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For persons with lower extremity (LE) amputation, acquisition of surface electromyography (sEMG) from within the prosthetic socket remains a significant challenge due to the dynamic loads experienced during the gait cycle. However, these signals are critical for both understanding the clinical effects of LE amputation and determining the desired control trajectories of active LE prostheses. Current solutions for collecting within-socket sEMG are generally (i) incompatible with a subject's prescribed prosthetic socket and liners, (ii) uncomfortable, and (iii) expensive. This study presents an alternative within-socket sEMG acquisition paradigm using a novel flexible and low-profile electrode. First, the practical performance of this Sub-Liner Interface for Prosthetics (SLIP) electrode is compared to that of commercial Ag/AgCl electrodes within a cohort of subjects without amputation. Then, the corresponding SLIP electrode sEMG acquisition paradigm is implemented in a single subject with unilateral transtibial amputation performing unconstrained movements and walking on level ground. Finally, a quantitative questionnaire characterizes subjective comfort for SLIP electrode and commercial Ag/AgCl electrode instrumentation setups. Quantitative analyses suggest comparable signal qualities between SLIP and Ag/AgCl electrodes while qualitative analyses suggest the feasibility of using the SLIP electrode for real-time sEMG data collection from load-bearing, ambulatory subjects with LE amputation.

Objective: This study describes the development and offline validation of a heuristic algorithm for accurate prediction of ground terrain in a lower limb prosthesis. This method is based on inference of the ground terrain geometry using estimation of prosthetic limb kinematics during gait with a single integrated inertial measurement unit. Methods: We asked five subjects with below-knee amputations to traverse level ground, stairs, and ramps using a high-range-of-motion powered prosthesis while internal sensor data were remotely logged. We used these data to develop three terrain prediction algorithms. The first two employed state-of-the-art machine learning approaches, while the third was a directly tuned heuristic using thresholds on estimated prosthetic ankle joint translations and ground slope. We compared the performance of these algorithms using resubstitution error for the machine learning algorithms and overall error for the heuristic algorithm. Results: Our optimal machine learning algorithm attained a resubstitution error of $3.4\%$ using 45 features, while our heuristic method attained an overall prediction error of $2.8\%$ using only 5 features derived from estimation of ground slope and horizontal and vertical ankle joint displacement. Compared with pattern recognition, the heuristic performed better on each individual subject, and across both level and non-level strides. Conclusion and significance: These results demonstrate a method for heuristic prediction of ground terrain in a powered prosthesis. The method is more accurate, more interpretable, and less computationally expensive than machine learning methods considered state-of-the-art for intent recognition, and relies only on integrated prosthesis sensors. Finally, the method provides intuitively tunable thresholds to improve performance for specific walking conditions.

BackgroundFunctional magnetic resonance imaging (fMRI) provides critical information about the neurophysiology of the central nervous systems (CNS), posing clinical significance for the understanding of neuropathologies and advancement of rehabilitation. Typical fMRI study designs include subjects performing designed motor tasks within specific time frames, in which fMRI data are then analyzed by assuming that observed functional brain activations correspond to the designed tasks. Therefore, developing MRI-compatible sensors that enable real-time monitoring of subjects’ task performances would allow for highly accurate fMRI studies. While several MRI-compatible sensors have been developed, none have demonstrated the ability to measure individual muscle fascicle length during fMRI, which could help uncover the complexities of the peripheral and central nervous systems. Furthermore, previous MRI-compatible sensors have been focused on biologically intact populations, limiting accessibility to populations such as those who have undergone amputation.MethodsWe propose a lightweight, low-cost, skin impedance-insensitive pressure-based muscular motion sensor (pMMS) that provides reliable estimates of muscle fascicle length and joint angle. The muscular motions are captured through measured pressure changes in an air pocket wrapped around the muscle of interest, corresponding to its muscular motion. The muscle fascicle length and joint angle are then estimated from the measured pressure changes based on the proposed muscle-skin-sensor interaction dynamics. Furthermore, we explore an integration method of multiple pMMS systems to expand the sensor capacity of estimating muscle fascicle length and joint angle. Ultrasound imaging paired with joint encoder measurements are utilized to assess pMMS estimation accuracy of muscle fascicle length in the tibialis anterior (TA) and ankle joint angle, respectively, of five biologically intact subjects.ResultsWe found that a single pMMS sufficiently provides robust and accurate estimations of TA muscle fascicle length and ankle joint angle during dorsiflexion at various speeds and amplitudes. Further, differential pressure readings from two pMMSs, in which each pMMS were proximally and distally placed, were able to mitigate errors due to perturbations, expanding pMMS capacity for muscle fascicle length and ankle joint angle estimation during the full range of plantar flexion and dorsiflexion.ConclusionsOur results from this study demonstrate the feasibility of the pMMS system to further be incorporated in fMRI settings for real-time monitoring of subjects’ task performances, allowing sophisticated fMRI study designs.

Lower-limb assisted exoskeletons are widely researched for movement assistance or rehabilitation training. Due to advantages of compliance with human body and lightweight, some cable-driven prototypes have been developed, but most of these can assist only unidirectional movement. In this paper we present an untethered cable-driven ankle exoskeleton that can achieve plantarflexion-dorsiflexion bidirectional motion bilaterally using a pair of single motors. The main weights of the exoskeleton, i.e., the motors, power supplement units, and control units, were placed close to the proximity of the human body, i.e., the waist, to reduce the redundant rotation inertia which would apply on the wearer’s leg. A cable force transmission system based on gear-pulley assemblies was designed to transfer the power from the motor to the end-effector effectively. A cable self-tension device on the power output unit was designed to tension the cable during walking. The gait detection system based on a foot pressure sensor and an inertial measurement unit (IMU) could identify the gait cycle and gait states efficiently. To validate the power output performance of the exoskeleton, a torque tracking experiment was conducted. When the subject was wearing the exoskeleton with power on, the muscle activity of the soleus was reduced by 5.2% compared to the state without wearing the exoskeleton. This preliminarily verifies the positive assistance effect of our exoskeleton. The study in this paper demonstrates the promising application of a lightweight cable-driven exoskeleton on human motion augmentation or rehabilitation.

Finite element analysis (FEA) can be used to evaluate applied interface pressures and internal tissue strains for computational prosthetic socket design. This type of framework requires realistic patient-specific limb geometry and constitutive properties. In recent studies, indentations and inverse FEA with MRI-derived 3D patient geometries were used for constitutive parameter identification. However, long computational times and use of specialized equipment presents challenges for clinical, deployment. In this study, we present a novel approach for constitutive parameter identification using a combination of FEA, ultrasound indentation, and shear wave elastography. Local shear modulus measurement using elastography during an ultrasound indentation experiment has particular significance for biomechanical modeling of the residual limb since there are known regional dependencies of soft tissue properties such as varying levels of scarring and atrophy. Beyond prosthesis design, this work has broader implications to the fields of muscle health and monitoring of disease progression.

© 2001-2012 IEEE. Magnetic target tracking is a low-cost, portable, and passive method for tracking materials wherein magnets are physically attached or embedded without the need for line of sight. Traditional magnet tracking techniques use optimization algorithms to determine the positions and orientations of permanent magnets from magnetic field measurements. However, such techniques are constrained by high latencies, primarily due to the numerical calculation of the gradient. In this study, we derive the analytic gradient for multiple-magnet tracking and show a dramatic reduction in tracking latency. We design a physical system comprising an array of magnetometers and one or more spherical magnets. To validate the performance of our tracking algorithm, we compare the magnet tracking estimates with state-of-the-art motion capture measurements for each of four distinct magnet sizes. We find comparable position and orientation errors to state-of-the-art magnet tracking, but demonstrate increased maximum bandwidths of 336%, 525%, 635%, and 773% for the simultaneous tracking of 1, 2, 3, and 4 magnets, respectively. We further show that it is possible to extend the analytic gradient to account for disturbance fields, and we demonstrate the simultaneous tracking of 1 to 4 magnets with disturbance compensation. These findings extend the use of magnetic target tracking to high-speed, real-time applications requiring the tracking of one or more targets without the constraint of a fixed magnetometer array. This advancement enables applications such as low-latency augmented and virtual reality interaction, volitional or reflexive control of prostheses and exoskeletons, and simplified multi-degree-of-freedom magnetic levitation.

Scientist and technologist have long sought to advance limb prostheses that connect directly to the peripheral nervous system, enabling a person with amputation to volitionally control synthetic actuators that move, stiffen and power the prosthesis, as well as to experience natural afferent sensations from the prosthesis. Recently, the agonist-antagonist myoneural interface (AMI) was developed, a mechanoneural transduction architecture and neural interface system designed to provide persons with amputation improved muscle-tendon proprioception and neuroprosthetic control. In this paper, we provide an overview of the AMI, including its conceptual framing and pre-clinical science, surgical techniques for its construction, and clinical efficacy related to pain mitigation, phantom limb range of motion, fascicle dynamics, central brain proprioceptive sensorimotor preservation, and prosthetic controllability. Following this broad overview, we end with a discussion of current limitations of the AMI and potential resolutions to such challenges.

Neuroprosthetic devices controlled by persons with standard limb amputation often lack the dexterity of the physiological limb due to limitations of both the user's ability to output accurate control signals and the control system's ability to formulate dynamic trajectories from those signals. To restore full limb functionality to persons with amputation, it is necessary to first deduce and quantify the motor performance of the missing limbs, then meet these performance requirements through direct, volitional control of neuroprosthetic devices.We develop a neuromuscular modeling and optimization paradigm for the agonist-antagonist myoneural interface, a novel tissue architecture and neural interface for the control of myoelectric prostheses, that enables it to generate virtual joint trajectories coordinated with an intact biological joint at full physiologically-relevant movement bandwidth. In this investigation, a baseline of performance is first established in a population of non-amputee control subjects ([Formula: see text]). Then, a neuromuscular modeling and optimization technique is advanced that allows unilateral AMI amputation subjects ([Formula: see text]) and standard amputation subjects ([Formula: see text]) to generate virtual subtalar prosthetic joint kinematics using measured surface electromyography (sEMG) signals generated by musculature within the affected leg residuum.Using their optimized neuromuscular subtalar models under blindfolded conditions with only proprioceptive feedback, AMI amputation subjects demonstrate bilateral subtalar coordination accuracy not significantly different from that of the non-amputee control group (Kolmogorov-Smirnov test, [Formula: see text]) while standard amputation subjects demonstrate significantly poorer performance (Kolmogorov-Smirnov test, [Formula: see text]).These results suggest that the absence of an intact biological joint does not necessarily remove the ability to produce neurophysical signals with sufficient information to reconstruct physiological movements. Further, the seamless manner in which virtual and intact biological joints are shown to coordinate reinforces the theory that desired movement trajectories are mentally formulated in an abstract task space which does not depend on physical limb configurations.

Significance Despite advancements in prosthetic technologies, persons with amputation today suffer great diminution in mobility and quality of life. This is largely due to an outdated amputation paradigm that precludes efficacious communication between the residual limb and prosthesis. An amputation method utilizing agonist–antagonist myoneural interfaces (AMIs) constructs neuromuscular substrates in the residual limb to avail enhanced sensorimotor signaling. In our study, subjects with AMI amputation demonstrate improved motor control, phantom sensations, range of motion, and decreased pain when compared to patients with traditional amputation. With the demonstrated increases in motor coordination and position differentiation, our results suggest that patients with AMI amputation will be able to more efficaciously control bionic prostheses., Despite advancements in prosthetic technologies, patients with amputation today suffer great diminution in mobility and quality of life. We have developed a modified below-knee amputation (BKA) procedure that incorporates agonist–antagonist myoneural interfaces (AMIs), which surgically preserve and couple agonist–antagonist muscle pairs for the subtalar and ankle joints. AMIs are designed to restore physiological neuromuscular dynamics, enable bidirectional neural signaling, and offer greater neuroprosthetic controllability compared to traditional amputation techniques. In this prospective, nonrandomized, unmasked study design, 15 subjects with AMI below-knee amputation (AB) were matched with 7 subjects who underwent a traditional below-knee amputation (TB). AB subjects demonstrated significantly greater control of their residual limb musculature, production of more differentiable efferent control signals, and greater precision of movement compared to TB subjects (P < 0.008). This may be due to the presence of greater proprioceptive inputs facilitated by the significantly higher fascicle strains resulting from coordinated muscle excursion in AB subjects (P < 0.05). AB subjects reported significantly greater phantom range of motion postamputation (AB: 12.47 ± 2.41, TB: 10.14 ± 1.45 degrees) when compared to TB subjects (P < 0.05). Furthermore, AB subjects also reported less pain (12.25 ± 5.37) than TB subjects (17.29 ± 10.22) and a significant reduction when compared to their preoperative baseline (P < 0.05). Compared with traditional amputation, the construction of AMIs during amputation confers the benefits of enhanced physiological neuromuscular dynamics, proprioception, and phantom limb perception. Subjects’ activation of the AMIs produces more differentiable electromyography (EMG) for myoelectric prosthesis control and demonstrates more positive clinical outcomes.

BackgroundNeuroprosthetic devices controlled by persons with standard limb amputation often lack the dexterity of the physiological limb due to limitations of both the user’s ability to output accurate control signals and the control system’s ability to formulate dynamic trajectories from those signals. To restore full limb functionality to persons with amputation, it is necessary to first deduce and quantify the motor performance of the missing limbs, then meet these performance requirements through direct, volitional control of neuroprosthetic devices.MethodsWe develop a neuromuscular modeling and optimization paradigm for the agonist-antagonist myoneural interface, a novel tissue architecture and neural interface for the control of myoelectric prostheses, that enables it to generate virtual joint trajectories coordinated with an intact biological joint at full physiologically-relevant movement bandwidth. In this investigation, a baseline of performance is first established in a population of non-amputee control subjects ($$n = 8$$n=8). Then, a neuromuscular modeling and optimization technique is advanced that allows unilateral AMI amputation subjects ($$n = 5$$n=5) and standard amputation subjects ($$n = 4$$n=4) to generate virtual subtalar prosthetic joint kinematics using measured surface electromyography (sEMG) signals generated by musculature within the affected leg residuum.ResultsUsing their optimized neuromuscular subtalar models under blindfolded conditions with only proprioceptive feedback, AMI amputation subjects demonstrate bilateral subtalar coordination accuracy not significantly different from that of the non-amputee control group (Kolmogorov-Smirnov test,$$P \ge 0.052$$P≥0.052) while standard amputation subjects demonstrate significantly poorer performance (Kolmogorov-Smirnov test,$$P < 0.001$$P<0.001).ConclusionsThese results suggest that the absence of an intact biological joint does not necessarily remove the ability to produce neurophysical signals with sufficient information to reconstruct physiological movements. Further, the seamless manner in which virtual and intact biological joints are shown to coordinate reinforces the theory that desired movement trajectories are mentally formulated in an abstract task space which does not depend on physical limb configurations.

Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works The brain undergoes marked changes in function and functional connectivity after limb amputation. The agonist-antagonist myoneural interface (AMI) amputation is a procedure that restores physiological agonist-antagonist muscle relationships responsible for proprioceptive sensory feedback to enable greater motor control. We compared results from the functional neuroimaging of individuals (n = 29) with AMI amputation, traditional amputation, and no amputation. Individuals with traditional amputation demonstrated a significant decrease in proprioceptive activity, measured by activation of Brodmann area 3a, whereas functional activation in individuals with AMIs was not significantly different from controls with no amputation (P< 0.05). The degree of proprioceptive activity in the brain strongly correlated with fascicle activity in the peripheral muscles and performance on motor tasks (P < 0.05), supporting the mechanistic basis of the AMI procedure. These results suggest that surgical techniques designed to restore proprioceptive peripheral neuromuscular constructs result in desirable central sensorimotor plasticity.

We present electric-energy consequences from the primary mechanical design trade-offs in lower-extremity, knee and ankle powered prostheses walking on varied terrain. Previous work has studied level-ground walking and running, but has not yet examined the influence of design parameters in large range of motion tasks such as stair ascent and descent. There are four main hardware components commonly implemented in bionic ankles and knees that can be tuned to achieve desired performance: motor, reduction ratio N, series spring stiffness $\mathrm{K}_{\mathrm{s}}$, and parallel spring stiffness $\mathrm{K}_{\mathrm{p}}$. The allowed joint range of motion is a fifth parameter that can strongly affect electric energy consumption. Using a kinematically clamped analysis we evaluate the electric cost of transport (eCOT) for knee and ankle stair ascent and descent in addition to levelground walking. Results show parallel springs (PS) improve level-ground energetics but can be costly on stairs. Variable transmissions combined with PS can improve energetics but not more than simply limiting range of motion, while the knee does not benefit greatly from this complexity.

While amputation has traditionally been viewed as a failure of therapy, recent developments in amputation surgery and neural interfacing demonstrate improved functionality and bidirectional communication with prosthetic devices. The agonist antagonist myoneural interface (AMI) is one such bi-directional neural communication model comprised of two muscles, an agonist and an antagonist, surgically connected in series within the amputated residuum such that contraction of one muscle stretches the other. By preserving agonist-antagonist muscle dynamics, the AMI allows proprioceptive signals from mechanoreceptors within both muscles to be communicated to the central nervous system. Preliminary human evidence suggests that AMIs have the capacity to provide high fidelity control of a prosthetic device, force feedback, and natural proprioception. However, AMIs have been implemented only in planned amputations and require healthy distal tissues, whereas the majority of amputations occur in patients who do not have healthy distal tissues. Through the use of a dual-stage surgical procedure which leverages existent tissues, this study proposes a revision model for implementation of the AMI in patients who are undergoing traumatic amputation or have already undergone a standard amputation. This paper validates the resulting AMI’s physiology, revealing robust viability and mechanical and electrophysiological function. We demonstrate the presence of H-waves in regenerative grafts, indicating the incorporation of the AMI into physiological reflexive loops.

Biomechanical tissue properties have been hypothesized to play a critical role in the quantification of prosthetic socket production for individuals with limb amputation. In this investigation, a novel indenter platform is presented and its performance evaluated for the purposes of residual-limb tissue characterization. The indenter comprised 14 position- and force-controllable actuators that circumferentially surround a biological residuum to form an actuator ring. Each indenter actuator was individually controllable in position ( ${{97.1}}~\mu {\text {m}}$ accuracy) and force (330 mN accuracy) at a PC controller feedback rate of 500 Hz, allowing for a range of measurement across a residual stump. Data were collected from 162 sensors over an EtherCAT fieldbus to characterize the mechanical hyperviscoelastic tissue response of two transtibial residual-limbs from a study participant with bilateral amputations. At five distinct anatomical locations across the residual-limb, force versus deflection data—including hyperviscoelastic tissue properties—are presented, demonstrating the accuracy and versatility of the multi-indenter platform for residual-limb tissue characterization.

Acquisition of surface electromyography (sEMG) from a person with an amputated lower extremity (LE) during prosthesis-assisted walking remains a significant challenge due to the dynamic nature of the gait cycle. Current solutions to sEMG-based neural control of active LE prostheses involve a combination of customized electrodes, prosthetic sockets, and liners. These technologies are generally: (i) incompatible with a subject’s existing prosthetic socket and liners; (ii) uncomfortable to use; and (iii) expensive. This paper presents a flexible dry electrode design for sEMG acquisition within LE prosthetic sockets which seeks to address these issues. Design criteria and corresponding design decisions are explained and a proposed flexible electrode prototype is presented. Performances of the proposed electrode and commercial Ag/AgCl electrodes are compared in seated subjects without amputations. Quantitative analyses suggest comparable signal qualities for the proposed novel electrode and commercial electrodes. The proposed electrode is demonstrated in a subject with a unilateral transtibial amputation wearing her own liner, socket, and the portable sEMG processing platform in a preliminary standing and level ground walking study. Qualitative analyses suggest the feasibility of real-time sEMG data collection from load-bearing, ambulatory subjects.

We present an actuator designed for untethered, lower-extremity powered-prostheses that replicates biological kinetic and kinematic function of both human knees and ankles. An electric energy optimal hardware specification is defined by kinematically clamping walking gait data to the dynamic model of a series elastic actuator (SEA) and searching for motor, reduction ratio, and spring. The actuator is shown to achieve the required torque, angle, and velocity requirements for nominal walking conditions on level ground as well as varied terrain. The performance of the actuator is demonstrated on benchtop and as worn by a human subject with unilateral below knee amputation. The resulting design is a moment-coupled cantilever-beam reaction-force SEA (MC-RFSEA) that has a nominal torque rating of 85Nm, repeated peak torque of 175Nm, 105 degree range of motion, and a hardware mass of 1.6kg. Preliminary results from level-ground walking with the actuator tested in an ankle configuration show an electric cost of transport of 0.053J/kg when walking at 1.5m/s.

Ultrasound is a cost-effective, readily available, and non-ionizing modality for musculoskeletal imaging. Though some research groups have pursued methods that involve submerging the transducer and imaged body segment into a water bath, many limitations remain in regards to acquiring an unloaded volumetric image of an entire human limb in a fast, safe and adequately accurate manner. A 3D dataset of a limb is useful in several rehabilitative applications including biomechanical modeling of soft tissue, prosthetic socket design, monitoring muscle condition and disease progression, bone health, and orthopedic surgery. This paper builds on previous work from our group and presents the design, prototyping, and preliminary testing of a novel multi- modal imaging system for rapidly acquiring volumetric ultrasound imagery of human limbs, with a particular focus on residual limbs for improved prosthesis design. Our system employs a mecha- nized water tank setup to scan a limb with a clinical ultrasound transducer, and 3D optical imagery to track motion during a scan. The iterative closest point algorithm is utilized to compensate for motion and stitch the images into a final dataset. The results show preliminary 2D and 3D imaging of both a tissue-mimicking phantom and residual limbs. A volumetric error compares the ultrasound image data obtained to a previous MRI method. The results indicate potential for future clinical implementation. Con- cepts presented in this work could reasonably transfer to other imaging applications such as acoustic tomography, where motion artifact may distort image reconstruction.

© 2019 IOP Publishing Ltd. Objective. Over the last two decades, optical control of neuronal activity in the central nervous system has seen rapid development, demonstrating the utility of optogenetics as both an experimental and therapeutic tool. Conversely, applications of optogenetics in the peripheral nervous system have been relatively constrained by the challenges of temporally variable opsin expression, light penetration and immune attack of non-native opsins. Whilst opsin expression can be increased significantly through high-concentration viral induction, subsequent attack by the immune system causes temporal decay and high variability in electrophysiological response. Approach. In this study, we present a method to circumvent the aforementioned challenges by locally supplementing all-trans-retinal (ATR) (via a slow release pellet) to increase tissue photosensitivity in transgenic mice expressing channelrhodopsin 2 (ChR2) in nerves. Main results. In mice supplemented with ATR, we demonstrate enhanced electrophysiological activation and fatigue tolerance in response to optical stimulation for six weeks. Significance. Local supplementation of ATR enables improved optogenetic stimulation efficacy in peripheral nerves. This method enables greater exploration of neurophysiology and development of clinically-viable optogenetic treatments in the peripheral nervous system.

Leg stiffness, commonly estimated as the “compression” of a defined leg element in response to a load, has long been used to characterize terrestrial locomotion. This study investigated how goats adjust the stiffness of their hindlimbs to accommodate surfaces of different stiffness. Goats provide a compelling animal model for studying leg stiffness modulation, because they skillfully ambulate over a range of substrates that vary in compliance. To investigate the adjustments that goats make when walking over such substrates, ground reaction forces and three-dimensional trajectories of hindlimb markers were recorded as goats walked on rigid, rubber, and foam surfaces. Net joint moments, powers, and work at the hip, knee, ankle and metatarsophalangeal joints were estimated throughout stance via inverse dynamics. Hindlimb stiffness was estimated from plots of total leg force versus total leg length, and individual joint stiffnesses were estimated from plots of joint moment versus joint angle. Our results support the hypothesis that goats modulate hindlimb stiffness in response to surface stiffness; specifically, hindlimb stiffness decreased on the more compliant surfaces (p

Optogenetics has been used to orchestrate temporal- and tissue-specific control of neural tissues and offers a wealth of unique advantages for neuromuscular control. Here, we establish a closed-loop functional optogenetic stimulation (CL-FOS) system to control ankle joint position in murine models. Using the measurement of either joint angle or fascicle length as a feedback signal, we compare the controllability of CL-FOS to closed-loop functional electrical stimulation (CL-FES) and demonstrate significantly greater accuracy, lower rise times and lower overshoot percentages. We demonstrate orderly recruitment of motor units and reduced fatigue when performing cyclical movements with CL-FOS compared with CL-FES. We develop and investigate a 3-phase, photo-kinetic model to elucidate the underlying mechanisms for temporal variations in optogenetically activated neuromusculature during closed-loop control experiments. Methods and insights from this study lay the groundwork for the development of closed-loop optogenetic neuromuscular stimulation therapies and devices for peripheral limb control., Optogenetics is a promising alternative approach for restoration of neuromuscular function. Here the authors establish a closed-loop functional optogenetic stimulation for the control of limb joint angle in murine models, which demonstrates improved control and less fatigue than electrical stimulation systems.

Optogenetic technologies have been the subject of great excitement within the scientific community for their ability to demystify complex neurophysiological pathways in the central (CNS) and peripheral nervous systems (PNS). The excitement surrounding optogenetics has also extended to the clinic with a trial for ChR2 in the treatment of retinitis pigmentosa currently underway and additional trials anticipated for the near future. In this work, we identify the cause of loss-of-expression in response to transdermal illumination of an optogenetically active peroneal nerve following an anterior compartment (AC) injection of AAV6-hSyn-ChR2(H134R) with and without a fluorescent reporter. Using Sprague Dawley Rag2−/− rats and appropriate controls, we discover optogenetic loss-of-expression is chiefly elicited by ChR2-mediated immunogenicity in the spinal cord, resulting in both CNS motor neuron death and ipsilateral muscle atrophy in both low and high Adeno-Associated Virus (AAV) dosages. We further employ pharmacological immunosuppression using a slow-release tacrolimus pellet to demonstrate sustained transdermal optogenetic expression up to 12 weeks. These results suggest that all dosages of AAV-mediated optogenetic expression within the PNS may be unsafe. Clinical optogenetics for both PNS and CNS applications should take extreme caution when employing opsins to treat disease and may require concurrent immunosuppression. Future work in optogenetics should focus on designing opsins with lesser immunogenicity.

A transfemoral amputation has a significant effect on walking. Though current prosthetic knee options serve to restore mobility, as do purely passive devices, they do not fully restore nondisabled gait. Persons with transfemoral amputation incur a higher metabolic cost during walking than persons without amputation and as a result walk slower and for a shorter distance before tiring. An original variable-impedance transmission prosthetic knee (VI Knee) was tested with five study participants with unilateral transfemoral amputation at two steady-state walking speeds, one below and one above their preferred walking speed. While walking with the VI Knee, participants with shorter limbs showed a reduction in metabolic cost compared with their conventional C-Leg prosthesis, while those with longer limbs exhibited an increase. Though differences were observed between speeds, overall, the difference in metabolic cost (reduction or increase) was found to correlate significantly with rise in the center of mass, with those with shorter residual limbs exhibiting less overall lifting of the body during gait.

Existing robotic transtibial prostheses provide only ankle joint actuation and do not restore biarticular function of the gastrocnemius muscle. This paper presents the first powered biarticular transtibial prosthesis, which is a combination of a commercial powered ankle-foot prosthesis and a motorized robotic knee orthosis. The orthosis is controlled to emulate the human gastrocnemius based on neuromuscular models of matched nonamputees. Together with the ankle-foot prosthesis, the devices provide biarticular actuation. We evaluate differences between this biarticular condition and a monoarticular condition with the orthosis behaving as a free-joint. Six participants with transtibial amputation walk with the prosthesis on a treadmill while motion, force, and metabolic data are collected and analyzed for differences between conditions. The biarticular prosthesis reduces affected-side biological knee flexion moment impulse and hip positive work during late-stance knee flexion, compared to the monoarticular condition. The data do not support our hypothesis that metabolism decreases for all participants, but some participants demonstrate large metabolic reductions with the biarticular condition. These preliminary results suggest that a powered artificial gastrocnemius may be capable of providing large metabolic reductions compared to a monoarticular prosthesis, but further study is warranted to determine an appropriate controller for achieving more consistent metabolic benefits., United States. National Aeronautics and Space Administration (Grant NNX12AM16G)

Supplemental Digital Content is available in the text., Background: The agonist-antagonist myoneural interface (AMI) comprises a surgical construct and neural control architecture designed to serve as a bidirectional interface, capable of reflecting proprioceptive sensation of prosthetic joint position, speed, and torque from and advanced limb prosthesis onto the central nervous system. The AMI surgical procedure has previously been vetted in animal models; we here present the surgical results of its translation to human subjects. Methods: Modified unilateral below knee amputations were performed in the elective setting in 3 human subjects between July 2016 and April 2017. AMIs were constructed in each subject to control and interpret proprioception from the bionic ankle and subtalar joints. Intraoperative, perioperative, and postoperative residual-limb outcome measures were recorded and analyzed, including electromyographic and radiographic imaging of AMI musculature. Results: Mean subject age was 38 ± 13 years, and mean body mass index was 29.5 ± 5.5 kg/m2. Mean operative time was 346 ± 87 minutes, including 120 minutes of tourniquet time per subject. Complications were minor and included transient cellulitis and one instance of delayed wound healing. All subjects demonstrated mild limb hypertrophy postoperatively, and intact construct excursion with volitional muscle activation. All patients reported a high degree of phantom limb position perception with no reports of phantom pain. Conclusions: The AMI offers the possibility of improved prosthetic control and restoration of muscle-tendon proprioception. Initial results in this first cohort of human patients are promising and provide evidence as to the potential role of AMIs in the care of patients requiring below knee amputation.

State-of-the-art transtibial prostheses provide only ankle joint actuation and thus do not provide the biarticular function of the amputated gastrocnemius muscle. We develop a prosthesis that actuates both knee and ankle joints and then evaluate the incremental effects of this prosthesis as compared to ankle actuation alone. The prosthesis employs a quasi-passive clutched-spring knee orthosis, approximating the largely isometric behavior of the biological gastrocnemius, and utilizes a commercial powered ankle-foot prosthesis for ankle joint functionality. Two participants with unilateral transtibial amputation walk with this prosthesis on an instrumented treadmill, while motion, force, and metabolic data are collected. Data are analyzed to determine differences between the biarticular condition with the activation of the knee orthosis and the monoarticular condition with the orthosis behaving as a free-joint. As hypothesized, the biarticular system is shown to reduce both affected-side knee and hip moment impulse and positive mechanical work in both participants during the late stance knee flexion phase of walking, compared to the monoarticular condition. The metabolic cost of walking is also reduced for both participants. These very preliminary results suggest that biarticular functionality may provide benefits beyond even those of the most advanced monoarticular prostheses., Massachusetts Institute of Technology. Media Laboratory

Objective: Walking task prediction in powered leg prostheses is an important problem in the development of biomimetic prosthesis controllers. This paper proposes a novel method to predict upcoming walking tasks by estimating the translational motion of leg joints using an integrated inertial measurement unit. Methods: We asked six subjects with unilateral transtibial amputations to traverse flat ground, ramps, and stairs using a powered prosthesis while inertial signals were collected. We then performed an offline analysis in which we simulated a real-time motion tracking algorithm on the inertial signals to estimate knee and ankle joint translations, and then used pattern recognition separately on the inertial and translational signal sets to predict the target walking tasks of individual strides. Results: Our analysis showed that using inertial signals to derive translational signals enabled a prediction error reduction of 6.8% compared to that attained using the original inertial signals. This result was similar to that seen by addition of surface electromyography sensors to integrated sensors in previous work, but was effected without adding any extra sensors. Finally, we reduced the size of the translational set to that of the inertial set and showed that the former still enabled a composite error reduction of 5.8%. Conclusion and Significance: These results indicate that translational motion tracking can be used to substantially enhance walking task prediction in leg prostheses without adding external sensing modalities. Our proposed algorithm can thus be used as a part of a task-adaptive and fully integrated prosthesis controller.

Currently, the mobility of above-knee amputees is limited by the lack of available prostheses that can efficiently replicate biologically accurate movements. In this study, a powered knee prosthesis was designed utilizing a novel mechanism, known as a clutchable series-elastic actuator (CSEA).The CSEA includes a low-power clutch in parallel with an electric motor within a traditional series-elastic actuator. The stiffness of the series elasticity was tuned to match the elastically conservative region of the knee’s torque-angle relationship during the stance phase of locomotion. During this region, the clutch was used to efficiently store energy in the series elasticity. The fully autonomous knee prosthesis design utilized a brushless electric motor, ballscrew transmission and cable drive, as well as commercial electrical components. The knee was lighter than the eighth percentile and shorter than the first percentile male shank segment. The CSEA Knee was tested in a unilateral above-knee amputee walking at 1.3 m/s. During walking, the CSEA Knee provided biomechanically accurate torque-angle behavior, agreeing within 17% of the net work and 27% of the stance flexion angle produced by the biological knee. In addition, the process of locomotion reduced the net electrical energy consumption of the CSEA Knee. The knee’s motor generated 1.8 J/stride, and the net energy consumption was 3.6 J/stride, an order of magnitude less energy than previously published powered knee prostheses.

Although joint biomechanics and whole-body energetics are well documented for human walking, the underlying mechanisms that govern individual muscle-tendon behaviors are not fully understood. Here, we present a computational model of human walking that unifies muscle and joint biomechanics with whole-body metabolism for level-ground walking at self-selected speed. In the model, muscle-tendon units that dorsiflex the ankle, and flex and extend the knee, are assumed to act as linear springs upon neural activation; each muscle-tendon is modeled as a tendon spring in series with an isometric force source. To provide the mechanical power lost in step-to-step gait transitions, a Hill-type soleus muscle is modeled to actively plantar flex the ankle using muscle state and force as reflex feedback signals. Finally, to stabilize the trunk during stance, and to protract and retract each leg throughout the swing phase, two mono-articular Hill-type muscles actuate the model's hip joint. Following a forward dynamics optimization procedure, the walking model is shown to predict muscle and joint biomechanics, as well as whole-body metabolism, supporting the idea that the preponderance of leg muscles operate isometrically, affording the relatively high metabolic walking economy of humans.