Measuring embodiment: A review of methods for prosthetic devices.

The development of neural interfaces to provide improved control and somatosensory feedback from prosthetic limbs has initiated a new ability to probe the various dimensions of embodiment. Scientists in the field of neuroprosthetics require dependable measures of ownership, body representation, and agency to quantify the sense of embodiment felt by patients for their prosthetic limbs. These measures are critical to perform generalizable experiments and compare the utility of the new technologies being developed. Here, we review outcome measures used in the literature to evaluate the senses of ownership, body-representation, and agency. We categorize these existing measures based on the fundamental psychometric property measured and whether it is a behavioral or physiological measure. We present arguments for the efficacy and pitfalls of each measure to guide better experimental designs and future outcome measure development. The purpose of this review is to aid prosthesis researchers and technology developers in understanding the concept of embodiment and selecting metrics to assess embodiment in their research. Advances in the ability to measure the embodiment of prosthetic devices have far-reaching implications in the improvement of prosthetic limbs as well as promoting a broader understanding of ourselves as embodied agents.

Cellulose-acetate coating of carbon cloth diffusion layer for liquid-fed fuel cell applications.

Direct glucose fuel cells (DGFCs) and direct methanol fuel cells (DMFCs) commonly supply the reducing agent in liquid (aq.) form. In this work, we present key characteristics of implementing cellulose acetate (CA) coatings, which can subsequently be deacetylated toward cellulose, on carbon cloth used as a fuel diffusion layer in aqueous fuel-fed cells. Specifically, we illustrate functionality with an abiotic glucose fuel cell. Carbon cloth with and without a CA coating (with varying deacetylation) was characterized in terms of liquid permeation rate, electronic conductivity, and roll-off angle wetting characteristics. Additionally, fuel cell power production was measured over a variety of fuel concentrations and alkalinities by generating polarization curve data. These coatings facilitated a significant increase in aqueous solution permeation and adhesion properties, as well as providing up to two-fold increases in maximum power generation in an alkaline DGFC, despite experiencing some decreased conductivity of the carbon cloth diffusion layer.

Structural validity and reliability of the patient experience measure: A new approach to assessing psychosocial experience of upper limb prosthesis users.

Recent advances in upper limb prosthetics include sensory restoration techniques and osseointegration technology that introduce additional risks, higher costs, and longer periods of rehabilitation. To inform regulatory and clinical decision making, validated patient reported outcome measures are required to understand the relative benefits of these interventions. The Patient Experience Measure (PEM) was developed to quantify psychosocial outcomes for research studies on sensory-enabled upper limb prostheses. While the PEM was responsive to changes in prosthesis experience in prior studies, its psychometric properties had not been assessed. Here, the PEM was examined for structural validity and reliability across a large sample of people with upper limb loss (n = 677). The PEM was modified and tested in three phases: initial refinement and cognitive testing, pilot testing, and field testing. Exploratory factor analysis (EFA) was used to discover the underlying factor structure of the PEM items and confirmatory factor analysis (CFA) verified the structure. Rasch partial credit modeling evaluated monotonicity, fit, and magnitude of differential item functioning by age, sex, and prosthesis use for all scales. EFA resulted in a seven-factor solution that was reduced to the following six scales after CFA: social interaction, self-efficacy, embodiment, intuitiveness, wellbeing, and self-consciousness. After removal of two items during Rasch analyses, the overall model fit was acceptable (CFI = 0.973, TLI = 0.979, RMSEA = 0.038). The social interaction, self-efficacy and embodiment scales had strong person reliability (0.81, 0.80 and 0.77), Cronbach's alpha (0.90, 0.80 and 0.71), and intraclass correlation coefficients (0.82, 0.85 and 0.74), respectively. The large sample size and use of contemporary measurement methods enabled identification of unidimensional constructs, differential item functioning by participant characteristics, and the rank ordering of the difficulty of each item in the scales. The PEM enables quantification of critical psychosocial impacts of advanced prosthetic technologies and provides a rigorous foundation for future studies of clinical and prosthetic interventions.

Comparison of Myoelectric Control Schemes for Simultaneous Hand and Wrist Movement using Chronically Implanted Electromyography: A Case Series.

OBJECTIVE: A current biomedical engineering challenge is the development of a system that allows fluid control of multi-functional prosthetic devices through a human-machine interface. Here we probe this challenge by studying two subjects with trans-radial limb loss as they control a virtual hand and wrist system using 6 or 8 chronically implanted intramuscular electromyographic (iEMG) signals. The subjects successfully controlled a 4, 5, and 6 Degrees of Freedom (DoF's) virtual hand and wrist systems to perform a target matching task. APPROACH: Two control systems were evaluated where one tied EMG features directly to movement directions (Direct Control) and the other method determines user intent in the context of prior training data (Linear Interpolation). MAIN RESULTS: Subjects successfully matched most targets with both controllers but differences were seen as the complexity of the virtual limb system increased. The Direct Control method encountered difficulty due to crosstalk at higher DoF's. The Linear Interpolation method reduced crosstalk effects and outperformed Direct Control at higher DoF's. This work also studied the use of the Postural Control Algorithm to control the hand postures simultaneously with wrist degrees of freedom. SIGNIFICANCE: This work presents preliminary evidence that the PC algorithm can be used in conjunction with wrist control, that Direct Control with iEMG signals allows stable 4-DoF control, and that EMG pre-processing using the Linear Interpolation method can improve performance at 5 and 6-DoF's.

A Bionic Hand for Semi-Autonomous Fragile Object Manipulation via Proximity and Pressure Sensors.

Multiarticulate bionic hands are now capable of recreating the endogenous movements and grip patterns of the human hand, yet amputees continue to be dissatisfied with existing control strategies. One approach towards more dexterous and intuitive control is to create a semi-autonomous bionic hand that can synergistically aid a human with complex tasks. To that end, we have developed a bionic hand that can automatically detect and grasp nearby objects with minimal force using multi-modal fingertip sensors. We evaluated performance using a fragile-object task in which participants must move an object over a barrier without applying pressure above specified thresholds. Participants completed the task under three conditions: 1) with their native hand, 2) with the bionic hand using surface electromyography control, and 3) using the semi-autonomous bionic hand. We show that the semi-autonomous hand is extremely capable of completing this dexterous task and significantly outperforms a more traditional surface-electromyography controller. Furthermore, we show that the semi-autonomous bionic hand significantly increased users' grip precision and reduced users' perceived task workload. This work constitutes an important step towards more dexterous and intuitive bionic hands and serves as a foundation for future work on shared human-machine control for intelligent bionic systems.

The Point Digit II: Mechanical Design and Testing of a Ratcheting Prosthetic Finger.

INTRODUCTION: People with partial hand loss represent the largest population of upper limb amputees by a factor of 10. The available prosthetic componentry for people with digit loss provide various methods of control, kinematic designs, and functional abilities. Here, the Point Digit II is empirically tested and a discussion is provided comparing the Point Digit II with the existing commercially available prosthetic fingers. MATERIALS AND METHODS: Benchtop mechanical tests were performed using prototype Point Digit II prosthetic fingers. The battery of tests included a static load test, a static mounting tear-out test, a dynamic load test, and a dynamic cycle test. These tests were implemented to study the mechanisms within the digit and the ability of the device to withstand heavy-duty use once out in the field. RESULTS: The Point Digit II met or exceeded all geometric and mechanical specifications. The device can withstand over 300 lbs of force applied to the distal phalange and was cycled over 250,000 times without an adverse event representing 3 years of use. Multiple prototypes were utilized across all tests to confirm the ability to reproduce the device in a reliable manner. CONCLUSIONS: The Point Digit II presents novel and exciting features to help those with partial hand amputation return to work and regain ability. The use of additive manufacturing, unique mechanism design, and clinically relevant design features provides both the patient and clinician with a prosthetic digit, which improves upon the existing devices available.

A Myoelectric Postural Control Algorithm for Persons With Transradial Amputations: A Consideration of Clinical Readiness.

BACKGROUND: The bottleneck in upper limb prosthetic design is the myoelectric control algorithm. Here we studied the clinical readiness of the myoelectric postural control algorithm in a laboratory setting with two trans-radial amputees using a commercially available prosthetic limb system. TECHNIQUE: The postural control algorithm was integrated into prosthetic limb systems using standard of care components. A comparison between a commercial state of the art system (the i-limb revolution state-based myoelectric controller) and the postural controller was performed with two people with trans-radial amputation using a self-contained prosthesis system. DISCUSSION: The performance using the i-limb revolution state-based controller versus the postural controller was mixed based on the Southampton Hand Assessment Procedure. The SHAP scores indicate that the postural controller with i-limb revolution provided an average of 66% of hand function compared to an intact limb. Future work will study the advantages of the postural control algorithm in everyday use.

Combination of Simultaneous Artificial Sensory Percepts to Identify Prosthetic Hand Postures: A Case Study.

Multiple sources of sensory information are combined to develop hand posture percepts in the intact system, but the combination of multiple artificial somatosensory percepts by human prosthesis users has not been studied. Here, we report on a case study in which a person with transradial amputation identified prosthetic hand postures using artificial somatosensory feedback. He successfully combined five artificial somatosensory percepts to achieve above-chance performance of 95.0% and 75.7% in identifying four and seven postures, respectively. We studied how artificial somatosensation and the extant hand representation are combined in the decision-making process by providing two mappings between the prosthetic sensor and the location of the sensory percept: (1) congruent, and (2) incongruent. The participant's ability to combine and engage with the sensory feedback significantly differed between the two conditions. The participant was only able to successfully generalize prior knowledge to novel postures in the congruent mapping. Further, he learned postures more accurately and quickly in the congruent mapping. Finally, he developed an understanding of the relationships between postures in the congruent mapping instead of simply memorizing each individual posture. These experimental results are corroborated by a Bayesian decision-making model which tracked the participant's learning.

Design of a High-Speed Prosthetic Finger Driven by Peano-HASEL Actuators.

Current designs of powered prosthetic limbs are limited by the nearly exclusive use of DC motor technology. Soft actuators promise new design freedom to create prosthetic limbs which more closely mimic intact neuromuscular systems and improve the capabilities of prosthetic users. This work evaluates the performance of a hydraulically amplified self-healing electrostatic (HASEL) soft actuator for use in a prosthetic hand. We compare a linearly-contracting HASEL actuator, termed a Peano-HASEL, to an existing actuator (DC motor) when driving a prosthetic finger like those utilized in multi-functional prosthetic hands. A kinematic model of the prosthetic finger is developed and validated, and is used to customize a prosthetic finger that is tuned to complement the force-strain characteristics of the Peano-HASEL actuators. An analytical model is used to inform the design of an improved Peano-HASEL actuator with the goal of increasing the fingertip pinch force of the prosthetic finger. When compared to a weight-matched DC motor actuator, the Peano-HASEL and custom finger is 10.6 times faster, has 11.1 times higher bandwidth, and consumes 8.7 times less electrical energy to grasp. It reaches 91% of the maximum range of motion of the original finger. However, the DC motor actuator produces 10 times the fingertip force at a relevant grip position. In this body of work, we present ways to further increase the force output of the Peano-HASEL driven prosthetic finger system, and discuss the significance of the unique properties of Peano-HASELs when applied to the field of upper-limb prosthetic design. This approach toward clinically-relevant actuator performance paired with a substantially different form-factor compared to DC motors presents new opportunities to advance the field of prosthetic limb design.

Real-Time Prosthetic Digit Actuation by Optical Read-out of Activity-Dependent Calcium Signals in an Ex Vivo Peripheral Nerve.

Improved neural interfacing strategies are needed for the full articulation of advanced prostheses. To address limitations of existing control interface designs, the work of our laboratory has presented an optical approach to reading activity from individual nerve fibers using activity-dependent calcium transients. Here, we demonstrate the feasibility of such signals to control prosthesis actuation by using the axonal fluorescence signal in an ex vivo mouse nerve to drive a prosthetic digit in real-time. Additionally, signals of varying action potential frequency are streamed post hoc to the prosthesis, showing graded motor output and the potential for proportional neural control. This proof-of-concept work is a novel demonstration of the functional use of activity-dependent optical read-out in the nerve.

Functional Assessment of a Myoelectric Postural Controller and Multi-Functional Prosthetic Hand by Persons With Trans-Radial Limb Loss.

The functional assessment of myoelectric control algorithms by persons with amputation promotes the overarching goal of the field of prosthetic limb design: to replace what was lost. However, many studies use experimental paradigms with virtual interfaces and able-bodied subjects that do not capture the challenges of a clinical implementation with an amputee population. A myoelectric control system must be robust to variable physiology, loading effects of the prosthesis on the limb, and limb position effects during dynamic tasks. Here persons with transradial limb loss performed activities of daily living using a postural controller and multi-functional prosthetic hand in order to verify that the postural controller was robust to these clinical challenges. The Southampton Hand Assessment Procedure was performed by persons with limb loss and able-bodied subjects. The results indicate that persons with limb loss and able-limbed subjects achieved the same performance and therefore that the clinical challenges were overcome. Persons with limb loss achieved 55% of physiological hand function on average. Also, the postural controller is compared to other state of the art myoelectric controllers and prosthetic hands previously tested. This work confirms that the postural controller is potentially a clinically-viable method to control myoelectric multi-functional prosthetic hands.

Novel postural control algorithm for control of multifunctional myoelectric prosthetic hands.

The myoelectric controller (MEC) remains a technological bottleneck in the development of multifunctional prosthetic hands. Current MECs require physiologically inappropriate commands to indicate intent and lack effectiveness in a clinical setting. Postural control schemes use surface electromyography signals to drive a cursor in a continuous two-dimensional domain that is then transformed into a hand posture. Here, we present a novel algorithm for a postural controller and test the efficacy of the system during two experiments with 11 total subjects. In the first experiment, we found that performance increased when a velocity cursor-control technique versus a position cursor-control technique was used. Also, performance did not change when using 3, 4, or 12 surface electrodes. In the second experiment, subjects commanded a six degree-of-freedom virtual hand into seven functional postures without training, with completion rates of 82 +/- 4%, movement times of 3.5 +/- 0.2 s, and path efficiencies of 45 +/- 3%. Subjects retained the ability to use the postural controller at a high level across days after a single 1 hr training session. Our results substantiate the novel algorithm for a postural controller as a robust and advantageous design for a MEC of multifunction prosthetic hands.

Humans can integrate feedback of discrete events in their sensorimotor control of a robotic hand.

Providing functionally effective sensory feedback to users of prosthetics is a largely unsolved challenge. Traditional solutions require high band-widths for providing feedback for the control of manipulation and yet have been largely unsuccessful. In this study, we have explored a strategy that relies on temporally discrete sensory feedback that is technically simple to provide. According to the Discrete Event-driven Sensory feedback Control (DESC) policy, motor tasks in humans are organized in phases delimited by means of sensory encoded discrete mechanical events. To explore the applicability of DESC for control, we designed a paradigm in which healthy humans operated an artificial robot hand to lift and replace an instrumented object, a task that can readily be learned and mastered under visual control. Assuming that the central nervous system of humans naturally organizes motor tasks based on a strategy akin to DESC, we delivered short-lasting vibrotactile feedback related to events that are known to forcefully affect progression of the grasp-lift-and-hold task. After training, we determined whether the artificial feedback had been integrated with the sensorimotor control by introducing short delays and we indeed observed that the participants significantly delayed subsequent phases of the task. This study thus gives support to the DESC policy hypothesis. Moreover, it demonstrates that humans can integrate temporally discrete sensory feedback while controlling an artificial hand and invites further studies in which inexpensive, noninvasive technology could be used in clever ways to provide physiologically appropriate sensory feedback in upper limb prosthetics with much lower band-width requirements than with traditional solutions.

Dexterous control of a prosthetic hand using fine-wire intramuscular electrodes in targeted extrinsic muscles.

Restoring dexterous motor function equivalent to that of the human hand after amputation is one of the major goals in rehabilitation engineering. To achieve this requires the implementation of a effortless human-machine interface that bridges the artificial hand to the sources of volition. Attempts to tap into the neural signals and to use them as control inputs for neuroprostheses range in invasiveness and hierarchical location in the neuromuscular system. Nevertheless today, the primary clinically viable control technique is the electromyogram measured peripherally by surface electrodes. This approach is neither physiologically appropriate nor dexterous because arbitrary finger movements or hand postures cannot be obtained. Here we demonstrate the feasibility of achieving real-time, continuous and simultaneous control of a multi-digit prosthesis directly from forearm muscles signals using intramuscular electrodes on healthy subjects. Subjects contracted physiologically appropriate muscles to control four degrees of freedom of the fingers of a physical robotic hand independently. Subjects described the control as intuitive and showed the ability to drive the hand into 12 postures without explicit training. This is the first study in which peripheral neural correlates were processed in real-time and used to control multiple digits of a physical hand simultaneously in an intuitive and direct way.

Comparative study of state-of-the-art myoelectric controllers for multigrasp prosthetic hands.

A myoelectric controller should provide an intuitive and effective human-machine interface that deciphers user intent in real-time and is robust enough to operate in daily life. Many myoelectric control architectures have been developed, including pattern recognition systems, finite state machines, and more recently, postural control schemes. Here, we present a comparative study of two types of finite state machines and a postural control scheme using both virtual and physical assessment procedures with seven nondisabled subjects. The Southampton Hand Assessment Procedure (SHAP) was used in order to compare the effectiveness of the controllers during activities of daily living using a multigrasp artificial hand. Also, a virtual hand posture matching task was used to compare the controllers when reproducing six target postures. The performance when using the postural control scheme was significantly better (p < 0.05) than the finite state machines during the physical assessment when comparing within-subject averages using the SHAP percent difference metric. The virtual assessment results described significantly greater completion rates (97% and 99%) for the finite state machines, but the movement time tended to be faster (2.7 s) for the postural control scheme. Our results substantiate that postural control schemes rival other state-of-the-art myoelectric controllers.

Design and validation of a morphing myoelectric hand posture controller based on principal component analysis of human grasping.

An ideal myoelectric prosthetic hand should have the ability to continuously morph between any posture like an anatomical hand. This paper describes the design and validation of a morphing myoelectric hand controller based on principal component analysis of human grasping. The controller commands continuously morphing hand postures including functional grasps using between two and four surface electromyography (EMG) electrodes pairs. Four unique maps were developed to transform the EMG control signals in the principal component domain. A preliminary validation experiment was performed by 10 nonamputee subjects to determine the map with highest performance. The subjects used the myoelectric controller to morph a virtual hand between functional grasps in a series of randomized trials. The number of joints controlled accurately was evaluated to characterize the performance of each map. Additional metrics were studied including completion rate, time to completion, and path efficiency. The highest performing map controlled over 13 out of 15 joints accurately.

Mechanical design and performance specifications of anthropomorphic prosthetic hands: a review.

In this article, we set forth a detailed analysis of the mechanical characteristics of anthropomorphic prosthetic hands. We report on an empirical study concerning the performance of several commercially available myoelectric prosthetic hands, including the Vincent, iLimb, iLimb Pulse, Bebionic, Bebionic v2, and Michelangelo hands. We investigated the finger design and kinematics, mechanical joint coupling, and actuation methods of these commercial prosthetic hands. The empirical findings are supplemented with a compilation of published data on both commercial and prototype research prosthetic hands. We discuss numerous mechanical design parameters by referencing examples in the literature. Crucial design trade-offs are highlighted, including number of actuators and hand complexity, hand weight, and grasp force. Finally, we offer a set of rules of thumb regarding the mechanical design of anthropomorphic prosthetic hands.