Aabila Tharzeen 19210065

Advanced technologies for intuitive control and sensation of prosthetics

1. Introduction
The investment that the US Government made in advancing prosthetic technologies using the
funds through the Department of Defense (DoD), Department of Veterans Affairs (VA) and
National Institutes of Health (NIH) is significant. The Warfighters who risk their life for the
country should receive the highest level of care if they are injured, and the ones with limb loss
should be able to return to pre-injury levels of performance. As the available prosthetics cannot
provide intuitive control or sensory perception, the advancement in prosthetic technology is quite
important. This review article aims at expressing the interests of the DoD, VA, and NIH in
investing in the advancement of prosthetic technologies, especially in control and sensation. It
discusses about the goals of these agencies regarding improving the quality of life and
performance for Service Members, Veterans, and Civilians with limb loss.

1.1 Department of Defense

The warfighters with amputations are issued guidance to seek care in the Advanced
Rehabilitation Centers by DoD. The two main DoD agencies that are responsible for strategic
planning and execution are the US Army Medical Research and Materiel Command
(USAMRMC) and the Defense Advanced Research Projects Agency (DARPA).
1.2 Department of Veterans Affairs
The Veterans Health Administration within the Department of Veterans Affairs takes care of
Veterans with amputation [1]. The Amputee System of Care (ASoC) that provides specialized
expertise in amputation, comprises 7 Regional Amputation Centers. Through coordination and
collaboration with both Primary Care and other Specialty Care services, these amputation care
teams make sure that all medical, rehabilitation, and prosthetic needs of the Veteran are met.

1.3 National Institutes of Health

The National Institutes of Health supports research on advancing control and sensation of
prosthetic limbs and thereby aims at understanding the nature, behavior and application of
knowledge that can enhance health. NIH-funded activities focuses on attachment, weight,
actuators, sensors, power, aesthetics, and algorithms for intuitive control.

2 External systems
Active prosthetics were actuated with the power and have traditionally been controlled by human
physiological signals. In the last decade there was an advance from simple binary and sequence
controls to proportional EMG controls, fusion of EMG and IMU based methods [2,3], and
pattern recognition techniques. This helped in better execution of upper limb grasping tasks. The
limitation in using prosthetics was due to the factors such as comfort and fit of sockets. This is
being rectified by the advancement in 3D scanning and sensors embedded within sockets.

2.1 Electromyography
In electromyography (EMG), the powered upper extremity prosthetic systems are controlled
using sensors that are fabricated into the prosthetic socket that identify with specific residual
musculature. Pattern recognition systems are used to “learn” muscle activation patterns based on
trials [4]. The future work in the field of EMG is to improve high fidelity signal acquisition from
residual musculature to improve intuitive control.

2.2 Ultrasound
Ultrasound can be used to sample muscle activity from subjects with transradial amputation, the
obtained data is decoded using proprietary control algorithms, and to proportionally control a
simplistic linear movement in a virtual test [5]. Further work in this field includes optimizing the
size, power requirements, interface, and calibration.

2.3 Inertial measurement units (IMUs)

IMUs are small electronic devices that measure triaxial linear accelerations, rotational velocities,
and magnetic fields to determine spatial position and motion. IMUs have been used to control
advanced prosthetic devices, specifically the DEKA/LUKE arm. It is effective than EMG pattern
recognition for controlling the DEKA/LUKE arm for persons with transradial amputation [6].

2.4 Haptic feedback

As the external systems lack the aspect of sensation, the sense of a prosthetic limb belonging to
the body, is considered to be the key factor in recovery and prosthetic use. While the previously
mentioned control strategies are capable of only recording and not stimulating, recent advances
include the improvement of movement control using vibratory feedback [7].

3 Training
Training allows the users to utilize the advanced devices efficiently with the assistance of
Occupational Therapists and simple computer interfaces. This includes training the individual
muscles to contract with various levels of magnitude and timing and to co-contract with other
muscle groups.

4 Implanted peripheral systems

These systems involve an electrical interface to the severed peripheral nerve as well as electrodes
embedded in the residual muscles of amputees and thereby enabling bidirectional interaction
with prosthetic limbs. Through the stimulation of the peripheral nerve, sensory feedback is
provided. Researchers are developing a final system, agnostic to the prosthetic limb. Future
research includes improving longevity, reliability and resolution of the interface.

5 Brain–machine interfaces
Bidirectional brain–machine interfaces (BMIs) for prosthetic limbs involve translating neural
activity from the brain, and stimulating the brain to provide relevant sensory feedback [8]. With
regard to sensation, it is able to correlate to locations on the amputated limb which is a valuable
feedback to the user about his or her interaction with the environment.

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6 Surgical techniques and osseointegration
Targeted muscle reinnervation (TMR), regenerative peripheral nerve interface (RPNI), agonist–
antagonist myoneural interface (AMI), osseointegrated neural interface (ONI) are some of the
surgical techniques that provide unique advantages to neural interfaces for prosthetics [9]. These
allows to eliminate the need for some implanted components like batteries and transcutaneous
inductive charging coils.

7 Regenerative techniques
Regenerative techniques such as a tissue-engineered electronic nerve interface, (TEENI) and
sieve electrode designs increases the dimensionality of peripheral neural interface [10]. TEENI
encourages mechanically compatibility and sieve has a potential use for both simulation and
recording.

8 Discussion
The US Government, specifically the DoD, VA, and NIH have invested research and
development funding towards the advancement of intuitive control and sensation of prosthetics.
The overall objective of these agencies include the improvement of quality of living of people
with limb loss. Several federal agencies have also supported the development of large centers
across the country create quick changes through impactful researches. Though significant
advances has been made, there are still gaps in adopting the prosthetic system due to
technological and data transfer fidelity. Collaboration between different agencies will continue to
ensure that the goal to restore quality of life of the people with limb loss can be achieved
quickly.

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Reference
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