Search

One of the areas of application of composite materials is their use in the manufacture of parts of prosthetic limbs. Advances in the development of composite materials in recent years have led to an active growth in their use in modern orthopedic medicine. Composites have excellent characteristics of strength and weight compared with metallic materials, as well as biocompatibility, which allows them to be used in the manufacture of prostheses. The article discusses various composite materials and their physico-mechanical properties, manufacturing companies and their products for people with different needs. VIAM has developed a whole series of materials that can be proposed for the manufacture of prostheses.

Objective The aim of this study was to establish the mobility, satisfaction, and quality of life (QoL) among prosthesis users with dysvascular/diabetic amputation at both acute and long-term phases of prosthetic rehabilitation. Methods This is a multisite, cross-sectional outcomes analysis. A total of 341 individuals met the inclusion/exclusion criteria. Individuals were grouped into acute phases (0–3 months [n = 24], 4–6 months [n = 72]) and chronic phases (24–36 months [n = 91], 37–48 months [n = 53], 49–60 months [n = 47], and 60–84 months [n = 54]) after amputation. Mobility was measured with the Prosthetic Limb Users Survey of Mobility (PLUS-M), whereas QoL and satisfaction (Sat) were reported using 10-point scales adapted from the Prosthesis Evaluation Questionnaire–Well-Being (PEQ-WB). Composite PEQ-WB scores were also compared. Results The average mobility, QoL, and Sat among prosthesis users was, respectively, 44.8 ± 10.6, 7.6 ± 2.2, and 7.6 ± 2.2. There were no observed differences in mobility (F5,330 = 1.52, P = 0.18), QoL (F5,333 = 0.78, P = 0.57), or PEQ-WB (F5,335 = 1.618, P = 0.155) between any groups. For Sat, there was a group difference (F5,334 = 2.44, P = 0.03) as individuals appear to experience an initial increase in Sat with receipt of a prosthesis (0–3 months) compared with 25 to 36 months (P = 0.005), 49 to 60 months (P = 0.008), and 61 to 84 months (P = 0.009). Conclusions Those individuals with amputation secondary to dysvascular disease and diabetes who continue to participate in prosthetic rehabilitation appear to experience levels of mobility, Sat, and QoL 7 years after amputation comparable to that reported in the first 6 months postamputation. There may be a modest increase in Sat with receipt of an initial prosthesis, potentially due to an increased optimism for one's situation. Notably, the mobility levels observed in the dysvascular population through a range of long-term postamputation periods remain within a single standard deviation of the population mean for individuals with a lower-limb amputation using a prosthesis for mobility.

Neuroscience studies have proved that the absence of proper tactile feedback can affect human behavior. A qualitative and quantitative growth in flexible artificial touch sensing technologies has been witnessed over the recent years. The development of flexible, sensitive, cost-effective, and durable artificial tactile sensors is crucial for prosthetic rehabilitation. Many researchers are working on realizing a smart touch sensing system for prosthetic devices. To mimic the human sensory system is extremely difficult. The practical uses of the newly invented techniques in the industry are limited by complex fabrication processes and lack of proper data processing techniques. Many compatible flexible substrates, materials, and strategies for tactile sensors have been identified to enhance the amputee population. This paper reviews the flexible substrates, functional materials, preparation methods, and several computational techniques for artificial tactile sensors.

Measuring muscle activation via electric potential, referred to as electromyography (EMG), has traditionally been used for medical research and diagnosis of neuromuscular disorders. However, with the advent of powerful integrated circuits and micro-controllers, the EMG circuits and sensors can find their way into prosthetics, robotics and control systems. Surface electromyography and needle electromyography are two general methods of recording the electrical activities of muscle tissue. In this paper, surface electromyography is used to analyse the human arm muscle nerve signals and convert the obtained nerve signal into mechanical movement in a motor. This kind of bionic control module finds its greatest use in prosthetics. The surface detection of the nerve signals reduces the risk of operation on the amputated part of the patient and gives a proper control to the person in movement of the prosthetic arm/leg. The module has the advantage of being small and simple, and easily manageable when compared to the other available options. Further development in the module can lead to fully developed and human safe prosthetic limbs that are very much alike and do all the functions as the actual human limbs. Index Terms: Electromyography, Surface electromyography, Bio electrodes, Bionic Control, non-invasive technique, aphasia

Purpose: comparison of electromyographic activity of quadriceps muscle in persons with unilateral traumatic transtibial amputation using patellar tendon bearing supracondylar endoskeletal prosthesis with the unaffected limb in weight bearing positions. Method: 30 individuals aged 18-60 years were assessed using surface electromyography with functional level K3 according to K-level functional assessment scale to compare the activity of quadriceps of affected side using patellar tendon bearing supracondylar endoskeletal prosthesis with the unaffected side. The data was analysed using paired t-test. Result: There was a significant difference in the activity of VMO and VLO muscles of the quadriceps in high sitting positions. There was also a significant difference in the activity of VMO muscle in single limb stance and bipedal stance. However, there was no significant difference between the activity of VLO muscle in bipedal stance but there was reduced activity of VLO muscle in the prosthetic limb in single limb stance. Conclusion: The quadriceps activity was reduced in the affected limb in high sitting position, single limb stance and bipedal stance. However, no difference in the muscle activity was noted in VLO muscle in bipedal stance. Keywords: trans tibial amputation, patellar tendon bearing supracondylar prosthetis, surface electromyography.

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.

Individuals with upper extremity (UE) amputation abandon prostheses due to challenges with significant device weight—particularly among myoelectric prostheses—and limited device dexterity, durability, and reliability among both myoelectric and body-powered prostheses. The Modular Prosthetic Limb (MPL) system couples an advanced UE prosthesis with a pattern recognition paradigm for intuitive, non-invasive prosthetic control. Pattern recognition accuracy and functional assessment—Box & Blocks (BB), Jebsen-Taylor Hand Function Test (JHFT), and Assessment of Capacity for Myoelectric Control (ACMC)—scores comprised the main outcomes. 10 participants were included in analyses, including seven individuals with traumatic amputation, two individuals with congenital limb absence, and one with amputation secondary to malignancy. The average (SD) time since limb loss, excluding congenital participants, was 85.9 (59.5) months. Participants controlled an average of eight motion classes compared to three with their conventional prostheses. All participants made continuous improvements in motion classifier accuracy, pathway completion efficiency, and MPL manipulation. BB and JHFT improvements were not statistically significant. ACMC performance improved for all participants, with mean (SD) scores of 162.6 (105.3), 213.4 (196.2), and 383.2 (154.3), p = 0.02 between the baseline, midpoint, and exit assessments, respectively. Feedback included lengthening the training period to further improve motion classifier accuracy and MPL control. The MPL has potential to restore functionality to individuals with acquired or congenital UE loss.

Historical evidence suggests that prostheses have been used since ancient Egyptian times. Prostheses were usually utilized for function and cosmetic appearances. Nowadays, with the advancement of technology, prostheses such as artificial hands can not only improve functional, but have psychological advantages as well and, therefore, can significantly enhance an individual’s standard of living. Combined with advanced science, a prosthesis is not only a simple mechanical device, but also an aesthetic, engineering and medical marvel. Prosthetic limbs are the best tools to help amputees reintegrate into society. In this article, we discuss the background and advancement of prosthetic hands with their working principles and possible future implications. We also leave with an open question to the readers whether prosthetic hands could ever mimic and replace our biological hands.

Some animals adapt well to losing limbs, which may be due to an accident or amputation that was necessitated by a birth-defect or a cancerous growth. Others suffer greatly from having less limbs, negatively affecting their quality of life. Current advancements capacitate us to provide plastic prosthetic limbs by using additive manufacturing. However, modelling and printing proves challenging. This article describes the three steps taken to design an eco-friendly prosthetic for a disabled donkey, made out of plastic parts and belts. First, we sought to gain a better understanding of eco-design to increase durability of the prosthetic. Second, using computer aided design and optimisation, we explored optimal models in order to achieve a lightweight structure to sustain the weight of the animal. Third, the materials Acrylonitrile Butadiene Styrene and Polyethylene Terephthalate were considered to reduce environmental impact and maximise quality of life for the donkey. The product will be printed and fitted to a disabled donkey.

Objectives: The objective of the study was to explore the levels of mobility and its association with quality of life in lower limb amputees. Methodology: A cross-sectional correlational study was conducted at Chal foundation, Fauji Foundation Hospital and PIPOS on the sample of 230 patients for time duration of six months from January–July 2019. The lower limb amputees aged between 18-57 years, and using prosthesis from more than four months were included in the study. The level of mobility was measured through Self-reporting Prosthetic Limb User Survey of Mobility (SF-PLUS-M) questionnaire, while Prosthetic Evaluation Questionnaire (PEQ) was used to determine the Quality of Life (QOL) among prosthesis users. This data was analyzed by SPSS version 21. Results: The mean age of study participants was 43±14.89 years. The mean PLUS-M score was 39.48±14.33. The results showed a positive significant association between level of mobility and quality of life in lower limb amputees (p

The Prosthetic Limb Users Survey of Mobility (PLUS-M) is a self-report item bank designed to measure the abilities with which people with lower limb amputation perform physical activities. Although PLUS-M includes items that span a range of mobility, additional items are needed to accurately measure mobility of highly active prosthesis users, such as athletes and service members with lower limb amputation. The aim of this study was to understand mobility in highly active lower limb prosthesis users to inform the development of new items for the PLUS-M item bank.Focus groups were conducted with active, lower limb prosthesis users from across the USA. In-person and online focus groups were conducted by a trained facilitator using a semi-structured guide. Focus group transcripts were reviewed and coded by two researchers. Thematic analysis was used to identify important experiences across participants.Twenty-nine participants took part in four focus groups. Three resultant themes were identified: mobility after amputation, mobility characteristics, and healthcare providers and systems.Identified themes inform clinician and researcher understanding of mobility in highly active lower limb prosthesis users. The results of this study will be used to inform development of high-activity items for the PLUS-M item bank.Implications for rehabilitationParticipants described engagement in high-level activities as a learning process that included elements such as equipment challenges and modifications, pain and injury, and the need to trust the prosthetic limb.Participants with lower limb amputation who use prostheses identified mobility characteristics, such as postural changes, terrain, and obstacles, that influenced their ability to perform high-level activities.High-level mobility characteristics identified in these focus groups can be integrated into a revised version of the Prosthetic Limb Users Survey of Mobility to assess mobility in active adults and athletes with amputation.Rehabilitation professionals play an important role in facilitating access to specialized prosthetic components and training that can help patients achieve their mobility goals and potential.

Background/Aims For people with transfemoral amputations, newer technology, microprocessor-controlled prosthetic limbs, offer a level of performance that exceeds that of older, non-microprocessor controlled limbs. They are often requested by members of Her Majesty's Armed Forces who have been discharged from service (veterans) during applications for replacement limbs. However, as microprocessor-controlled prosthetic limbs cost far exceeds that of non-microprocessor controlled limbs, justification for their provision is essential to ensure that they are seen as value for money for the NHS in the UK. To date, literature focuses on measures of objective performance when demonstrating the value of one limb over another, but it ignores individual lifestyles within this process. This project aims to explore the reasons underpinning individual requests for specific types of prosthetic lower limb in a population of veterans with amputations. Methods This pilot study explored secondary data, consisting of patient statements, from the evaluation process associated with applications for new microprocessor-controlled prosthetic limbs. The data referred to a sample population of non-serving veterans with amputations who attended a veteran prosthetic centre for the ongoing maintenance and replacement of their prosthetic limbs (n=15). Results Findings from the study suggest an interconnection between function, psychology and emotional context. Individual statements demonstrate that, while functional performance influences choice, it is the application of function to life and lifestyle that underpins the meaning of improvements in performance for the individual. Conclusions Further research investigating the meaning of limb performance to the life of an individual is essential to facilitate effective prescription of limbs that meet individual need, and ensuring accurate distribution of what are currently limited funds.

The loss of somatosensory feedback after transfemoral amputation imposes a serious challenge in achieving postural stability. In the recent past, weight shifting exercises with fixed ankle joint have been reported useful in boosting the limit of stability (LOS) only in the sound limb; the LOS on the prosthetic limb did not improve. A fixed ankle joint restricts movement in the anterior-posterior direction at the ankle level. Thus, it may suppress the ability to move forward LOS despite awareness of center of pressure (COP) due to vibrotactile feedback. Therefore, it could have limited the improvement in the LOS of a prosthetic limb in previous studies. This article investigates this hypothesis by evaluating the effect of vibrotactile feedback in the LOS of transfemoral amputees with fixed as well as movable ankle joints. This evaluation is done during weight shifting exercises. Firstly, we developed an in-house COP guided vibrotactile sensory feedback system. Next, we recruited five transfemoral amputees to perform a weight-shifting exercise with a) fixed ankle joint (single-axis cushion heel (SACH) foot) and b) movable ankle joint (single-axis foot). Finally, we analyzed the recorded center of pressure trajectory signals for the limit of stability. The findings of repeated measures ANOVA showed a marginally significant interaction ( $\text{F}_{{(\text {1, 4})}}= {5.7}$ , $\text {p}={0.07}$ , $\eta \text {p}^{{2}}= {0.591}$ ) between ankle joint and feedback conditions during backward shifting in weight shifting exercise. Further analysis showed that during the backward shifting fixed ankle joint did not improve in the presence of vibrotactile feedback, while a marginally significant ( $\text {p}={0.14}$ ) improved LOS was observed in the movable ankle joint with feedback. The findings conclude that the vibrotactile feedback is more effective in transfemoral amputees with movable ankle joint compared with fixed ankle joint.

Much has been written about the potential of artificial intelligence (AI) to support, and even transform, the lives of disabled people. It is true that many advances have been made, ranging from robotic arms and other prosthetic limbs supported by AI, decision support tools to aid clinicians and the disabled themselves, and route planning software for those with visual impairment. Many individuals are benefiting from the use of such tools, improving our accessibility and changing lives. But what are the true limits of such tools? What are the ethics of allowing AI tools to suggest different courses of action, or aid in decision-making? And does AI offer too much promise for individuals? I have recently undergone a life changing accident which has left me severely disabled, and together with my daughter who is blind, we shall explore the day-to-day realities of how AI can support, and frustrate, disabled people. From this, we will draw some conclusions as to how AI software and technology might best be developed in the future.

Myoelectric signals are regarded as the control signal for prosthetic limbs. But, the main research challenge is reliable and repeatable movement detection using electromyography. In this study, the analysis of the muscle synergy pattern has been considered as a key idea to cope with this main challenge. The main objective of this research was to provide an analytical tool to recognize six wrist movements through electromyography (EMG) based on analysis of the muscle synergy patterns. In order to design such a system‚ the synergy patterns of the wrist muscles have been extracted and utilized to identify wrist movements. Also, different decision fusion algorithms were used to increase the reliability of the synergy pattern classification. The classification performance was evaluated while no data subject was enrolled. In terms of the achieved performance, using a multi-layer perceptron (MLP) neural network as the fusion algorithm turned out to be the best combination. The classification average accuracy, obtained in an offline manner, was about 99.78 ± 0.45%. While the classification average cross-validation accuracy, obtained in an offline manner, using Bayesian fusion, and Bayesian fuzzy clustering (BFC) fusion algorithm were 99.33 ± 0.80% and 96.43 ± 1.08%, respectively.

This paper aims to review the key concepts in prosthetic limb prescription for adults with limb loss, including the benefits of a multidisciplinary team. There is a relative absence of literature directly describing the role of a team-based approach to prosthetic limb prescription. However, comparable literature can be found in other rehabilitation topics and medical disciplines, generally in support of team-based approaches to patient care. While there is a growing body of comparative effectiveness literature for prosthetic componentry, there is generally a lack of coherent prescribing guidelines. Thus, specific prescription choices are often guided by foundational knowledge, expected functional outcomes, and the clinical experience of the prescribing team. Given the inherent complexities and lack of established guidelines, prosthetic limb prescription is ideally accomplished through a team-based approach involving a physiatrist, prosthetist, and physical or occupational therapist. Each member serves a valuable role based on their unique educational backgrounds and clinical experience.

Osseointegration is a relatively new technique for prosthetic limb attachment that offers various improvements for patients with amputation and facilitates joint preservation. We present a case of implant loosening during rehabilitation in a patient with transtibial amputation that was successfully managed through a combination of measures, aiming to promote re-osseointegration of the implant.Not much is known about structured management of adverse events after osseointegration. Septic or aseptic loosening is currently regarded as implant failure, prompting removal and possible re-implantation at a later stage. The objective of this case report was to evaluate the feasibility of salvaging a loosened implant.Case report.A novel treatment approach was employed to enable renewed osseointegration of the implant. First, the bone-implant interface was disrupted and renewed through axial rotation and distal repositioning of the implant. Afterwards, extracorporal shockwave therapy and antibiotic treatment were administered. Prosthetic rehabilitation was then started anew. Regular follow-up x-rays and clinical evaluations were conducted, including standardized outcome tests.These combined measures led to a successful re-osseointegration of the implant. In a 21-month follow-up, the patient regained a stable and secure gait pattern, using his prosthesis every day for 15 hours and scoring above average on standardized outcome measures.This represents the first report of implant salvage after failed primary osseointegration. As the associated risks of this novel treatment are very low, investigations are warranted to evaluate this approach on a larger scale.

Many philosophers have argued that prosthetic limbs are the subjects of some of the same rights as traditional body parts. This is a strong argument in favour of respecting the rights of users of prosthetics. I argue that all of the reasons to consider paradigm prosthetics the subjects of body-like rights apply to the relationship between some emotional support animals (ESAs) and their handlers. ESAs are integrated into the functioning of their handlers in ways that parallel the ways that paradigm prosthetics are integrated into the functioning of their users. ESAs are also phenomenologically integrated into their handler’s lives in ways that parallel the phenomenological integration that prosthetic users experience. These parallels provide a strong reason to take the rights of ESA handlers much more seriously than we do now. I will highlight that the current treatment of ESA handlers presumes that they have no rights to ESAs at all. Even if ESAs are the subject of very minimal body-like rights, ESA handlers are having their rights violated. There are of course disanalogies between ESAs and paradigm prosthetics. Most notably, ESAs are alive and separate from their handlers. However, none of these disanalogies are relevant to the question of body-like rights. The differences between ESAs and paradigm prosthetics are in terms of what treatment is owed to them, not in terms of what rights their handlers and users should have. ESAs are not prosthetics, but they deserve some of the rights prosthetics do.

Traditional methods of prosthetics fabrication are slow, messy, inaccessible and prohibitively expensive, particularly in developing nations and conflict areas. The development of 3D printing technology allows for prosthetics to be made cost-effectively with an added degree of customization and personalization not previously utilized. 3D printing is quickly expanding in the field of prosthetics, but has rarely been implemented in developing nations or countries in armed conflict, despite these areas having the largest number of amputees and the greatest shortage of prosthetics. Resource-poor areas can use 3D printing as a means of providing prosthetic care for local amputees, as this technology is uniquely suited to help amputees acquire high-quality, affordable, comfortable prosthetics. The use of 3D printing can fulfil the critically unmet need for culturally appropriate prosthetic technology and alleviate many of the psychosocial effects suffered by amputees worldwide, but only if such programmes are implemented properly. This synthesized literature review provides information on the process of, usage for and benefits of utilizing 3D printing for prosthetic limbs.

Prosthetics by definition need to be functional, but can they be stylish as well? It seems the only limitation is imagination. Stigma has always existed around people with limb loss and those who compensate for that loss with prosthetic limbs. Since the end of the First World War, when simple, prostheses not much better than mannequin limbs were mass-produced to funnel wounded veterans back into physical labour, prosthetic limbs have aspired to be functional and invisible. But over the past few years, smaller prosthetics companies have begun to reject that mindset.

Aims Osseointegrated prosthetic limbs allow better mobility than socket-mounted prosthetics for lower limb amputees. Fractures, however, can occur in the residual limb, but they have rarely been reported. Approximately 2% to 3% of amputees with socket-mounted prostheses may fracture within five years. This is the first study which directly addresses the risks and management of periprosthetic osseointegration fractures in amputees. Methods A retrospective review identified 518 osseointegration procedures which were undertaken in 458 patients between 2010 and 2018 for whom complete medical records were available. Potential risk factors including time since amputation, age at osseointegration, bone density, weight, uni/bilateral implantation and sex were evaluated with multiple logistic regression. The mechanism of injury, technique and implant that was used for fixation of the fracture, pre-osseointegration and post fracture mobility (assessed using the K-level) and the time that the prosthesis was worn for in hours/day were also assessed. Results There were 22 periprosthetic fractures; they occurred exclusively in the femur: two in the femoral neck, 14 intertrochanteric and six subtrochanteric, representing 4.2% of 518 osseointegration operations and 6.3% of 347 femoral implants. The vast majority (19/22, 86.4%) occurred within 2 cm of the proximal tip of the implant and after a fall. No fractures occurred spontaneously. Fixation most commonly involved dynamic hip screws (10) and reconstruction plates (9). No osseointegration implants required removal, the K-level was not reduced after fixation of the fracture in any patient, and all retained a K-level of ≥ 2. All fractures united, 21 out of 22 patients (95.5%) wear their osseointegration-mounted prosthetic limb longer daily than when using a socket, with 18 out of 22 (81.8%) reporting using it for ≥ 16 hours daily. Regression analysis identified a 3.89-fold increased risk of fracture for females (p = 0.007) and a 1.02-fold increased risk of fracture per kg above a mean of 80.4 kg (p = 0.046). No increased risk was identified for bilateral implants (p = 0.083), time from amputation to osseointegration (p = 0.974), age at osseointegration (p = 0.331), or bone density (g/cm2, p = 0.560; T-score, p = 0.247; Z-score, p = 0.312). Conclusion The risks and sequelae of periprosthetic fracture after press-fit osseointegration for amputation should not deter patients or clinicians from considering this procedure. Females and heavier patients are likely to have an increased risk of fracture. Age, years since amputation, and bone density do not appear influential. Cite this article: Bone Joint J 2020;102-B(2):162–169.

Description, A stretchable pressure sensor can provide highly sensitive and strain-unperturbed measurement to pressures on deformed skins., A stretchable pressure sensor is a necessary tool for perceiving physical interactions that take place on soft/deformable skins present in human bodies, prosthetic limbs, or soft robots. However, all existing types of stretchable pressure sensors have an inherent limitation, which is the interference of stretching with pressure sensing accuracy. Here, we present a design for a highly stretchable and highly sensitive pressure sensor that can provide unaltered sensing performance under stretching, which is realized through the synergistic creations of an ionic capacitive sensing mechanism and a mechanically hierarchical microstructure. Via this optimized structure, our sensor exhibits 98% strain insensitivity up to 50% strain and a low pressure detection limit of 0.2 Pa. With the capability to provide all the desired characteristics for quantitative pressure sensing on a deformable surface, this sensor has been used to realize the accurate sensation of physical interactions on human or soft robotic skin.

Percutaneous osseointegrated (OI) implants are increasingly viable as an alternative to socket suspension of prosthetic limbs. Upper extremity prostheses have also become more complex to better replicate hand and arm function and attempt to recreate pre-amputation functional levels. With more functionality comes heavier devices that put more stress on the bone-implant interface, which could be an issue for implant stability. This study quantified transhumeral loading at defined amputation levels using four simulated prosthetic limb-types: (1) body powered hook, (2) myoelectric hook, (3) myoelectric hand, and (4) advanced prosthetic limb. Computational models were constructed to replicate the weight distribution of each prosthesis type, then applied to motion capture data collected during Advanced Activities of Daily Living (AADLs). For activities that did not include a handheld weight, the body powered prosthesis bending moments were 13-33% (range of means for each activity across amputation levels) of the intact arm moments (reference 100%), torsional moments were 12-15%, and axial pullout forces were 30-40% of the intact case (p≤0.001). The myoelectric hook and hand bending moments were 60-99%, torsional moments were 44-97%, and axial pullout forces were 62-101% of the intact case. The advanced prosthesis bending moments were 177-201%, torsional moments were 164-326%, and axial pullout forces were 133-185% of the intact case (p≤0.001). The addition of a handheld weight for briefcase carry and jug lift activities reduced the overall impact of the prosthetic model itself, where the body powered forces and moments were much closer to those of the intact model, and more complex prostheses further increased forces and moments beyond the intact arm levels. These results reveal a ranked order in loading magnitude according to complexity of the prosthetic device, and highlight the importance of considering the patient's desired terminal device when planning post-operative percutaneous OI rehabilitation and training.

Functional, comfortable prosthetic limbs depend on personalised sockets, currently designed using an iterative, expert-led process, which can be expensive and inconvenient. Computer-aided design and manufacturing (CAD/CAM) offers enhanced repeatability, but far more use could be made from clinicians’ extensive digital design records. Knowledge-based socket design using smart templates could collate successful design features and tailor them to a new patient. Based on 67 residual limb scans and corresponding sockets, this paper develops a method of objectively analysing personalised design approaches by expert prosthetists, using machine learning: principal component analysis (PCA) to extract key categories in anatomic and surgical variation, and k-means clustering to identify local ‘rectification’ design features. Rectification patterns representing Total Surface Bearing and Patella Tendon Bearing design philosophies are identified automatically by PCA, which reveals trends in socket design choice for different limb shapes that match clinical guidelines. Expert design practice is quantified by measuring the size of local rectifications identified by k-means clustering. Implementing smart templates based on these trends requires clinical assessment by prosthetists and does not substitute training. This study provides methods for population-based socket design analysis, and example data, which will support developments in CAD/CAM clinical practice and accuracy of biomechanics research.

Major lower extremity amputations have been an area of much concern in the Caribbean population. Hence, the purpose of this research was to investigate the current trends in major lower-extremity amputations. Data regarding all major lower-extremity amputations performed at a tertiary care institution in Trinidad and Tobago, from January 2010 to December 2016 were reviewed. The variation of yearly trends, gender, type of amputation and reason for amputation were analysed. The yearly amputation rate demonstrated a progressive increase from 2010 to 2016, the average for the seven years was 28 per 105/year. Males accounted for 59% of cases, and 60% of amputations were done above the level of the knee joint. The most common reason for amputation was control of sepsis in 71.5% of cases. A strong association between major amputations and prior intervention for a foot-related problem was observed, as 52% of the sample had a pre-existing wound or a prior minor amputation (32%). Overall, 14.5% of all amputees were able to acquire a prosthesis. Diabetes mellitus was the most consistently associated co-morbidity occurring in 91% of the study population. Major limb amputations continue to affect our population significantly, with a rise in the amputation rate despite the introduction of a Vascular Surgical Unit. Diabetes and its foot-related complications are one of the leading causes of major lower extremity amputations. Prosthetic limb acquisition for our amputee population continues to be lacking, reflected by the low prosthetic acquisition rate observed.

The World Health Organization (WHO) estimated over 40 million amputees throughout the world, out of 30% are upper limb amputees. In recent times, the prosthetic devices play a major role in technological development. A plenty of amputees are among us who are not able to compete with others only because some part of their body is not fully functional. There are prosthetic limbs available for amputees as a commercial solution in economically developing nations, to overcome the drawbacks in prosthetic limbs like finger movements and wrist movements. Electroen cephalography (EEG) signals offers tremendous influence on the progression of assistive haptic rehabilitation devices. These signals are highly utilized by the academic world to ingress the functions and behavior of human motion. Though EEG controlled supporting/assistive devices have gained the consideration of people, few studies and comprehensive reviews have been done on this. Hence the goal of this paper is to examine a variety of promising recent related works to offer research gap that should be looked into further.

Heterotopic ossification (HO) refers to ectopic bone formation, typically in residual limbs following trauma and injury. A review of injuries from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) indicated that approximately 70% of war wounds involved the musculoskeletal system, largely in part from the use of improvised explosive devices (IED) and rocket-propelled grenades (RPG). HO is reported to occur in approximately 63%–65% of wounded warriors from OIF and OEF. Symptomatic HO may delay rehabilitation regimens since it often requires modifications to prosthetic limb componentry and socket size. There is limited evidence indicating a mechanism for preventing HO. This may be due to inadequate models, which do not produce HO bone structure that is morphologically similar to HO samples obtained from wounded warfighters injured in theatre. We hypothesized that using a high-power blast of air (shockwave) and simulated battlefield trauma (i.e. bone damage, tourniquet, bacteria, negative pressure wound therapy) in a large animal model, HO would form and have similar morphology to ectopic bone observed in clinical samples. Initial radiographic and micro-computed tomography (CT) data demonstrated ectopic bone growth in sheep 24 weeks post-procedure. Advanced histological and backscatter electron (BSE) analyses showed that 5 out of 8 (63%) sheep produced HO with similar morphology to clinical samples. We conclude that not all ectopic bone observed by radiograph or micro-CT in animal models is HO. Advanced histological and BSE analyses may improve confirmation of HO presence and morphology, which we demonstrated can be produced in a large animal model., Graphical abstract Unlabelled Image

Prostheses play a critical role in healthcare provision for many patients and encompass aesthetic facial prostheses, prosthetic limbs and prosthetic joints, bones, and other implantable medical devices in musculoskeletal surgery. An increasingly important component in cutting-edge healthcare treatments is the ability to accurately capture patient anatomy in order to guide the manufacture of personalized prostheses. This article examines methods for capturing patient anatomy and discusses the degrees of personalization in medical manufacturing alongside a summary of current trends in scanning technology with a focus on identifying workflows for incorporating personalization into patient-specific products. Over the next decade, with increased harmonization of both personalization and automated prosthetic manufacturing will be the realization of improved patient compliance, satisfaction, and clinical outcomes.

When a body's neural-muscle network systems are disrupted, electrical stimulation can re-establish communication. Artificial intelligence could provide further insight into how the human body works. The article summarises various ongoing research projects into targeted electrical stimulation of muscles and surgical implanting of electrodes, enabling patient rehabilitation. Specific research is described whereby artificial neurons were created that act like biological ones. These synthetic neurons can be used in bio-electronic implant devices to treat chronic diseases where they can respond in real time to demands, in the same way a healthy body's neurons do. Another research project created a communication system to mimic muscle-tendon communication and to make disconnected biological pathways active again for use with prosthetic limbs.

Objectives To identify different models of care (MOC) post transtibial amputation (TTA) and relate these to achievement of rehabilitation milestones. Design Retrospective analysis of rehabilitation milestone data and a survey of MOC in 10 vascular centres. Setting NHS Scotland vascular centres. Participants All unilateral TTA between January 2011 and December 2014 (n = 643). Main outcome measures Time (in days) to achieve the following rehabilitation milestones: compression therapy, early walking aid, casting for a prosthetic limb, prosthetic delivery, inpatient discharge and final discharge from rehabilitation. MOC were scored according to seven key aspects of service provision. Results The mean age of the cohort was 67 [standard deviation (SD) 13] years, 76% were male and 63% had peripheral arterial disease and diabetes. The median number of days to achieve rehabilitation milestones varied between centres {compression therapy six [interquartile range (IQR) 0–12], early walking aid 14 (IQR 10–27), prosthetic casting 39 (IQR 27–71), prosthetic delivery 53 (IQR 36–87), inpatient discharge 53 (IQR 29–85) and final discharge from rehabilitation 141 (IQR 92–209)}. Only two centres included all seven key aspects of service provision within their MOC. Vascular centres that achieved the optimal MOC achieved the rehabilitation milestones more quickly than other vascular centres. Conclusions A positive association was found between optimal MOC and early achievement of rehabilitation milestones post TTA. Key aspects of service provision associated with a quicker time to achieve rehabilitation milestones included: use of a postoperative rigid dressing, specialist physiotherapy input in the early postoperative period, daily inpatient gym sessions and inpatient prosthetic provision. To the authors’ knowledge, this is the first study to document MOC following TTA and to relate these to the achievement of rehabilitation milestones.

Osseointegrated (OI) prosthetic limbs have been shown to provide an advantageous treatment option for amputees. In order for the OI prosthesis to be successful, the titanium implant must rapidly achieve and maintain proper integration with the bone tissue and remain free of infection. Electrochemical methods can be utilized to control and/or monitor the interfacial microenvironment where the titanium implant interacts with the biological system (host bone tissue or bacteria). This review will summarize the current understanding of how electrochemical modalities can influence bone tissue and bacteria with specific emphasis on applications where the metallic prosthesis itself can be utilized directly as a stimulating electrode for enhanced osseointegration and infection control. In addition, a summary of electrochemical impedance sensing techniques that could be used to potentially assess osseointegration and infection status of the metallic prosthesis is presented.

Additive manufacturing used with custom electromyographic sensors has been demonstrated for neuroprosthetic limb manufacturing and is now translating to the clinical environment. These manufacturing methods have dramatically reduced device weight while increasing the capability for multi-finger dexterity. Using wearable electromyography sensors standalone from the prosthetic limb, a new virtual training method has been designed and tested to improve human–machine interaction. This type of training leverages real-time visual feedback to user inputs, supporting improved timing and magnitudes of muscle contractions. The combination of these technologies may provide a stronger affinity between the pediatric patient group and the device.

To terminate gait, the mechanical work-done by the lower-limbs is likely to be predominantly negative but how such work is produced/completed has not previously been investigated. The aim of this study was to determine the amount of negative mechanical (external) work-done by the lower-limbs, along with the associated joints (muscle) work, to terminate gait and how these work contributions were affected by a change in surface angle. Eight males completed terminations on the level floor and a declined ramp. Negative mechanical limb-work (limbW(−ve)) was computed (each orthogonal direction) as the dot-product of the ground-reaction-force and centre-of-mass (CoM) velocity. Inverse dynamics was used to calculate ankle, knee and hip negative joints (muscle) work (Wj(−ve)). Measures were determined for each limb for the two-locomotor steps of gait termination. The trailing-limb did 67% (−0.386 J/kg) of the overall limbW(−ve) to terminate gait on the level; and this increased to 74% (−0.451 J/kg) for ramp trials. Wj(−ve) was greater for the trailing- (ankle −0.315; knee −0.357; hip −0.054 J/kg) compared to terminating- limb (ankle, −0.063; knee −0.051; hip −0.014 J/kg), with the increases in ankle Wj(−ve) being temporally associated with increases in perpendicular limbW(−ve). Wj(−ve) increased on both limbs for declined compared to level surface, particularly at the knee (declined −0.357, level −0.096 J/kg), with such increases being temporally associated with increases in parallel limbW(−ve). These findings provide new perspectives on how the limbs do work on the CoM to terminate gait, and may be helpful in designing prosthetic limbs to facilitate walking on ramps.

As the demand for sensory feedback to and from prosthetic limbs becomes increasingly desirable, implantable neural interfaces are becoming more attractive. Here, we briefly review the current landscape of extra-neural electrodes for interfacing the peripheral nervous system exploring both clinical and exploratory sciences.

In this paper, we develop an Artificial Neural Networks (ANN) based softmax classifier mated to ANN sparse autoencoders to classify human's hand and lower arm movements in healthy participants utilizing muscles' Electromyography (EMG) signal datasets from [1]. We preprocess the data for the classifier in three main ways; filtering, replacing the data with its equivalent RMS value, and finally, dimension reduction using two stacked autoencoders. The classifier achieved a classification accuracy of more than 99% for the first data set with 10 moves, and more than 93% for the second data set with 26 moves. The average classification time for a single movement was 2.1 microseconds. Comparing these results to [1] we find over 7.6% classification accuracy improvement and more than 23% increase in classification speed; both improvements are essential in developing controllable prosthetic limbs.