative strategy to inject energy at the residual hip has been proposed to compensate for the lack of energy of the missing leg. Here, we show that a portable and powered hip exoskeleton assisting both the residual and intact limb induced a reduction of walking energy expenditure in four individuals with above-knee amputation. The reduction of the energy expenditure, quantified using the Physiological Cost Index, was in the range [-10, -17]% for all study participants compared to walking without assistance, and between [-2, -24]% in three out of four study participants compared to walking without the device. Additionally, all study participants were able to walk comfortably and confidently with the hip exoskeleton overground at both their self-selected comfortable and fast speed without any observable alterations in gait stability. The study findings confirm that injecting energy at the hip level is a promising approach for individuals with above-knee amputation. By reducing the energy expenditure of walking and facilitating gait, a hip exoskeleton may extend mobility and improve locomotor training of individuals with above-knee amputation, with several positive implications for their quality of life.
Asunto(s)
Amputación Quirúrgica , Amputados , Miembros Artificiales , Metabolismo Energético , Dispositivo Exoesqueleto , Cadera , Caminata , Humanos , Caminata/fisiología , Masculino , Adulto , Amputación Quirúrgica/rehabilitación , Amputados/rehabilitación , Persona de Mediana Edad , Marcha/fisiología , Femenino , Fenómenos Biomecánicos , Diseño de Prótesis , RodillaRESUMEN
Limb amputation can lead to significant functional challenges in daily activities, prompting amputees to use prosthetic devices (PDs). However, the cognitive demands of PDs and usability issues have resulted in user rejections. This study aimed to create a Human Performance Model for Upper-Limb Prosthetic Devices (HPM-UP). The model used formulations of learnability, error rate, memory load, efficiency, and satisfaction to assess usability. The model was validated in an experiment with 30 healthy participants using a bypass prosthetic device. Findings indicated that the HPM-UP successfully predicted the usability of prosthetic devices, aligning with human subject data. This research proposes a quantitative approach to predict upper limb prosthetic device usability by quantifying each dimension and computationally connecting them. The model, available on Github and executable with Rstudio, could enable clinicians to assess and analyze the human performance of various commercial prostheses, aiding in recommending optimal devices for patients.