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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. [ABSTRACT FROM AUTHOR]

Background: Restorative Brain–Computer Interfaces (BCI) that combine motor imagery with visual feedback and functional electrical stimulation (FES) may offer much-needed treatment alternatives for patients with severely impaired upper limb (UL) function after a stroke. Objectives: This study aimed to examine if BCI-based training, combining motor imagery with FES targeting finger/wrist extensors, is more effective in improving severely impaired UL motor function than conventional therapy in the subacute phase after stroke, and if patients with preserved cortical-spinal tract (CST) integrity benefit more from BCI training. Methods: Forty patients with severe UL paresis (< 13 on Action Research Arm Test (ARAT) were randomized to either a 12-session BCI training as part of their rehabilitation or conventional UL rehabilitation. BCI sessions were conducted 3–4 times weekly for 3–4 weeks. At baseline, Transcranial Magnetic Stimulation (TMS) was performed to examine CST integrity. The main endpoint was the ARAT at 3 months post-stroke. A binominal logistic regression was conducted to examine the effect of treatment group and CST integrity on achieving meaningful improvement. In the BCI group, electroencephalographic (EEG) data were analyzed to investigate changes in event-related desynchronization (ERD) during the course of therapy. Results: Data from 35 patients (15 in the BCI group and 20 in the control group) were analyzed at 3-month follow-up. Few patients (10/35) improved above the minimally clinically important difference of 6 points on ARAT, 5/15 in the BCI group, 5/20 in control. An independent-samples Mann–Whitney U test revealed no differences between the two groups, p = 0.382. In the logistic regression only CST integrity was a significant predictor for improving UL motor function, p = 0.007. The EEG analysis showed significant changes in ERD of the affected hemisphere and its lateralization only during unaffected UL motor imagery at the end of the therapy. Conclusion: This is the first RCT examining BCI training in the subacute phase where only patients with severe UL paresis were included. Though more patients in the BCI group improved relative to the group size, the difference between the groups was not significant. In the present study, preserved CTS integrity was much more vital for UL improvement than which type of intervention the patients received. Larger studies including only patients with some preserved CST integrity should be attempted. [ABSTRACT FROM AUTHOR]

Background: Closing the control loop in myoelectric prostheses by providing artificial somatosensory feedback is recognized as an important goal. However, designing a feedback interface that is effective in realistic conditions is still a challenge. Namely, in some situations, feedback can be redundant, as the information it provides can be readily obtained through hearing or vision (e.g., grasping force estimated from the deformation of a compliant object). EMG feedback is a non-invasive method wherein the tactile stimulation conveys to the user the level of their own myoelectric signal, hence a measurement intrinsic to the interface, which cannot be accessed incidentally. Methods: The present study investigated the efficacy of EMG feedback in prosthesis force control when 10 able-bodied participants and a person with transradial amputation used a myoelectric prosthesis to grasp compliant objects of different stiffness values. The performance with feedback was compared to that achieved when the participants relied solely on incidental cues. Results: The main outcome measures were the task success rate and completion time. EMG feedback resulted in significantly higher success rates regardless of pin stiffness, indicating that the feedback enhanced the accuracy of force application despite the abundance of incidental cues. Contrary to expectations, there was no difference in the completion time between the two feedback conditions. Additionally, the data revealed that the participants could produce smoother control signals when they received EMG feedback as well as more consistent commands across trials, signifying better control of the system by the participants. Conclusions: The results presented in this study further support the efficacy of EMG feedback when closing the prosthesis control loop by demonstrating its benefits in particularly challenging conditions which maximized the utility of intrinsic feedback sources. [ABSTRACT FROM AUTHOR]

Background: One of the drawbacks of lower-limb prostheses is that they do not provide explicit somatosensory feedback to their users. Electrotactile stimulation is an attractive technology to restore such feedback because it enables compact solutions with multiple stimulation points. This allows stimulating a larger skin area to provide more information concurrently and modulate parameters spatially as well as in amplitude. However, for effective use, electrotactile stimulation needs to be calibrated and it would be convenient to perform this procedure while the subject is seated. However, amplitude and spatial perception can be affected by motion and/or physical coupling between the residual limb and the socket. In the present study, we therefore evaluated and compared the psychometric properties of multichannel electrotactile stimulation applied to the thigh/residual limb during sitting versus walking. Methods: The comprehensive assessment included the measurement of the sensation and discomfort thresholds (ST & DT), just noticeable difference (JND), number of distinct intervals (NDI), two-point discrimination threshold (2PD), and spatial discrimination performance (SD). The experiment involved 11 able-bodied participants (4 females and 7 males; 29.2 ± 3.8 years), 3 participants with transtibial amputation, and 3 participants with transfemoral amputation. Results: In able-bodied participants, the results were consistent for all the measured parameters, and they indicated that both amplitude and spatial perception became worse during walking. More specifically, ST and DT increased significantly during walking vs. sitting (2.90 ± 0.82 mA vs. 2.00 ± 0.52 mA; p < 0.001 for ST and 7.74 ± 0.84 mA vs. 7.21 ± 1.30 mA; p < 0.05 for DT) and likewise for the JND (22.47 ± 12.21% vs. 11.82 ± 5.07%; p < 0.01), while the NDI became lower (6.46 ± 3.47 vs. 11.27 ± 5.18 intervals; p < 0.01). Regarding spatial perception, 2PD was higher during walking (69.78 ± 17.66 mm vs. 57.85 ± 14.87 mm; p < 0.001), while the performance of SD was significantly lower (56.70 ± 10.02% vs. 64.55 ± 9.44%; p < 0.01). For participants with lower-limb amputation, the ST, DT, and performance in the SD assessment followed the trends observed in the able-bodied population. The results for 2PD and JND were however different and subject-specific. Conclusion: The conducted evaluation demonstrates that electrotactile feedback should be calibrated in the conditions in which it will be used (e.g., during walking). The calibration during sitting, while more convenient, might lead to an overly optimistic (or in some cases pessimistic) estimate of sensitivity. In addition, the results underline that calibration is particularly important in people affected by lower-limb loss to capture the substantial variability in the conditions of the residual limb and prosthesis setup. These insights are important for the implementation of artificial sensory feedback in lower-limb prosthetics applications. [ABSTRACT FROM AUTHOR]

Background: The development of bionic legs has seen substantial improvements in the past years but people with lower-limb amputation still suffer from impairments in mobility (e.g., altered balance and gait control) due to significant limitations of the contemporary prostheses. Approaching the problem from a human-centered perspective by focusing on user-specific needs can allow identifying critical improvements that can increase the quality of life. While there are several reviews of user needs regarding upper limb prostheses, a comprehensive summary of such needs for those affected by lower limb loss does not exist.Methods: We have conducted a systematic review of the literature to extract important needs of the users of lower-limb prostheses. The review included 56 articles in which a need (desire, wish) was reported explicitly by the recruited people with lower limb amputation (N = 8149).Results: An exhaustive list of user needs was collected and subdivided into functional, psychological, cognitive, ergonomics, and other domain. Where appropriate, we have also briefly discussed the developments in prosthetic devices that are related to or could have an impact on those needs. In summary, the users would like to lead an independent life and reintegrate into society by coming back to work and participating in social and leisure activities. Efficient, versatile, and stable gait, but also support to other activities (e.g., sit to stand), contribute to safety and confidence, while appearance and comfort are important for the body image. However, the relation between specific needs, objective measures of performance, and overall satisfaction and quality of life is still an open question.Conclusions: Identifying user needs is a critical step for the development of new generation lower limb prostheses that aim to improve the quality of life of their users. However, this is not a simple task, as the needs interact with each other and depend on multiple factors (e.g., mobility level, age, gender), while evolving in time with the use of the device. Hence, novel assessment methods are required that can evaluate the impact of the system from a holistic perspective, capturing objective outcomes but also overall user experience and satisfaction in the relevant environment (daily life). [ABSTRACT FROM AUTHOR]

Background: Myoelectric control based on hand gesture classification can be used for effective, contactless human-machine interfacing in general applications (e.g., consumer market) as well as in the clinical context. However, the accuracy of hand gesture classification can be impacted by several factors including changing wrist position. The present study aimed at investigating how channel configuration (number and placement of electrode pads) affects performance in hand gesture recognition across wrist positions, with the overall goal of reducing the number of channels without the loss of performance with respect to the benchmark (all channels).Methods: Matrix electrodes (256 channels) were used to record high-density EMG from the forearm of 13 healthy subjects performing a set of 8 gestures in 3 wrist positions and 2 force levels (low and moderate). A reduced set of channels was chosen by applying sequential forward selection (SFS) and simple circumferential placement (CIRC) and used for gesture classification with linear discriminant analysis. The classification success rate and task completion rate were the main outcome measures for offline analysis across the different number of channels and online control using 8 selected channels, respectively.Results: The offline analysis demonstrated that good accuracy (> 90%) can be achieved with only a few channels. However, using data from all wrist positions required more channels to reach the same performance. Despite the targeted placement (SFS) performing similarly to CIRC in the offline analysis, the task completion rate [median (lower-upper quartile)] in the online control was significantly higher for SFS [71.4% (64.8-76.2%)] compared to CIRC [57.1% (51.8-64.8%), p < 0.01], especially for low contraction levels [76.2% (66.7-84.5%) for SFS vs. 57.1% (47.6-60.7%) for CIRC, p < 0.01]. For the reduced number of electrodes, the performance with SFS was comparable to that obtained when using the full matrix, while the selected electrodes were highly subject-specific.Conclusions: The present study demonstrated that the number of channels required for gesture classification with changing wrist positions could be decreased substantially without loss of performance, if those channels are placed strategically along the forearm and individually for each subject. The results also emphasize the importance of online assessment and motivate the development of configurable matrix electrodes with integrated channel selection. [ABSTRACT FROM AUTHOR]

Background: Despite important advancements in control and mechatronics of myoelectric prostheses, the communication between the user and his/her bionic limb is still unidirectional, as these systems do not provide somatosensory feedback. Electrotactile stimulation is an attractive technology to close the control loop since it allows flexible modulation of multiple parameters and compact interface design via multi-pad electrodes. However, the stimulation interferes with the recording of myoelectric signals and this can be detrimental to control.Methods: We present a novel compact solution for simultaneous recording and stimulation through dynamic blanking of stimulation artefacts. To test the system, a feedback coding scheme communicating wrist rotation and hand aperture was developed specifically to stress the myoelectric control while still providing meaningful information to the subjects. Ten subjects participated in an experiment, where the quality of closed-loop myoelectric control was assessed by controlling a cursor in a two degrees of freedom target-reaching task. The benchmark performance with visual feedback was compared to that achieved by combining visual feedback and electrotactile stimulation as well as by using electrotactile feedback only.Results: There was no significant difference in performance between visual and combined feedback condition with regards to successfully reached targets, time to reach a target, path efficiency and the number of overshoots. Therefore, the quality of myoelectric control was preserved in spite of the stimulation. As expected, the tactile condition was significantly poorer in completion rate (100/4% and 78/25% for combined and tactile condition, respectively) and time to reach a target (9/2 s and 13/4 s for combined and tactile condition, respectively). However, the performance in the tactile condition was still good, with no significant difference in path efficiency (38/8%) and the number of overshoots (0.5/0.4 overshoots), indicating that the stimulation was meaningful for the subjects and useful for closed-loop control.Conclusions: Overall, the results demonstrated that the developed system can provide robust closed-loop control using electrotactile stimulation. The system supports different encoding schemes and allows placing the recording and stimulation electrodes next to each other. This is an important step towards an integrated solution where the developed unit will be embedded into a prosthetic socket. [ABSTRACT FROM AUTHOR]

Background: Hand amputation can have a truly debilitating impact on the life of the affected person. A multifunctional myoelectric prosthesis controlled using pattern classification can be used to restore some of the lost motor abilities. However, learning to control an advanced prosthesis can be a challenging task, but virtual and augmented reality (AR) provide means to create an engaging and motivating training.Methods: In this study, we present a novel training framework that integrates virtual elements within a real scene (AR) while allowing the view from the first-person perspective. The framework was evaluated in 13 able-bodied subjects and a limb-deficient person divided into intervention (IG) and control (CG) groups. The IG received training by performing simulated clothespin task and both groups conducted a pre- and posttest with a real prosthesis. When training with the AR, the subjects received visual feedback on the generated grasping force. The main outcome measure was the number of pins that were successfully transferred within 20 min (task duration), while the number of dropped and broken pins were also registered. The participants were asked to score the difficulty of the real task (posttest), fun-factor and motivation, as well as the utility of the feedback.Results: The performance (median/interquartile range) consistently increased during the training sessions (4/3 to 22/4). While the results were similar for the two groups in the pretest, the performance improved in the posttest only in IG. In addition, the subjects in IG transferred significantly more pins (28/10.5 versus 14.5/11), and dropped (1/2.5 versus 3.5/2) and broke (5/3.8 versus 14.5/9) significantly fewer pins in the posttest compared to CG. The participants in IG assigned (mean ± std) significantly lower scores to the difficulty compared to CG (5.2 ± 1.9 versus 7.1 ± 0.9), and they highly rated the fun factor (8.7 ± 1.3) and usefulness of feedback (8.5 ± 1.7).Conclusion: The results demonstrated that the proposed AR system allows for the transfer of skills from the simulated to the real task while providing a positive user experience. The present study demonstrates the effectiveness and flexibility of the proposed AR framework. Importantly, the developed system is open source and available for download and further development. [ABSTRACT FROM AUTHOR]

Background: A prosthetic system should ideally reinstate the bidirectional communication between the user's brain and its end effector by restoring both motor and sensory functions lost after an amputation. However, current commercial prostheses generally do not incorporate somatosensory feedback. Even without explicit feedback, grasping using a prosthesis partly relies on sensory information. Indeed, the prosthesis operation is characterized by visual and sound cues that could be exploited by the user to estimate the prosthesis state. However, the quality of this incidental feedback has not been objectively evaluated.Methods: In this study, the psychometric properties of the auditory and visual feedback of prosthesis motion were assessed and compared to that of a vibro-tactile interface. Twelve able-bodied subjects passively observed prosthesis closing and grasping an object, and they were asked to discriminate (experiment I) or estimate (experiment II) the closing velocity of the prosthesis using visual (VIS), acoustic (SND), or combined (VIS + SND) feedback. In experiment II, the subjects performed the task also with a vibrotactile stimulus (VIB) delivered using a single tactor. The outcome measures for the discrimination and estimation experiments were just noticeable difference (JND) and median absolute estimation error (MAE), respectively.Results: The results demonstrated that the incidental sources provided a remarkably good discrimination and estimation of the closing velocity, significantly outperforming the vibrotactile feedback. Using incidental sources, the subjects could discriminate almost the minimum possible increment/decrement in velocity that could be commanded to the prosthesis (median JND < 2% for SND and VIS + SND). Similarly, the median MAE in estimating the prosthesis velocity randomly commanded from the full working range was also low, i.e., approximately 5% in SND and VIS + SND.Conclusions: Since the closing velocity is proportional to grasping force in state-of-the-art myoelectric prostheses, the results of the present study imply that the incidental feedback, when available, could be usefully exploited for grasping force control. Therefore, the impact of incidental feedback needs to be considered when designing a feedback interface in prosthetics, especially since the quality of estimation using supplemental sources (e.g., vibration) can be worse compared to that of the intrinsic cues. [ABSTRACT FROM AUTHOR]

Background: Active hand prostheses controlled using electromyography (EMG) signals have been used for decades to restore the grasping function, lost after an amputation. Although myocontrol is a simple and intuitive interface, it is also imprecise due to the stochastic nature of the EMG recorded using surface electrodes. Furthermore, the sensory feedback from the prosthesis to the user is still missing. In this study, we present a novel concept to close the loop in myoelectric prostheses. In addition to conveying the grasping force (system output), we provided to the user the online information about the system input (EMG biofeedback). Methods: As a proof-of-concept, the EMG biofeedback was transmitted in the current study using a visual interface (ideal condition). Ten able-bodied subjects and two amputees controlled a state-of-the-art myoelectric prosthesis in routine grasping and force steering tasks using EMG and force feedback (novel approach) and force feedback only (classic approach). The outcome measures were the variability of the generated forces and absolute deviation from the target levels in the routine grasping task, and the root mean square tracking error and the number of sudden drops in the force steering task. Results: During the routine grasping, the novel method when used by able-bodied subjects decreased twofold the force dispersion as well as absolute deviations from the target force levels, and also resulted in a more accurate and stable tracking of the reference force profiles during the force steering. Furthermore, the force variability during routine grasping did not increase for the higher target forces with EMG biofeedback. The trend was similar in the two amputees. Conclusions: The study demonstrated that the subjects, including the two experienced users of a myoelectric prosthesis, were able to exploit the online EMG biofeedback to observe and modulate the myoelectric signals, generating thereby more consistent commands. This allowed them to control the force predictively (routine grasping) and with a finer resolution (force steering). The future step will be to implement this promising and simple approach using an electrotactile interface. A prosthesis with a reliable response, following faithfully user intentions, would improve the utility during daily-life use and also facilitate the embodiment of the assistive system. [ABSTRACT FROM AUTHOR]

Background: Electrocutaneous stimulation can restore the missing sensory information to prosthetic users. In electrotactile feedback, the information about the prosthesis state is transmitted in the form of pulse trains. The stimulation frequency is an important parameter since it influences the data transmission rate over the feedback channel as well as the form of the elicited tactile sensations. Methods: We evaluated the influence of the stimulation frequency on the subject's ability to utilize the feedback information during electrotactile closed-loop control. Ten healthy subjects performed a real-time compensatory tracking (standard test bench) of sinusoids and pseudorandom signals using either visual feedback (benchmark) or electrocutaneous feedback in seven conditions characterized by different combinations of the stimulation frequency (FSTIM) and tracking error sampling rate (FTE). The tracking error was transmitted using two concentric electrodes placed on the forearm. The quality of tracking was assessed using the Squared Pearson Correlation Coefficient (SPCC), the Normalized Root Mean Square Tracking Error (NRMSTE) and the time delay between the reference and generated trajectories (TDIO). Results: The results demonstrated that FSTIM was more important for the control performance than FTE. The quality of tracking deteriorated with a decrease in the stimulation frequency, SPCC and NRMSTE (mean) were 87.5% and 9.4% in the condition 100/100 (FTE/FSTIM), respectively, and deteriorated to 61.1% and 15.3% in 5/5, respectively, while the TDIO increased from 359.8 ms in 100/100 to 1009 ms in 5/5. However, the performance recovered when the tracking error sampled at a low rate was delivered using a high stimulation frequency (SPCC = 83.6%, NRMSTE = 10.3%, TDIO = 415.6 ms, in 5/100). Conclusions: The likely reason for the performance decrease and recovery was that the stimulation frequency critically influenced the tactile perception quality and thereby the effective rate of information transfer through the feedback channel. The outcome of this study can facilitate the selection of optimal system parameters for somatosensory feedback in upper limb prostheses. The results imply that the feedback variables (e.g., grasping force) should be transmitted at relatively high frequencies of stimulation (>25 Hz), but that they can be sampled at much lower rates (e.g., 5 Hz). [ABSTRACT FROM AUTHOR]

Background: The loss of a hand is a traumatic experience that substantially compromises an individual's capability to interact with his environment. The myoelectric prostheses are state-of-the-art (SoA) functional replacements for the lost limbs. Their overall mechanical design and dexterity have improved over the last few decades, but the users have not been able to fully exploit these advances because of the lack of effective and intuitive control. Bimanual tasks are particularly challenging for an amputee since prosthesis control needs to be coordinated with the movement of the sound limb. So far, the bimanual activities have been often neglected by the prosthetic research community.Methods: We present a novel method to prosthesis control, which uses a semi-autonomous approach in order to simplify bimanual interactions. The approach supplements the commercial SoA two-channel myoelectric control with two additional sensors. Two inertial measurement units were attached to the prosthesis and the sound hand to detect the movement of both limbs. Once a bimanual interaction is detected, the system mimics the coordination strategies of able-bodied subjects to automatically adjust the prosthesis wrist rotation (pronation, supination) and grip type (lateral, palmar) to assist the sound hand during a bimanual task. The system has been evaluated in eight able-bodied subjects performing functional uni- and bi-manual tasks using the novel method and SoA two-channel myocontrol. The outcome measures were time to accomplish the task, semi-autonomous system misclassification rate, subjective rating of intuitiveness, and perceived workload (NASA TLX).Results: The results demonstrated that the novel control interface substantially outperformed the SoA myoelectric control. While using the semi-autonomous control the time to accomplish the task and the perceived workload decreased for 25 and 27%, respectively, while the subjects rated the system as more intuitive then SoA myocontrol.Conclusions: The novel system uses minimal additional hardware (two inertial sensors) and simple processing and it is therefore convenient for practical implementation. By using the proposed control scheme, the prosthesis assists the user's sound hand in performing bimanual interactions while decreasing cognitive burden. [ABSTRACT FROM AUTHOR]

Background: Sensory feedback is critical for grasping in able-bodied subjects. Consequently, closing the loop in upper-limb prosthetics by providing artificial sensory feedback to the amputee is expected to improve the prosthesis utility. Nevertheless, even though amputees rate the prospect of sensory feedback high, its benefits in daily life are still very much debated. We argue that in order to measure the potential functional benefit of artificial sensory feedback, the baseline open-loop performance needs to be established.Methods: The myoelectric control of naïve able-bodied subjects was evaluated during modulation of electromyographic signals (EMG task), and grasping with a prosthesis (Prosthesis task). The subjects needed to activate the wrist flexor muscles and close the prosthesis to reach a randomly selected target level (routine grasping). To assess the baseline performance, the tasks were performed with a different extent of implicit feedback (proprioception, prosthesis motion and sound). Finally, the prosthesis task was repeated with explicit visual force feedback. The subjects' ability to scale the prosthesis command/force was assessed by testing for a statistically significant increase in the median of the generated commands/forces between neighboring levels. The quality of control was evaluated by computing the median absolute error (MAE) with respect to the target.Results: The subjects could successfully scale their motor commands and generated prosthesis forces across target levels in all tasks, even with the least amount of implicit feedback (only muscle proprioception, EMG task). In addition, the deviation of the generated commands/forces from the target levels decreased with additional feedback. However, the increase in implicit feedback, from proprioception to prosthesis motion and sound, seemed to have a more substantial effect than the final introduction of explicit feedback. Explicit feedback improved the performance mainly at the higher target-force levels.Conclusions: The study establishes the baseline performance of myoelectric control and prosthesis grasping force. The results demonstrate that even without additional feedback, naïve subjects can effectively modulate force with good accuracy with respect to that achieved when increasing the amount of feedback information. [ABSTRACT FROM AUTHOR]

Background: To effectively replace the human hand, a prosthesis should seamlessly respond to user intentions but also convey sensory information back to the user. Restoration of sensory feedback is rated highly by the prosthesis users, and feedback is critical for grasping in able-bodied subjects. Nonetheless, the benefits of feedback in prosthetics are still debated. The lack of consensus is likely due to the complex nature of sensory feedback during prosthesis control, so that its effectiveness depends on multiple factors (e.g., task complexity, user learning).Methods: We evaluated the impact of these factors with a longitudinal assessment in six amputee subjects, using a clinical setup (socket, embedded control) and a range of tasks (box and blocks, block turn, clothespin and cups relocation). To provide feedback, we have proposed a novel vibrotactile stimulation scheme capable of transmitting multiple variables from a multifunction prosthesis. The subjects wore a bracelet with four by two uniformly placed vibro-tactors providing information on contact, prosthesis state (active function), and grasping force. The subjects also completed a questionnaire for the subjective evaluation of the feedback.Results: The tests demonstrated that feedback was beneficial only in the complex tasks (block turn, clothespin and cups relocation), and that the training had an important, task-dependent impact. In the clothespin relocation and block turn tasks, training allowed the subjects to establish successful feedforward control, and therefore, the feedback became redundant. In the cups relocation task, however, the subjects needed some training to learn how to properly exploit the feedback. The subjective evaluation of the feedback was consistently positive, regardless of the objective benefits. These results underline the multifaceted nature of closed-loop prosthesis control as, depending on the context, the same feedback interface can have different impact on performance. Finally, even if the closed-loop control does not improve the performance, it could be beneficial as it seems to improve the subjective experience.Conclusions: Therefore, in this study we demonstrate, for the first time, the relevance of an advanced, multi-variable feedback interface for dexterous, multi-functional prosthesis control in a clinically relevant setting. [ABSTRACT FROM AUTHOR]

Background: Restoring sensory feedback in myoelectric prostheses is still an open challenge. Closing the loop might lead to a more effective utilization and better integration of these systems into the body scheme of the user. Electrotactile stimulation can be employed to transmit the feedback information to the user, but it represents a strong interference to the recording of the myoelectric signals that are used for control. Time-division multiplexing (TDM) can be applied to avoid this interference by performing the stimulation and recording in dedicated, non-overlapping time windows.Methods: A closed-loop compensatory tracking task with myocontrol and electrotactile stimulation was used to investigate how the duration of the feedback window (FW) influences the ability to perceive the feedback information and react with an appropriate control action. Nine subjects performed eight trials with continuous recording and contralateral feedback (CONT-CLT) and TDM with ispilateral stimulation and recording using the FW of 40 ms (TDM40), 100 ms (TDM100) and 300 ms (TDM300). The tracking quality was evaluated by comparing the reference and generated trajectories using cross-correlation coefficient (CCCOEF), time delay, root mean square tracking error, and the amount of overshoot.Results: The control performance in CONT-CLT was the best in all the outcome measures. The overall worst performance was obtained using TDM with the shortest FW (TDM40). There was no significant difference between TDM100 and TDM300, and the quality of tracking in these two conditions was high (CCCOEF ~ 0.95). The results demonstrated that FW duration is indeed an important parameter in TDM, which appears to have an optimal value. Among the tested cases, the FW duration of 100 ms seems to be the best trade-off between the quality of perception and a limited command update rate.Conclusions: This study represents the first systematic evaluation of a TDM-based approach for closing the loop using electrotactile feedback in myoelectric systems. The overall conclusion is that TDM is a feasible and attractive method for closed-loop myocontrol, since it is easy to implement (software-only solution), has limited impact on the performance when using proper FW duration, and might decrease habituation due to burst-like stimulation delivery. [ABSTRACT FROM AUTHOR]

Background: Dexterous prosthetic hands that were developed recently, such as SmartHand and i-LIMB, are highly sophisticated; they have individually controllable fingers and the thumb that is able to abduct/adduct. This flexibility allows implementation of many different grasping strategies, but also requires new control algorithms that can exploit the many degrees of freedom available. The current study presents and tests the operation of a new control method for dexterous prosthetic hands.Methods: The central component of the proposed method is an autonomous controller comprising a vision system with rule-based reasoning mounted on a dexterous hand (CyberHand). The controller, termed cognitive vision system (CVS), mimics biological control and generates commands for prehension. The CVS was integrated into a hierarchical control structure: 1) the user triggers the system and controls the orientation of the hand; 2) a high-level controller automatically selects the grasp type and size; and 3) an embedded hand controller implements the selected grasp using closed-loop position/force control. The operation of the control system was tested in 13 healthy subjects who used Cyberhand, attached to the forearm, to grasp and transport 18 objects placed at two different distances.Results: The system correctly estimated grasp type and size (nine commands in total) in about 84% of the trials. In an additional 6% of the trials, the grasp type and/or size were different from the optimal ones, but they were still good enough for the grasp to be successful. If the control task was simplified by decreasing the number of possible commands, the classification accuracy increased (e.g., 93% for guessing the grasp type only).Conclusions: The original outcome of this research is a novel controller empowered by vision and reasoning and capable of high-level analysis (i.e., determining object properties) and autonomous decision making (i.e., selecting the grasp type and size). The automatic control eases the burden from the user and, as a result, the user can concentrate on what he/she does, not on how he/she should do it. The tests showed that the performance of the controller was satisfactory and that the users were able to operate the system with minimal prior training. [ABSTRACT FROM AUTHOR]