RESUMEN
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).
Asunto(s)
Amputados , Miembros Artificiales , Humanos , Amputación Quirúrgica , Amputados/psicología , Calidad de Vida , Extremidad SuperiorRESUMEN
The main requirement for an amputee is to regain the function of the lost limb. In order to fully benefit from powered prosthetic legs, the user must rely on the dynamic control of the device. Progress in high-level control for powered prosthetic legs is currently challenged by the inability of current control schemes to generalize to large repertoires of movements as well as adapting to external mechanical demands. This ultimately leads the user to adopt compensatory movements, lack of comfort, higher energy requirements during walking and standing. This study uses a feedforward model of muscle activation and force generation that applies mathematical formulations of muscle synergies to generate synthetic activation profiles underlying walking across different speeds. Estimated activation profiles are used to drive forward subject-specific numerical models of the lower extremity musculoskeletal system. The model was validated on one individual with uni-lateral transtibial amputation and its predictions were compared to experimental torques from inverse dynamic calculations. Results showed that a generic muscle synergy driven personalized musculoskeletal model can fit the ankle torques of the intact limb of a person with transtibial amputation (RMSD = 0.1329±0.02). The estimated moments might be suitable as the control signal to drive powered prostheses to ultimately improve physical interaction between the user and a powered prostheses during dynamic motor tasks.
Asunto(s)
Amputación Quirúrgica , Velocidad al Caminar , Humanos , Fenómenos Biomecánicos , Pierna/fisiología , Articulación del Tobillo/fisiología , MúsculosRESUMEN
When faced with a novel object, we explore it to understand its shape. This way we combine information coming from different senses, as touch, proprioception and vision, together with the motor information embedded in our motor execution plan. The exploration process provides a structure and constrains this rich flow of inputs, supporting the formation of a unified percept and the memorization of the object features. However, how the exploration strategies are planned is still an open question. In particular, is the exploration strategy used to memorize an object different from the exploration strategy adopted in a recall task? To address this question we used iCube, a sensorized cube which measures its orientation in space and the location of the contacts on its faces. Participants were required to explore the cube faces where little pins were positioned in varying number. Participants had to explore the cube twice and individuate potential differences between the two presentations, which could be performed either haptically alone, or with also vision available. The haptic and visuo-haptic (VH) exploratory strategies changed significantly when finalized to memorize the structure of the object with respect to when the same object was explored to recall and compare it with its memorized instance. These findings indicate that exploratory strategies are adapted not only to the property of the object to be analyzed but also to the prospective use of the resulting representation, be it memorization or recall. The results are discussed in light of the possibility of a systematic modeling of natural VH exploration strategies.