Combining Surgical Innovations in Amputation Surgery-Robotic Harvest of the Rectus Abdominis Muscle, Transplantation and Targeted Muscle Reinnervation Improves Myocontrol Capability and Pain in a Transradial Amputee.

Adding robotic surgery to bionic reconstruction might open a new dimension. The objective was to evaluate if a robotically harvested rectus abdominis (RA) transplant is a feasible procedure to improve soft-tissue coverage at the residual limb (RL) and serve as a recipient for up to three nerves due to its unique architecture and to allow the generation of additional signals for advanced myoelectric prosthesis control. A transradial amputee with insufficient soft-tissue coverage and painful neuromas underwent the interventions and was observed for 18 months. RA muscle was harvested using robotic-assisted surgery and transplanted to the RL, followed by end-to-end neurroraphy to the recipient nerves of the three muscle segments to reanimate radial, median, and ulnar nerve function. The transplanted muscle healed with partial necrosis of the skin mesh graft. Twelve months later, reliable, and spatially well-defined Hoffmann-Tinel signs were detectable at three segments of the RA muscle flap. No donor-site morbidities were present, and EMG activity could be detected in all three muscle segments. The linear discriminant analysis (LDA) classifier could reliably distinguish three classes within 1% error tolerance using only the three electrodes on the muscle transplant and up to five classes outside the muscle transplant. The combination of these surgical procedure advances with emerging (myo-)control technologies can easily be extended to different amputation levels to reduce RL complications and augment control sites with a limited surface area, thus facilitating the usability of advanced myoelectric prostheses.

Longitudinal Case Study of Regression-Based Hand Prosthesis Control in Daily Life.

Hand prostheses are usually controlled by electromyographic (EMG) signals from the remnant muscles of the residual limb. Most prostheses used today are controlled with very simple techniques using only two EMG electrodes that allow to control a single prosthetic function at a time only. Recently, modern prosthesis controllers based on EMG classification, have become clinically available, which allow to directly access more functions, but still in a sequential manner only. We have recently shown in laboratory tests that a regression-based mapping from EMG signals into prosthetic control commands allows for a simultaneous activation of two functions and an independent control of their velocities with high reliability. Here we aimed to study how such regression-based control performs in daily life in a two-month case study. The performance is evaluated in functional tests and with a questionnaire at the beginning and the end of this phase and compared with the participant's own prosthesis, controlled with a classical approach. Already 1 day after training of the regression model, the participant with transradial amputation outperformed the performance achieved with his own Michelangelo hand in two out of three functional metrics. No retraining of the model was required during the entire study duration. During the use of the system at home, the performance improved further and outperformed the conventional control in all three metrics. This study demonstrates that the high fidelity of linear regression-based prosthesis control is not restricted to a laboratory environment, but can be transferred to daily use.

Adaptive Auto-Regressive Proportional Myoelectric Control.

In proportional myographic control, one can control either position or velocity of movement. Here, we propose to use adaptive auto-regressive filters, so as to gradually adjust between the two. We implemented this in an adaptive system with closed-loop feedback, where both the user and the machine simultaneously attempt to follow a cursor on a 2-D arena. We tested this on 15 able-bodied and three limb-deficient participants using an eight-channel myoelectric armband. The human-machine pairs learn to perform smoother cursor movements with a larger range of motion when using the auto-regressive filters, as compared with our previous effortswithmoving-average filters. Importantly, the human-machine system converges to an approximate velocity control strategy resulting in faster and more accuratemovements with lessmuscle effort. The method is not specific tomyoelectriccontroland could be used equally well for motion control using high-dimensional signals from reinnervatedmuscles or direct brain recordings.

A Classification Method for Myoelectric Control of Hand Prostheses Inspired by Muscle Coordination.

Dexterous upper limb myoelectric prostheses can, to some extent, restore the motor functions lost after an amputation. However, ensuring the reliability of myoelectric control is still an open challenge. In this paper, we propose a classification method that exploits the regularity in muscle activation patterns (uniform scaling) across different force levels within a given movement class. This assumption leads to a simple training procedure, using training data collected at single contraction intensity for each movement class. The proposed method was compared to the widely accepted benchmark [linear discriminant analysis (LDA) classifier] using off-line and online evaluation. The off-line classification errors obtained with the new method were either lower or higher than LDA depending upon the chosen feature set. In the online evaluation, the new classification method was operated using amplitude-EMG features and compared to the state-of-the-art LDA classifier combined with the time domain feature set. The online evaluation was performed in 11 able-bodied and one amputee subject using a set of four functional tasks mimicking daily-life activities. The tasks assessed the dexterity (e.g., switching between functions) and robustness of control (e.g., handling heavy objects). With the new classification scheme, the amputee performed better in all functional tasks, whereas the able-bodied subjects performed significantly better in three out of four functional tasks. Overall, the novel method outperformed the state-of-the-art approach (LDA) while utilizing less training data and a smaller feature set. The proposed method is, therefore, a simple but effective and robust classification scheme, convenient for online implementation and clinical use.

Simultaneous control of multiple functions of bionic hand prostheses: Performance and robustness in end users.

Myoelectric hand prostheses are usually controlled with two bipolar electrodes located on the flexor and extensor muscles of the residual limb. With clinically established techniques, only one function can be controlled at a time. This is cumbersome and limits the benefit of additional functions offered by modern prostheses. Extensive research has been conducted on more advanced control techniques, but the clinical impact has been limited, mainly due to the lack of reliability in real-world conditions. We implemented a regression-based control approach that allows for simultaneous and proportional control of two degrees of freedom and evaluated it on five prosthetic end users. In the evaluation of tasks mimicking daily life activities, we included factors that limit reliability, such as tests in different arm positions and on different days. The regression approach was robust over multiple days and only slightly affected by changing in the arm position. Additionally, the regression approach outperformed two clinical control approaches in most conditions.

Context-dependent adaptation improves robustness of myoelectric control for upper-limb prostheses.

OBJECTIVE: Dexterous upper-limb prostheses are available today to restore grasping, but an effective and reliable feed-forward control is still missing. The aim of this work was to improve the robustness and reliability of myoelectric control by using context information from sensors embedded within the prosthesis. APPROACH: We developed a context-driven myoelectric control scheme (cxMYO) that incorporates the inference of context information from proprioception (inertial measurement unit) and exteroception (force and grip aperture) sensors to modulate the outputs of myoelectric control. Further, a realistic evaluation of the cxMYO was performed online in able-bodied subjects using three functional tasks, during which the cxMYO was compared to a purely machine-learning-based myoelectric control (MYO). MAIN RESULTS: The results demonstrated that utilizing context information decreased the number of unwanted commands, improving the performance (success rate and dropped objects) in all three functional tasks. Specifically, the median number of objects dropped per round with cxMYO was zero in all three tasks and a significant increase in the number of successful transfers was seen in two out of three functional tasks. Additionally, the subjects reported better user experience. SIGNIFICANCE: This is the first online evaluation of a method integrating information from multiple on-board prosthesis sensors to modulate the output of a machine-learning-based myoelectric controller. The proposed scheme is general and presents a simple, non-invasive and cost-effective approach for improving the robustness of myoelectric control.

User adaptation in Myoelectric Man-Machine Interfaces.

State of the art clinical hand prostheses are controlled in a simple and limited way that allows the activation of one function at a time. More advanced laboratory approaches, based on machine learning, offer a significant increase in functionality, but their clinical impact is limited, mainly due to lack of reliability. In this study, we analyse two conceptually different machine learning approaches, focusing on their robustness and performance in a closed loop application. A classification (finite number of classes) and a regression (continuous mapping) based projection of EMG into external commands were applied while artificially introducing non-stationarities in the EMG signals. When tested on ten able-bodied individuals and one transradial amputee, the two methods were similarly influenced by non-stationarities when tested offline. However, in online tests, where the user could adapt his muscle activation patterns to the changed conditions, the regression-based approach was significantly less influenced by the changes in signal features than the classification approach. This observation demonstrates, on the one hand, the importance of online tests with users in the loop for assessing the performance of myocontrol approaches. On the other hand, it also demonstrates that regression allows for a better user correction of control commands than classification.

A Novel Percutaneous Electrode Implant for Improving Robustness in Advanced Myoelectric Control.

Despite several decades of research, electrically powered hand and arm prostheses are still controlled with very simple algorithms that process the surface electromyogram (EMG) of remnant muscles to achieve control of one prosthetic function at a time. More advanced machine learning methods have shown promising results under laboratory conditions. However, limited robustness has largely prevented the transfer of these laboratory advances to clinical applications. In this paper, we introduce a novel percutaneous EMG electrode to be implanted chronically with the aim of improving the reliability of EMG detection in myoelectric control. The proposed electrode requires a minimally invasive procedure for its implantation, similar to a cosmetic micro-dermal implant. Moreover, being percutaneous, it does not require power and data telemetry modules. Four of these electrodes were chronically implanted in the forearm of an able-bodied human volunteer for testing their characteristics. The implants showed significantly lower impedance and greater robustness against mechanical interference than traditional surface EMG electrodes used for myoelectric control. Moreover, the EMG signals detected by the proposed systems allowed more stable control performance across sessions in different days than that achieved with classic EMG electrodes. In conclusion, the proposed implants may be a promising interface for clinically available prostheses.

Improving the Robustness of Myoelectric Pattern Recognition for Upper Limb Prostheses by Covariate Shift Adaptation.

Fundamental changes over time of surface EMG signal characteristics are a challenge for myocontrol algorithms controlling prosthetic devices. These changes are generally caused by electrode shifts after donning and doffing, sweating, additional weight or varying arm positions, which results in a change of the signal distribution-a scenario often referred to as covariate shift. A substantial decrease in classification accuracy due to these factors hinders the possibility to directly translate EMG signals into accurate myoelectric control patterns outside laboratory conditions. To overcome this limitation, we propose the use of supervised adaptation methods. The approach is based on adapting a trained classifier using a small calibration set only, which incorporates the relevant aspects of the nonstationarities, but requires only less than 1 min of data recording. The method was tested first through an offline analysis on signals acquired across 5 days from seven able-bodied individuals and four amputees. Moreover, we also conducted a three day online experiment on eight able-bodied individuals and one amputee, assessing user performance and user-ratings of the controllability. Across different testing days, both offline and online performance improved significantly when shrinking the training model parameters by a given estimator towards the calibration set parameters. In the offline data analysis, the classification accuracy remained above 92% over five days with the proposed approach, whereas it decreased to 75% without adaptation. Similarly, in the online study, with the proposed approach the performance increased by 25% compared to a test without adaptation. These results indicate that the proposed methodology can contribute to improve robustness of myoelectric pattern recognition methods in daily life applications.

Concurrent Adaptation of Human and Machine Improves Simultaneous and Proportional Myoelectric Control.

Myoelectric control of a prosthetic hand with more than one degree of freedom (DoF) is challenging, and clinically available techniques require a sequential actuation of the DoFs. Simultaneous and proportional control of multiple DoFs is possible with regression-based approaches allowing for fluent and natural movements. Conventionally, the regressor is calibrated in an open-loop with training based on recorded data and the performance is evaluated subsequently. For individuals with amputation or congenital limb-deficiency who need to (re)learn how to generate suitable muscle contractions, this open-loop process may not be effective. We present a closed-loop real-time learning scheme in which both the user and the machine learn simultaneously to follow a common target. Experiments with ten able-bodied individuals show that this co-adaptive closed-loop learning strategy leads to significant performance improvements compared to a conventional open-loop training paradigm. Importantly, co-adaptive learning allowed two individuals with congenital deficiencies to perform simultaneous 2-D proportional control at levels comparable to the able-bodied individuals, despite having to a learn completely new and unfamiliar mapping from muscle activity to movement trajectories. To our knowledge, this is the first study which investigates man-machine co-adaptation for regression-based myoelectric control. The proposed training strategy has the potential to improve myographic prosthetic control in clinically relevant settings.

Covariate shift adaptation in EMG pattern recognition for prosthetic device control.

Ensuring robustness of myocontrol algorithms for prosthetic devices is an important challenge. Robustness needs to be maintained under nonstationarities, e.g. due to electrode shifts after donning and doffing, sweating, additional weight or varying arm positions. Such nonstationary behavior changes the signal distributions - a scenario often referred to as covariate shift. This circumstance causes a significant decrease in classification accuracy in daily life applications. Re-training is possible but it is time consuming since it requires a large number of trials. In this paper, we propose to adapt the EMG classifier by a small calibration set only, which is able to capture the relevant aspects of the nonstationarities, but requires re-training data of only very short duration. We tested this strategy on signals acquired across 5 days in able-bodied individuals. The results showed that an estimator that shrinks the training model parameters towards the calibration set parameters significantly increased the classifier performance across different testing days. Even when using only one trial per class as re-training data for each day, the classification accuracy remained > 92% over five days. These results indicate that the proposed methodology can be a practical means for improving robustness in pattern recognition methods for myocontrol.