Journal of Bionic Engineering

https://doi.org/10.1007/s42235-022-00169-1

REVIEW ARTICLE

Intelligent Knee Prostheses: A Systematic Review of Control Strategies

Linrong Li1,2,3 · Xiaoming Wang1,2,3 · Qiaoling Meng1,2,3 · Changlong Chen1,2,3 · Jie Sun1,2,3 · Hongliu Yu1,2,3 

Received: 1 November 2021 / Revised: 19 January 2022 / Accepted: 21 January 2022

© Jilin University 2022

Abstract
The intelligent knee prosthesis is capable of human-like bionic lower limb control through advanced control systems and
artificial intelligence algorithms that will potentially minimize gait limitations for above-knee amputees and facilitate their
reintegration into society. In this paper, we sum up the control strategies corresponding to the prevailing control objectives
(position and impedance) of the current intelligent knee prosthesis. Although these control strategies have been successfully
implemented and validated in relevant experiments, the existing deficiencies still fail to achieve optimal performance of the
controllers, which complicates the definition of a standard control method. Before a mature control system can be developed,
it is more important to realize the full potential for the control strategy, which requires upgrading and refining the relevant
key technologies based on the existing control methods. For this reason, we discuss potential areas for improvement of the
prosthetic control system based on the summarized control strategies, including intent recognition, sensor system, prosthetic
evaluation, and parameter optimization algorithms, providing future directions toward optimizing control strategies for the
next generation of intelligent knee prostheses.

Keywords  Intelligent knee prosthesis · Finite-state machine · Volitional control · Sensor system · Intent recognition ·
Parameter tuning

1 Introduction cylinders with springs to simulate the damping and stiffness

The knee joint is flexed and extended in the sagittal plane
around the horizontal axis during daily walking in healthy
people, which requires the coordination of muscles, bones,
ligaments, and other parts. Above-knee amputations result
in inevitable distress for patients with a lack of function such
as walking, and standing [1]. The prosthetic wear remains
the most straightforward way to facilitate the patient's social
integration and return to normal ambulatory function. Vari-
able damping prosthetic knees are currently in widespread
clinical use worldwide [2–4]. It uses hydraulic or pneumatic
* Hongliu Yu
yhl98@hotmail.com
1
Institute of Rehabilitation Engineering and Technology,
University of Shanghai for Science and Technology, No.
516, Jungong Road, Yangpu District, Shanghai 200093,
China
2
Shanghai Engineering Research Center of Assistive Devices,
Shanghai 200093, China
3
Key Laboratory of Neural-Functional Information
and Rehabilitation Engineering of the Ministry of Civil
Affairs, Shanghai 200093, China
effects of human muscles and tendons, which are adjusted
online by a microcontroller to form a kinetic model that can
approximate the human musculoskeletal system. As opposed
to traditional manually adjustable damping type prostheses,
the former allow for a greater range of walking speeds and
environmental adaptation [5, 6].
Although the variable damping prosthetic knee has dem-
onstrated its clinical applicability and commercial feasibility,
the lower extremity prosthesis still lacks additional active
work to mimic healthy human behavior during normal walk-
ing [7, 8]. Powered prostheses can help users perform vari-
ous movements with ease by providing them with positive
work through devices such as motors or miniature mercury
[9–15]. However, such prostheses are complex, as evidenced
by the redundancy of the humanoid motion mechanism and
the presence of external random disturbances that make
motion trajectories unpredictable, as well as by the demand-
ing hardware design, such as actuation energy sources and
high-performance controllers.
Hybrid passive-active (HPA) knee prostheses are
promising to address the lack of active power of variable
damping prostheses and the disadvantages of poor bionic

13
Vol.:(0123456789)

performance of powered prostheses. Ideally, body posture
data (e.g., angular velocity and torque) is used to deter-
mine whether the current gait phase requires dissipated
energy or net positive work [16] and then the appropriate
drive mode is selected. However, since the presence of
hysteresis makes it difficult to switch modes during part of
the phase of the walking gait, most HPA knee prostheses
use passive mode during walking on level ground, as well
as ascending stairs in the dynamic mode [17, 18]. There-
fore, for a more competitive HPA knee prosthesis, better
mode-shift responsiveness and better coupling of active
and passive unit mechanics are required.
All types of prostheses, despite the essential differences
in actuator design, are undeniably blossoming in the direc-
tion of intelligent control. To the best of our knowledge,
the control strategy plays a connecting role in the whole
prosthetic control system, it must respond correctly to the
amputee's intentions and convert to the ideal output state of
the device [19]. In other words, despite the current advances
in mechanical processing and actuator technology, fully
exploiting the performance of the control strategy will
allow patients to benefit maximally from the dynamic intel-
ligent control of the prosthesis in their daily lives. Today,
comprehensive reviews of the intelligent prosthetic knees
have been carried out by many researchers. Some research-
ers have focused on providing an overview of the entire
prosthetic system to provide a comprehensive assessment
of the opportunities and challenges of prosthetic develop-
ment [19–21], while these articles provide a well-rounded
summary of prosthetics, the focus is not on how to go about
improving the performance of the control strategy. Farina
et al. discuss the latest technologies in the field of bionic
devices, with an outlook on the design, manufacture and
testing of the next generation of clinical prosthetic systems,
the starting point of the article being from a clinical perspec-
tive rather than a control strategy [22]. On the other hand,
many researchers have reviewed control strategies for intel-
ligent prostheses, yet future developments for key technolo-
gies are rarely mentioned [23–25]. Several researchers have
discussed key techniques for prosthetic control, but only for
volitional control [26–28]. It thus appears that an overview
of key technologies for the control strategy of intelligent
knee prostheses is still lacking.
In this paper, we are dedicated to discussing the state-
of-the-art control strategies available and, in contrast to the
above review, we also discuss related technologies that have
had a profound impact on these control strategies. The aim
of this paper is to provide future directions for improving the
control performance of prosthetic devices. The structure of
the paper is as follows. In Sect. 2, we present a brief clas-
sification of the existing control strategies, and the details of
the working principles are outlined in Sect. 3. To provide a
better idea of future developments, we present the relevant
13
L. Li et al.
technical discussions in Sect. 4. The discussion and results
will be developed in Sect. 5.
2 Method
2.1 Search Method
In this paper, we implement a systematic review of control
strategies for intelligent knee prostheses by combining two
strategies: literature search and reference to typical review
literature. The former conducted a literature search using
three different databases (i.e., IEEE Xplore, PubMed.gov,
WEB OF SCIENCE) over the time frame of 2005 to the
present. Synonymous words are connected by OR logic,
for example, “knee”, “lower limb”, “transfemoral”, and
“extremity” as one category, and “intelligence”, “power”,
“control”, “active”, “artificial”, and “bionic” as another
important category of filter indicators. Each category of
synonyms will be connected to the main keyword "Prosthe*"
or "artificial limb" by AND logic. We further removed irrel-
evant or duplicate articles by AND NOT logic, paper titles,
reading abstracts, etc. The second strategy was to browse the
review articles related to intelligent knee prostheses in the
last few years [19–28], to retrace the literature cited in the
articles, and to continue the new search with them as cited
objects to achieve a gaps checking of the first strategy. The
final 65 available articles will be included in this review.
2.2 Classification Method
To the best of our knowledge, the current control objectives
of intelligent lower limb prostheses are mainly trajectory
tracking and impedance torque control [21] (Fig. 1). Tra-
jectory tracking defines the positional trajectory extracted
from an able-bodied person or residual limb motion as a
continuous function of time [11, 29, 30], from which the
desired prosthetic trajectory is mapped in the form of a look-
up table [31] or online acquisition [29], which was one of
the earliest controllers used for powered prostheses. The
trajectory tracking approach can control the prosthesis to
achieve the position results we expect; however, the premise
is that the joints need to output high impedance, which is
incompatible with the characteristics of human gait. Toward
ideal joint impedance control, generating torque trajectories
instead of position trajectories is widely used. This strategy
uses segmentation functions to model each joint as a virtual
spring–damper system to approximate the torque in each
phase of the complete gait cycle versus the joint angle and
can provide a functional gait that is representative of nor-
mal gait biomechanics [15]. In other words, the resultant
movement of each prosthetic joint is due to a combination of
user input and prosthetic input, rather than high impedance
Intelligent Knee Prostheses: A Systematic Review of Control Strategies

3 Control Strategy
Trajectory
tracking 3.1 Strategies for Trajectory Tracking

High 3.1.1 Echo Control

impedance
Impedance
control
Variable
impedance
Fig. 1  Classification and impedance characteristics of control targets
for lower limb prostheses
control generated by the prosthetic input alone [32]. As
shown in Table 1, we classify the existing outstanding con-
trol strategies according to the ideal control objectives of the
lower limb prosthesis, i.e., joint trajectory and joint imped-
ance torque. In particular, the first subset of layers includes
replay methods, continuous control approach, finite-state
approach, and volitional control methods. A more detailed
description of these control strategies will be developed in
Sect. 3.
Echo control was one of the first solutions to be applied
to powered prostheses [93, 94]. This approach is relatively
simple to implement, whereby the position trajectory on the
healthy side is recorded by sensors and the trajectory is then
reproduced on the prosthetic side with a time delay [95].
Although some researchers have used sensors to capture the
kinematic trajectory on the healthy side and implement the
control in the prototype [33, 34], the inevitable wearing of
additional sensors on the healthy side would still be mentally
taxing for the patient. In general, echo control allows for
good trajectory tracking control but also has many disadvan-
tages, notably (1) it has a half-step delay and patients must
spend time adapting to this rhythm [93], (2) almost all lower
limb movements in amputees need to start with the healthy
leg [34], and (3) the control scheme relies heavily on the
regularity of the steady-state gait period, which further leads
to reduced flexibility of the prosthesis [33, 35].
3.1.2 Complementary Limb Motion Estimation
CLME was initially developed and successfully tested in
the field of rehabilitation robotics [96, 97]. Vallery et al.
performed an experimental evaluation [97] and applied
this control strategy to control a knee joint prosthesis [30].
Unlike echo control, CLME measures the kinematic data of
the residual limb rather than the sound leg and then regresses
these data to obtain a mapping function that performs
a deduction of the intended action of the impaired limb,
which means that CLME can respond to the controller with
very little or no delay. The control strategy can be explained
by the physiological movement phenomena of the human
body, as the person exhibits strong inter-joint coordination

Table 1  Classification of Control targets Control strategy References

prosthetic control strategies
corresponding to different Trajectory tracking Replay approach Echo control [33–35]
control targets
Complementary limb motion estima- [30, 36, 37]
tion (CLME)
Classifier-based trajectory tracking [17, 38–41]
Continuous approach Virtual constraint control [13, 42–53]
Joint impedance torque Finite-state approach Finite-state impedance control (FIC) [9, 11, 12, 14,
15, 29, 31, 32,
54–78]
Volitional control Volitional-FSM control [79–86]
Direct mapping of torque [10, 87–89]
Neuromuscular model control [90–92]

13

while moving, and this intrinsic link can be discovered in
the representation of a mapping function [98]. However,
the fact that CLME faces a more complex hardware system
than other control strategies is the main reason that limits its
development in the field of prosthetics.
3.1.3 Classifier‑Based Invariant Trajectory Tracking Control
Following an invariant trajectory requires setting a corre-
sponding trajectory for each detected movement pattern,
triggered by the recognition result of the classifier. For
example, Mendez et al., propose a heuristic algorithm-based
trajectory following control for swing phase, where mul-
tiple pre-set swing trajectories are switched by threshold
determination. When crossing an obstacle, subjects would
hold the residual limb longer and minimum-jerk program-
ming switched the swing trajectory to the appropriate knee
flexion angle, thereby increasing foot clearance across the
obstacle [40]. Gao et al. used electroencephalogram (EEG)
signals processed using the discrete wavelet transform, and
the extracted time–frequency domain features were used
as input to a support vector machine to classify the user's
hypothetical movement intentions, with the prosthetic limb
executing the corresponding gait trajectory generated by the
encoded ground reaction force based on the classification
results [41]. Classifier-based trajectory tracking control must
be programmed with specific trajectories for each activity
that the user may perform. In addition, intent recognition
algorithms are at a premium, either heuristic rule based or
machine learning algorithms that ideally operate with 100%
online accuracy; otherwise, they can lead to gait distortions
and even cause the user to fall.
3.1.4 Virtual Constraint Control
The virtual constraint control method uses the effective tra-
jectory of a monotonic phase variable defined by the kin-
ematic parameters of the lower limb as a virtual constraint,
which represents a continuous gait phase enforced by the
drive of the device during walking to achieve a uniform gait
similar to that of an able-bodied person [44]. Gregg et al.
obtained an effective shape based on the trajectory of the
center of pressure and the position of the ground reaction
force under the foot (mapped to the reference frame of the
movement on the standing leg) [43–46]. However, in Ref.
[44], only the standing phase of a gait cycle used virtual
constraints, while the swing phase used an FSM, which may
result in a delayed or discontinuous switch from the stand-
ing phase to the swing phase [99]. Gregg et al. [13] have
recently used the discrete Fourier transform to parameterize
the phase angle of the residual thigh with a periodic virtual
constraint that continuously defines the joint kinematics
required for gait, unifying the entire gait cycle and allowing
13
L. Li et al.
continuous phasers to produce a stable walking speed. The
thigh phase angle strongly parameterizes the user's ipsilat-
eral leg joint pattern during non-smooth walking, so that the
same phase variables can be used to define periodic virtual
constraints for any speed/slope condition, allowing multiple
amputee subjects to walk with the same fixed control gains
under these conditions [49]. Virtual constraint control shows
great potential for clinical benefit, but there is still a need to
prove compatibility and applicability across multiple activ-
ity modes.
3.2 Strategies for Joint Impedance Torque
3.2.1 Finite‑State Impedance Control
To achieve more precise, human-compatible control of pros-
theses, intelligent bionic devices must make constant con-
trol decisions during movement. This is undoubtedly a huge
challenge since our gait is a highly complex behavior [100].
Therefore, researchers often use FSM to divide the gait
cycle into several states. The identification and switching
rules between these discrete states is an important aspect, as
energy is generated and transferred to the user at the appro-
priate equilibrium point during the transition of the phase
by means of a virtual spring-damping system and remains
passive for the rest of the time [101]. In this way, the ideal
joint torque for each gait phase can be approximated by the
output of a segmented impedance function. The process of
FIC is shown in Fig. 2. During ambulation, the control pro-
cess of the prosthesis determines the current control model
based on gait events, while the identification of gait events
and the switching of the control model rely on feedback from
multiple sensors. Please note that the impedance function is
not a fixed functional equation and that different step phases
require the setting of appropriate impedance parameters. A
typical impedance framework is shown in Eq. (1):
(1)
( )
𝜏m = km 𝜃 − 𝜃em + bm w,
where 𝜏 is the joint torque, k is the stiffness coefficient, 𝜃 is
the joint angle, 𝜃e is the equilibrium position, b is the damp-
ing coefficient and 𝜔 is the angular velocity of the joint. m
represents the gait phase, and the corresponding impedance
parameters are km , 𝜃em and bm . This impedance law is widely
used; for example, Sup et al. [54] divided the gait cycle into
a stance phase, where the stance phase is provided with a
high stiffness by an impedance function to prevent excessive
flexion, and a swing phase that acts as a damper to assist in
the flexion of the prosthesis. The same impedance control
law is used to control the powered knee and ankle prosthesis,
except that the FSM consists of five walking states for more
precise control [56, 58].
Intelligent Knee Prostheses: A Systematic Review of Control Strategies

Fig. 2  FIC realizes conversion

from high-level intent to low-
level motor control High-level control

Switch rules

1 2 3 4 5

Knee angle (deg)

Biological sensors

Gait phase (m)

Impedance laws
Mechanical sensors

Low-level control

Table 2  FIC law used in Ref. [14] behavior of the knee, consistent with the net work and stand-
State Control law Gait phase
ing flexion angle produced by the biological knee joint.
In general, FIC has been popularly applied in various
1 𝜏 = b𝜃̇ Stance research teams and has achieved considerable control results
2 𝜏 = k(𝜃 − 𝜃k ) + (b1 (𝜃 − 𝜃b )2 + b2 )𝜃̇ Early swing flexion [9, 11, 14, 15, 29, 31, 54–76], yet refinements on this con-
3 𝜏 = b1 (𝜃 − 𝜃b )2 + b2 𝜃̇ Late swing flexion trol strategy have not stopped until now. The first step is
( )

4 𝜏 = k(𝜃 − 𝜃k ) + b𝜃̇ Early swing extension
5 𝜏 = (b1 (𝜃 − 𝜃b )2 + b2 )𝜃̇ Late swing extension
The impedance control law can likewise be expressed
by Eq. (2):
)3
(2)
(
𝜏m = k1m (𝜃 − 𝜃em ) + k2m 𝜃 − 𝜃em + bm w.
The joint torque 𝜏m in each gait can be described by a
combination of linear and cubic stiffness terms and linear
damping, where k1m and k2m characterize the linear and
cubic stiffnesses corresponding to the gait phase and the
other parameters are consistent with those described in
Eq. (1). This impedance control law was used in a four-
phase FSM by Sup et  al., and was able to provide the
required joint torque to produce a near-normal gait [15,
70].
As opposed to changing the impedance parameters of a
separate impedance control law to output torque in different
steps, Rouse et al. [14] designed for each state an individual
impedance law (Table 2), and experimental results on ampu-
tee patients showed biomechanically accurate torque-angle
to further improve the adaptability of the controller, which
requires the design of controllers other than for level walking
(e.g., ascending and descending stairs), and the parameters
of the PD gain and switching rules must be adjusted for both
different users and different activities at each gait period
to achieve the best possible control. However, more task
controllers imply more parameter tuning, which not only
costs the clinician hours for different patients [74], but also
the curse of dimensionality caused by multi-dimensional
parameters can degrade the performance of the classifier. In
addition, although Liu et al. suggested the use of transition
rules based on Dempster–Shafer theory (DST), which gener-
ated higher accuracy in state transition times [12], it remains
a challenge to precisely determine the relative times within
the gait cycle and achieve accurate, seamless, and smooth
mode switching [100, 102, 103].
3.2.2 Volitional Impedance Control
Volitional-FSM Control Unlike the previously mentioned
classifier-based invariant trajectory tracking control, in this
approach, machine learning as a core component of high-
level control enables classification of user motion intent

13

and switching of control models based on fused signals
from multiple sensors (Fig. 2). A corresponding impedance
method is used for each mode, and the transition of states is
achieved through the FSM. For example, Ha et al. [80] col-
lected surface EMG from the patient's residual hamstrings
and quadriceps, and given an impedance framework, the
subjects were able to accurately track positional commands
in a virtual environment (non-weight bearing), showing
the potential for controlling powered prostheses, even with
ankle motion. This hypothesis was subsequently tested by
Hargrove et al., where knee and ankle motion could be accu-
rately decoded using EMG signals measured from residual
muscle [81], which showed a strong potential for subject
control of the ankle joint through real-time feedback from
powered knee prostheses [79]. Hargrove et al. proposed a
targeted muscle reinnervation (TMR)-enhanced control
system, where the fusion of EMG signals and mechanical
sensor data enables not only the system to correctly identify
walking patterns and generate corresponding knee and ankle
torques, but also enables the user to safely switch movement
patterns to cope with different terrains [82, 83]. The benefits
of Volitional-FSM control are, firstly, based on the fusion
of biological and mechanical sensor signals providing an
appreciable recognition rate, and in addition the myoelectric
signals help with pattern prediction and early switching for
intuitive prosthetic control. However, obtaining high-quality
biosignals is difficult, which usually requires attaching the
sensor to the skin, and these electrical signals are usually
weak and susceptible to interference, not to mention the
looseness and vibration caused during walking.
Direct mapping joint torque It has been shown that the
EMG signal can be used to predict or decode the net torque
[104] and impedance [105] generated from the joint. Some
researchers have experimented with direct EMG control
under level-ground walking [10, 88] and stair ascent con-
ditions [87, 89]. In these control systems, the high-level
controller contains feed-forward proportional myoelectric
signals and the low-level controller includes feedback for
kinematics or dynamics. For example, in Ref. [87], the sys-
tem is an open-loop feedforward torque control model with
only proportional myoelectric signals as feedforward signals.
In the low-level controller, the author proposes a propor-
tional myoelectric control law that outputs a desired joint
torque based on the surface EMG signals and then the trans-
fer function outputs the desired motor current. Using EMG
signals to directly map joint torque has both advantages and
disadvantages. The merit is that, although using the EMG
signal as a proportional control input to obtain the desired
joint impedance can be easily generated by other methods,
user feedback indicates that they have an increased sense
of control over the device [26], which suggests that sub-
jects can achieve good volitional control through training.
Some points for improvement are, firstly, the direct mapping
13
L. Li et al.
without a model, which can lead to inaccurate EMG and
torque relationships [28]. The second is the need for online
adjustment of the control gain by the adaptive controller
[106].
Neuromuscular model-based control To ameliorate the
shortcomings of directly mapping torque using EMG sig-
nals, some studies have been conducted to model the torque-
generating muscles to further improve the robustness of the
control [107, 108]. Thatte et al. proposed a neuromuscular
model-based control method for prosthetic limbs [90]. The
model uses the seven Hill-type muscle–tendon units of the
human body (hip flexors, gluteus, hamstrings, vastus, gas-
trocnemius, soleus, tibialis anterior), where the torque and
oscillation control generated by the muscles is converted
by the SEA controller into motor voltage and generate joint
torque in the seven-linked planar biped. Machine learning is
an alternative to creating a biological muscle model based
on a mathematical model (i.e., a 'Hill-type' muscle model)
[91]. This approach will effectively deal with the non-linear
relationship between EMG and kinematic and kinetic signals
[109]. Besides, the patient and the prosthesis are driven by
almost identical neuromuscular control, which facilitates the
response to unexpected situations such as tripping and then
reacting and continuing to walk, a response effect that can-
not be achieved with impedance control. However, solving
the forward dynamic calculations of such musculoskeletal
models can be time-consuming, thus hindering the real-time
control of robotic devices.
4 Key Points to Enhance
The control strategies for intelligent knee prostheses have
been discussed above. Though there is currently no standard
solution, they share the common aim of providing patients
with better walking function and helping them return to
social life earlier. Before these control strategies can reach
their full potential, the challenges associated with these sys-
tems must be addressed. We have outlined potential areas
of improvement based on the contents of Table 1, and the
main criteria for inclusion are the outlook of the authors on
their work as well as the description of shortcomings in the
article, and, additionally, the time frame was 2015 to the
present. The results are illustrated in Fig. 3, where a total of
23 articles were selected (including 7 on replay approach, 4
on continuous approach, 7 on finite-state approach, and 5 on
volitional control) and potential upgrade targets (40 items)
were recorded. Note that some articles provided an outlook
on multiple areas, which means that the aggregated number
of upgrade elements will be larger than the total number of
articles. After further sorting, we found that 40% of the arti-
cles show a keen interest in future enhancements to the sys-
tem for intention recognition, including verification in more
Intelligent Knee Prostheses: A Systematic Review of Control Strategies

Parameter
Sensor system
10% optimization
Reliability 18% Parameter tuning
[9], [33], [37], [78], [83], [9], [40], [69], [78]
[85], [86]
Sensory feedback Eigenvalue optimization
[83] [78]

7% Intent recognition
Others
Activities
Subjects
[13], [47], [48], [53], [68],
[40], [65], [90]
[78], [86]
Prosthetic 40% Mode transition
evaluation [39], [40], [48], [76]
Accommodation
[17], [40], [53], [71], 25% Accuracy
[37], [41], [78], [83], [85]
[77], [83], [84]
Anti-interference
Hardware platform
[78], [83], [84], [90]
[9], [17], [34], [53], [77], [86]

6 Intent recognition Sensor system Prosthetic evaluation Prosthetic evaluation Others Total
(16) (7) ( 10) (4) ( 3) (40)
Research directions
Number of Literature

0
Replay approach Continuous approach Finite-state approach Volitional control Total
(7) (4) ( 7) (5) (23)
Control approach

Fig. 3  Overview of potential areas for improvement based on the control strategies summarized in Table 1

activities scenarios, increasing the accuracy of the classifier,
natural switching of modes, and anti-interference capabil-
ity. 25% of the articles saw a need for future upgrades to the
prosthetic evaluation and we encompassed accommodation
time and hardware platform. Views on improvements to sen-
sor system and parameter optimization occupy 18% and 10%
of the references in Table 1, respectively, along with some
other research directions, but are not considered as the focus
of this paper. References and specific classifications of these
techniques are shown in Fig. 3, and detailed discussions are
developed in the following subsections.
4.1 Intent Recognition
4.1.1 Activities and Accuracy
Intent recognition is one of the paramount elements of
intelligent knee prostheses; it serves to recognize the user's
intent as well as the environmental terrain, which provides
a reference target for the ideal state of the prosthesis. As a
matter of fact, many researchers have developed classifiers
capable of recognizing various terrains and have achieved
satisfactory results. For example, a typical use of a heuris-
tic rule algorithm as a classifier (high-level control) is the
CYBERLEGs series, with insoles and IMUs as decision
signals into the FSM, which consists of eight states: initia-
tion, termination, standing, walking, ascending, quiet sitting,
sitting down, and standing up. Experiments have shown a
recognition success rate of over 94.8% for all states [64,
110]. Machine learning-based classifiers are now widely
used in intelligent knee devices. Classifiers like artificial
neural network (ANN) [111], linear discriminant analysis
(LDA) [79, 112], Gaussian mixture model (GMM) [113],
quadratic discriminant analysis (QDA) [80], and dynamic
Bayesian network (DBN) [82, 114–116] have achieved satis-
factory recognition rates in the Vanderbilt series prostheses.

13

The main recognition areas, however, are restricted to five
modes of level walking, stair ascending and descending, and
slope ascending and descending. Recently, deep learning
techniques have received attention in pattern recognition
for bionic devices. Research has shown that convolutional
neural network (CNN) can achieve high recognition rates in
a wide range of motion patterns [117, 118]. It can also be
used for intent recognition based on machine vision, which
relies more on the environmental information collected from
the camera [119, 120].
In general, it will not be difficult to raise the accuracy of
classifiers by fusing EMG [121, 122] and mechanical sig-
nals or bilateral lower limb neuromechanical signals [123]
to achieve sample diversity, to establish more complete
switching rules or training data. However, this is limited to
some specific motion patterns; although machine learning-
based classifiers can be trained off-line continuously and
over time to improve classifier performance, they struggle,
as do heuristics, to model or build rules for unpredictable
events. It may be necessary to rely on further development
of volitional control to resolve the situation. Machine vision
classifiers based on deep learning will be promising, as
reflected by the potential to handle some emergency situa-
tions and recognize more irregular activities while exerting
high accuracy, although this may require a large number of
samples for training.
4.1.2 Mode Transition
A critical issue that needs to be addressed to achieve comfort
in facing multiple terrains like a normal person is an assur-
ance that the prosthesis can achieve a safe and seamless task
transition to the predicted pattern, which will affect the user's
trust in the prosthetic device. For example, Varol et al. [113]
proposed an activity switching controller based on a voting
scheme, where the pattern switch occurs if more than 80%
of the classification results agree and the current activity pat-
tern is locked for a period of time after the switch. Although
the switching process is limited to a specific phase, experi-
ments have shown that users do not feel a perceived delay.
Huang et al. [121] similarly achieved a high precision and
seamlessly and safely implemented task switching function;
however, such a process is also switched at a specific critical
time. To investigate the effect of switching timing on control
performance, Zhang et al. [124] quantified performance and
balance in activity transitions to provide important guid-
ance and criteria for determining mode switching times for
powered prostheses, and experimental results showed that
switching control modes too early or too late can interfere
with the user's walking stability.
While sensor fusion techniques can help to reduce the
error rate of intent recognition, it has been shown that not
all misrecognition causes a subjective perception of walking
13
L. Li et al.
instability in the user [125]. For example, misclassification
between level walking and ramp ascent is actually not sig-
nificantly felt by the patient, because the impedance settings
of the two are relatively close. Even in the case of false
recognition, there are potential solutions to reduce the per-
formance impact of the error on the user's gait as long as
the error is detected within a certain time frame [126]. In
other words, a clear criterion for the critical time window
for walking mode transitions seems to be more important for
achieving natural and seamless movement mode transitions,
and it may require careful adaptation to different mechanical
designs and individual user situations [124].
4.1.3 Anti‑interference
Despite the increasing maturity of EMG signal-based pattern
recognition and intuitive control of prostheses, the presence
of multiple internal and external influences such as muscle
fatigue [127], electrode displacement [128], and socket loos-
ening has greatly affected the performance of the system.
Having good resistance to interference is necessary to solve
their dilemma in commercial use and clinical trials. Many
researchers have recently proposed solutions to address
these headaches, such as using a log-likelihood metric to
detect whether the EMG signal receives a perturbation and
to determine whether the classifier uses separate mechanical
sensors or fused information to predict motion patterns [84],
or perhaps using an online adaptive algorithm to adapt to
changes in the input signal [85, 86]. These online adaptive
algorithms minimize the degree of interference signals to the
extent possible, but the stability of the EMG signal-based
pattern recognition system still requires a robust EMG signal
acquisition environment such as an adapted patient's socket
and high-performance electrodes to fundamentally improve
the system.
4.2 Sensor System
4.2.1 Reliability
The decision-making signals output by the control strategy
all need to be triggered based on feedback from the sensor
system, which places strict requirements on the reliability
of the signals. Bernal-Torres et al. used an inertial measure-
ment unit (IMU) to record the motion information of the
healthy leg and was able to accurately playback no more
than 2° of error in the prosthetic test platform [33]. Vallery
et al. [30] used a goniometer–gyroscope device to measure
knee and hip flexion angles and velocities in both legs as
input to a mapping function for trajectory supplementation
of the residual limb, and gait evaluation showed promis-
ing results. Furthermore, to identify information about
gait phase, joint angle (potentiometer [10, 12, 32, 129] and
Intelligent Knee Prostheses: A Systematic Review of Control Strategies
encoder [11, 14]), torque (axial force sensors [11, 130], load
sensors, and insoles [110]), position and velocity (Hall effect
sensors [11, 62]) are also widely used as control variables for
FIC of active knee prostheses with satisfactory results. Not
surprisingly, the mechanical sensors demonstrated substan-
tial reliability in multiple control strategy tests, albeit mostly
done in a laboratory setting. Unlike mechanical sensors, the
electrodes are usually used to collect surface EMG signals
from the muscle groups on the side of the residual limb and
are located on the wall of the socket. However, obtaining
robust surface EMG signals is still difficult, since it has more
variability and noise than mechanical sensor data. One first
solution is to provide a stable myoelectric acquisition envi-
ronment for the electrode sensors. The requirement for the
socket is to minimize its movement relative to the bottom
residual muscle of the patient, maintaining good contact
between the electrode and the skin [131]. The second solu-
tion is to design adaptive filtering for feature values that
are susceptible to variation due to external influences [132],
which effectively reduces non-smooth artifacts and improves
the robustness of the system. Another solution is to use
higher-performance electrode sensors such as high-density
EMG systems and implantable electrodes [133–135]. These
sensors are implanted on the surface of human muscles and
provide a better quality of EMG signal than the electrodes
applied to the surface skin [136].
4.2.2 Sensory Feedback
Able-bodied people can autonomously adjust their gait to
adapt to different environments based on visual, sensory,
and other feedback [137]. Top-notch intelligent prostheses
replace the patient's disabled motion sensory circuitry with
sensors as decision signals, but the lack of sensory feedback
makes the patient less cognizant of the prosthesis [138, 139],
leading to significant safety concerns when driving a car,
navigating uneven terrain, or climbing ladders [140]. Better
cognitive integration of the user’s limb with the prosthesis
will contribute to their confidence and satisfaction with the
prosthesis [141].
In recent years, multi-faceted efforts have been made by
researchers to address the perceptual recovery of patients
with above-knee amputations. Restoring sensory feedback
out of the residual limb through non-invasive techniques is
an easily achievable means, such as vibration [142, 143]
and tactile stimulation [144]. This is not the best alterna-
tive, because the difference in the location of the feedback
leads to a forced adaptation of the subjects to train. The use
of agonist–antagonist myoneural interface (AMI) to restore
autonomic sensation in amputees is a promising clinical
surgical approach. The agonist–antagonist muscle relation-
ship is an afferent feedback modality for lower limb joint
motion control, in which when the agonist muscle contracts,
a corresponding myoelectric signal is generated while the
antagonist muscle stretches, producing afferent feedback
that is transmitted through its motor nerve [145]. Recent
studies applying the AMI technique to transtibial amputees
and transfemoral amputees have shown that establishing
interfaces to reconnect severed agonist–antagonist relation-
ships will potentially enhance prosthetic controllability and
sensory feedback [145, 146]. Another method is to stimu-
late sciatic nerves by implanting sensors that evoke sensa-
tion in the phantom legs and feet. The kinematic or kinetic
information collected by the external sensors is coded in the
controller and converted into parameters for neural stimu-
lation. These parameters drive the activity of the sciatic
nerve implant, which is ultimately felt by the patient via
neural transmission [147]. For example, in recent studies
where patients were implanted with transversal intraneural
multichannel electrodes (TIMEs), experiments showed that
sensor-induced sensory feedback led to improved confidence
in the prosthesis [148], mobility [147], and finer pressure
perception [149] through integration with the prosthesis. In
addition, flat interface nerve electrodes (FINEs) have been
shown to be successful in lower extremity sensory feed-
back recovery applications, where people implanted with
FINEs are more perceptive of some spatially extended areas,
indicating that users can perform better balance and motor
movements [150].
No doubt, the future of prosthetics will continue to delve
into the direction of sensory feedback, as it is about user sat-
isfaction with prosthetic technology. However, this process
will certainly be accompanied by extensive clinical trials,
material improvements for long-term skin implant sensors
[151], computational models for designing neural interfaces
[152], etc. More importantly, for this technology to move
toward widespread use or even commercial use, more health-
care professionals are still needed to provide a training base
and psychological counseling for patients.
4.3 Prosthetic Evaluation
4.3.1 Accommodation
Prosthetic accommodation prior to prosthetic evaluation is a
complex, but necessary process. In addition to the need for
prosthetic experts to coordinate various aspects of the pros-
thesis, such as control parameters and mechanical specifica-
tions, to accommodate different users, it also requires the user
to train under the guidance of a prosthetic expert to fit the
prosthesis. The accommodation modalities of prostheses are
currently divided into wear training and virtual tracking train-
ing. Current evidence on the accommodation period required
by different users is limited [153, 154], partly because different
users have different physical conditions and their subjective
perceptions of the comfort of walking with the device on may
13

vary. On the other hand, the range of motion of the training
varies, which leads to accommodation times ranging from
a few minutes [9, 14] to several hours for patients [39]. For
virtual tracking training, primarily applied in experiments of
volitional control [80, 146, 155], the patient needs to complete
the corresponding trajectory task according to the instructions
in front of the display, which is usually a multiple and long-
cycle process to achieve good performance requirements [80].
In the future, it will be necessary to refine the evaluation index
of user accommodation time, while professional prosthesis
experts develop training programs based on the user's own
condition and clinical indicators [156]. Moreover, the appro-
priate use of sensory feedback technology to improve the user's
trust and perception of the prosthesis will further raise the
efficiency of the control strategy evaluation of the prosthesis.
4.3.2 Hardware Platform
The evaluation of control strategies for intelligent prostheses
requires subjects to participate in extensive testing to gener-
ate convincing data. This is critical because the prosthetic
manufacturer can tailor the control program based on the
results of the evaluation. However, before testing control
strategies, researchers tend to dedicate substantial time to
a hardware platform for the prosthesis, which is extremely
inconvenient for the comparison and application of control
strategies. Based on the results of the review in Fig. 3 that
involves prostheses, we have expanded in Table 3, to better
illustrate where the current prosthetic hardware platforms
are problematic. In mechanical terms, the actuator should
have some bionic design to meet the biological character-
istics of human joint motion, so that the user perceives that
this is not the result of motion produced by the prosthesis
alone [77]. From the electrical system, the dazzling array
of communication and power tethers will make it difficult
for some prostheses to get out of the laboratory for testing
[9, 12, 13]. On top of that, a common phenomenon is that
the prosthesis is overweight [9, 65, 77], which makes the
prosthesis much less portable. Obviously, the wide variety
of hardware platforms for prosthetics is still not standard-
ized, thus creating performance gaps in control strategies. To
reduce the duplication of work in the bottom hardware build
and allow researchers to focus on the control system chal-
lenges, Azocar et al. proposed Open-source leg, a systematic
open-source platform that provides a complete reference for
mechatronic design [76].
4.4 Parameter Optimization
4.4.1 Parameter Tuning
High-performance smart prostheses have to deal with abun-
dant parameters during control, especially for prostheses
13
L. Li et al.
using FIC, since multiple phase parameters need to be con-
figured for one walking cycle. Personalizing the device for
different users in a manually tuned manner can take a lot of
labor time when the number of movement patterns increases
and the continuous state of the device control can lead to a
high-dimensional curse. The most used approach is to reduce
the number of parameters directly and indirectly by rede-
signing the controller model (define fewer states) [11] or by
excluding unnecessary parameters [73] (Table 4). Although
the method described above alleviates the labor time of
the prosthetist to a certain extent, it still requires manual
off-line tuning of parameters. Artificial intelligence-based
tuning methods such as cyber expert systems [158] and
gradient descent have demonstrated the potential of online
tuning. However, the tuning performance of these systems
for high-dimensional impedance data needs to be evaluated.
Huang et al. proposed an adaptive dynamic programming
(ADP) tuner to achieve automatic online adjustment of 12
impedance parameters of the prosthetic knee [68]. This is
the first time that a reinforcement learning-based control-
ler has been used to personalize the control parameters of
a prosthesis, owing to the ADP's ability to process high-
dimensional control variables and its superior handling of
non-linear systems.
Manual tuning approach is still an indispensable approach
at the current stage, as it requires the rehabilitation physician
to set the initial parameters according to the user's physical
conditions. Building on this to optimize the control param-
eters by various algorithms or online tuning to promote per-
sonalized efficiency would be promising, although for now
it still relies on implementation in a laboratory environment.
4.4.2 Eigenvalue Optimization
To obtain a highly accurate pattern recognition system, a
large number of sensors were put into use; for example,
Spanias et al. fused EMG signals with mechanical sensors,
involving a total of 22 sensors, of which 16 eigenvalues
were defined, which led to a system recognition accuracy
of more than 96% [85]. However, wearing too many sen-
sors will lead to user resistance, and the associated increase
in features can cause overfitting and reduce the classifica-
tion performance. That means it is worthwhile for research-
ers to explore the trade-off between classifier performance
and system complexity. In other words, it is commendable
if a system has low complexity but can achieve high per-
formance. Chen et al. proposed a parameter optimization
strategy that avoids using the same parameters for all stages
and instead selects the best classification parameters for each
stage individually, which was shown to reduce the computa-
tional burden and improve the overall classification accuracy
[159]. Khademi et al. used different algorithms, respectively,
Non-dominated Sorting Biogeography-Based Optimization
 Table 3  Overview of hardware platforms for different prostheses
Prosthesis Mechanical properties Electrical system H (mm) TM (g)
DU Transmission CT (Nm) SS Comm to EP PS BL
KJ AJ

Open-source leg [76] T-motor U8-16 Two-stage timing belt, 50 59 JE, ME, LS, IMU W O 17500 Ss ADJ 3900
four-link mechanism
Utah leg [39] Maxon EC 4pole A roller screw and a tim- 39 NA JE, ME, IMU, LS W O 8000 Ss & 40 floors ADJ 2600
ing belt transmission
TF 8 leg [69] T-motor U10-Plus Motor is directly inte- NA NA JE, ME, FS, CS, TS, W&T O 5500 Ss 443 3700
grated with the nut of IMU
the ball screw
Intelligent Knee Prostheses: A Systematic Review of Control Strategies

VU leg [11] KJ: Maxon EC-4, AJ: A three-stage belt and NA NA LS, IMU, JE, CS, HS, W O 1.5 h of CW ADJ 5000
Maxon 14pole chain speed reduction ME
transmission
SCSA knee [157] Hydraulic cylinder, A lead screw and gear 7.5 - IMU, LS, ME, AS T O 36,000 Ss or 6 h of CW 300 2200 (KJ)
Maxon EC-22 train
PR leg [9] ILM 85 × 26 motor 3 sun-planetary gears and 57.2 NA ME, TS, LS, OE, IMU T T or O 14,875 Ss 492 6090
3 ring-planetary gears
UTD leg [13] Maxon EC 4pole Belt and ball screw drive NA NA ME, FS, OE, IMU T T NA NA 4800
Ampro leg [65] MOOG BN23 Gear with pulley belt NA NA ME, LS T O NA ADJ 7500
CYBERLEGs Beata leg KJ: Maxon EC-i40, AJ: KJ: SEA with ball-screw 55 30.6 Pressure insoles, IMU, T T NA NA 6500
[77] Maxon EC-4pole mechanism, AJ: MAC- ME
CEPA
CSEA knee [14] Maxon EC 4pole Clutchable SEA with 40 – ME, LS, IMU W O 30,000 Ss or 40 km 285 (KJ) 2700 (KJ)
ball-screw mechanism (8.7 h)

ADJ, adjustable; AJ, ankle joint; AS, angle sensor; BL, battery life; Comm, communication; CS, current sensor; CT, continuous torque; CW, continuous walking; DU = drive unit; EP , external
peripherals; EU, execution unit; FS, force sensor; H, height; HS, Hall effect sensor; IP, installation position; JE, joint encoder; KJ, knee joint; LPB, lithium polymer battery; LS, load sensor; MAC-
CEPA, mechanically adjustable compliance and controllable equilibrium position actuator; ME, motor encoder; MP, microprocessor; MT, maximum torque; NA, not applicable; O, on-board;
OE, optical encoder; PS, power supply; SS, sensor system; S, step; T, Tethering; TS, torque sensor; TM, total mass; WV, working voltage

13


13
Table 4  Overview of parameter tuning methods for different prostheses
Prosthesis Parameters Tuning method Duration Evaluation criteria

Ampro leg [65] 28 WPs (24 IPs, 4 trigger THs), 28 RAP
(24 IPs, 4 trigger THs), 28 RDP (24
IPs, 4 trigger THs)
PR leg [9] 28 WPs (4 phases, each contains 6 IPs,
and a radian parameter)
VU leg (3rd Gen.) [11] 6 WPs (2 phases, each contains 3 IPs),
push off trigger angle, push off strength parameters
VU leg (2nd Gen.) [73] 140 parameters (5 modes, 6 IPs for 4
states per mode and 20 transitions)
VU leg (1st Gen.) [32] 15 WPs (5 phases, each contains 3 IPs)
CSEA knee [14] 15 WPs (5 phases)
Open-source leg [76] 140 parameters (5 modes, 6 IPs for 4
states per mode and 20 transitions)
NREL-A1 [68] 12 WPs (4 phases, each contains 3 IPs)
MT 6 TFAs, each 30–45 min (1) Comparison of kinematic and kinetic
curves, (2) comfortable gait
MT 8 subjects, each less than 30 min (1) Comparison of kinematic and kinetic
curves, (2) comfortable propulsion for
AB
Reduce gait phases that require MT of – (1) Comfortable gait, (2) achieve a biome-
chanical movement curve for healthy gait
RP and propose a set of initial allocation First parameter tuning in 5 h or less Walk in comfort in five movement modes
parameters, MT
MT through user feedback and visual – (1) Comfortable gait, (2) satisfy kinematic
inspection and kinetic trajectories
An iterative approach based on three 6–8 min (1) Comparison of kinematic and kinetic
criteria curves, (2) clinical input from prosthetic
manufacturer, (3) comfortable gait
RP and MT based on feedback from the 2–3 h (1) Tuning continues until a series of
prosthetist and patient clinical walking goals are achieved, (2)
prosthetist, therapists and participants
were satisfied with the performance of
prosthetics
OT by ADP controller 10 min or 300 GCs (1) Over 490 GCs, (2) at least three of the
first five tuning iterations of each phase
meet the tolerance criteria

ADP,  adaptive dynamic programming; GC, gait cycle; IP, impedance parameter; MT, manual tuning; OT, online tuning; RAP, ramp ascent parameter; RDP, ramp descent parameter; RP, reduce
parameters; SP, standing parameter; TH, threshold; WP, walking parameter
L. Li et al.
Intelligent Knee Prostheses: A Systematic Review of Control Strategies
(NSBBO) [78] and Gradient-based Multi-Objective Feature
Selection (GMOFS) [160], to eliminate irrelevant or redun-
dant features and measurement signals while maintaining
performance, i.e., providing maximum performance and
minimum complexity for gait pattern recognition. These
two frameworks have the potential to reduce the number of
parameter calibrations and clinical visits.
5 Discussion
In this paper, we summarize the control strategies corre-
sponding to the current dominant control goals (position and
impedance) of the intelligent knee robot. Although these
control strategies have been successfully implemented and
validated in the relevant experiments, the existing defects
still fail to deliver the best performance of the controller,
which makes it difficult to define a standard control method.
To develop a full-fledged control system, we believe that it
is necessary to upgrade and refine the associated key tech-
nologies based on the existing control methods. We have
synthesized the future perspectives or research limitations
of the control strategies covered in Table 1, the results show
that intent recognition and prosthetic evaluation are the key
issues for all control strategy upgrades. The former should
provide an accurate, universal, naturally switching, inter-
ference-resistant ideal device state for the control strategy.
The latter should provide a high-performance, portable, and
customizable prosthetic hardware platform to ensure the
performance of the control strategy and provide hardware
support for subsequent targeted improvements. Besides, the
sensor system is a common object of concern in addition
to the continuous approach, whereas the volitional control
expresses a stronger desire to upgrade the reliability and sen-
sory feedback function of the sensor system (Fig. 3). Finally,
continuous parameter optimization would have considerable
benefits for clinical applications, but currently, it is mainly
the FIC that is doing the relevant work.
As the functionality of the base activity continues to
improve, more expansion modes will be supported by
prosthetics in the future. For some irregular activities that
are difficult to establish rules or modeling training, deep
learning-based machine vision classifiers may have a bet-
ter chance, although it puts a higher level of computational
performance on the controller. For both FIC and voli-
tional-FSM control, seamless, natural mode switching is
as important as recognition accuracy. The former requires
a standard critical window time individually designed to
suit the mechanical configuration or the user's own situa-
tion, while the latter can be achieved to a foolproof level
by increasing the amount of sample data, off-line learning
time, and techniques for information fusion. It is also nec-
essary to alleviate the performance degradation of control
strategies involving myoelectric signal processing caused
by external disturbances, which requires the development
of suitable adaptive algorithms.
Mechanical sensors have proven their stability and reli-
ability in several control strategies, such as echo control,
CLME, and FIC. However, few reliability evaluations have
been performed in an environment away from the labora-
tory, and future work may be needed to complement this
aspect. Volitional control based on surface EMG signals
from residual limbs has shown promising results in some
non-weight-bearing situations, but the performance in
real-world applications frustrates users because the sen-
sors are affected by external noise, position shifts, etc. that
weaken the performance of the control system. Therefore,
to make users change their minds about volitional control,
the upgrade of the sensor system is the first step to be
taken. The recent use of invasive electrodes to produce
neural stimulation on the user has shown great potential
for control and sensory feedback effects, which is encour-
aging for voluntary control. While we still have a long
way to go before the technology is widely available, it is
exciting to see what a reliable sensor system with sensory
feedback can do for the control system at that time.
Almost all control strategies share the problems of
small sample size, long testing period, tedious operation,
and poor repeatability during performance evaluation. In
the early stages of evaluation, relevant medical profes-
sionals should provide appropriate guidance and develop
an objective training program, and quantify the accom-
modation time of the prosthesis in the future to further
accelerate the user's proficiency and self-confidence in the
prosthesis. In addition, an integrated modular and func-
tional prosthetic hardware platform needs to be developed
to facilitate the testing of different subjects and the com-
parison of different control strategies, so as to improve
the efficiency of prosthetic performance evaluation and
subsequent control fine-tuning. We have every reason to
believe that the continuous optimization of the prosthetic
evaluation process will provide more targeted improve-
ments to the control strategy in the future.
Tuning the impedance parameters is a key technique that
must require attention for FIC. Although manual tuning by
experts takes a lot of labor time, it is necessary at this stage,
especially to set the initial impedance parameters. Online
update of control parameters based on user gait informa-
tion through artificial intelligence technology to improve the
efficiency of personalization will be an interesting research
direction for the future. Once the technology is available
out of the laboratory environment, it is believed that the
enhancements to FIC will be tremendous. In addition, keep-
ing high performance while reducing the input feature values
of classifiers is a worthwhile future direction, especially for
multi-sensor fusion prosthetic systems.
13

6 Conclusion
This article provides an overview of typical control strate-
gies for intelligent knee prostheses and discusses their poten-
tial upgrade elements. In the retrieved results, 40% of the
authors believe that there is still a need to improve the intel-
ligent recognition performance of prostheses in the future,
while 18% consider the reliability of sensor systems and the
feedback potential of sensors, considering that the two com-
plement each other in their applications. The future research
direction of prostheses is mainly focused on both intelligent
recognition and sensing, which is up to 58% in total. Two
other important branches of research are the evaluation of
prostheses (25%) and the optimization of control algorithms
(10%), respectively, implying that improvements in expert
training, hardware devices, and algorithm optimization are
still needed in the future. Consequently, the current control
strategy still has many limitations that cause inconvenience
and trouble to users. The technology upgrade around the
four aspects of intent recognition, sensor system, prosthetic
evaluation, and parameter optimization will deliver multiple
promotions of intelligent recognition, human device sensing,
system evaluation, and personalization for the device, which
provides a powerful platform and major development direc-
tion for future intelligent control of lower limb prostheses.
As time progresses, prosthetic control techniques will be
perfected and we are confident that the quality of life and
self-confidence of our patients will be taken to another level,
helping them to integrate into the society.
Acknowledgements  The authors would like to thank the support of the
National Natural Science Foundation of China (grant no. 62073224)
and National Key Research and Development Program of China (grant
no. 2018YFB1307303).
Declarations  and inclines. IEEE Transactions on Robotics, 34, 686–701.
14. Rouse, E., Mooney, L. M., & Herr, H. (2014). Clutch-
Conflict of interest  The authors declare that they have no conflict of
interest.
References
1. Narang, I. C., Mathur, B. P., Singh, P., & Jape, V. S. (1984).
Functional capabilities of lower limb amputees. Prosthetics and
Orthotics International, 8, 43–51.
2. Bellmann, M., Köhler, T. M., & Schmalz, T. (2018). Comparative
biomechanical evaluation of two technologically different micro-
processor-controlled prosthetic knee joints in safety-relevant
daily-life situations. Biomedical Engineering-Biomedizinische
Technik, 64, 407–420.
3. Campbell, J. H., Stevens, P. M., & Wurdeman, S. R. (2020).
OASIS 1: Retrospective analysis of four different microprocessor
knee types. Journal of Rehabilitation and Assistive Technologies
Engineering, 7, 2055668320968476.
13
L. Li et al.
4. Kaufman, K. R., Bernhardt, K. A., & Symms, K. (2018). Func-
tional assessment and satisfaction of transfemoral amputees
with low mobility (FASTK2): A clinical trial of micropro-
cesso-controlled vs. non-microprocessor -controlled knees.
Clinical Biomechanics, 58, 116–122.
5. McGrath, M., Laszczak, P., Zahedi, S., & Moser, D. (2018).
Microprocessor knees with “standing support” and articulat-
ing, hydraulic ankles improve balance control and inter-limb
loading during quiet standing. Journal of Rehabilitation and
Assistive Technologies Engineering, 5, 2055668318795396.
6. Thiele, J., Schöllig, C., Bellmann, M., & Kraft, M. (2019).
Designs and performance of three new microprocessor-con-
trolled knee joints. Biomedical Engineering - Biomedizinische
Technik, 64, 119–126.
7. Awad, M. I., Dehghani-Sanij, A. A., Moser, D., & Zahedi, S.
(2016). Motor electrical damping for back-drivable prosthetic
knee. In Proceedings of the 11th France-Japan & 9th Europe-
Asia Congress on Mechatronics/17th International Confer-
ence on Research and Education in Mechatronics, Compiegne,
France, pp. 348–353.
8. Elery, T., Rezazadeh, S., Reznick, E., Gray, L., & Gregg, R.
(2020). Effects of a powered knee-ankle prosthesis on amputee
hip compensations: A case series. IEEE Transactions on Neu-
ral Systems and Rehabilitation Engineering, 28, 2944–2954.
9. Elery, T., Rezazadeh, S., Nesler, C., & Gregg, R. D. (2020).
Design and validation of a powered knee–ankle prosthesis with
high-torque, low-impedance actuators. IEEE Transactions on
Robotics, 36, 1649–1668.
10. Hoover, C. D., Fulk, G. D., & Fite, K. B. (2012). The design
and initial experimental validation of an active myoelectric
transfemoral prosthesis. Journal of Medical Devices-transac-
tions of The ASME, 6, 011005.
11. Lawson, B. E., Mitchell, J., Truex, D., Shultz, A., Ledoux,
E., & Goldfarb, M. (2014). A robotic leg prosthesis: Design,
control, and implementation. IEEE Robotics & Automation
Magazine, 21, 70–81.
12. Liu, M., Zhang, F., Datseris, P., & Huang, H. (2014). Improv-
ing finite state impedance control of active-transfemoral pros-
thesis using dempster-shafer based state transition rules. Jour-
nal of Intelligent & Robotic Systems, 76, 461–474.
13. Quintero, D., Villarreal, D. J., Lambert, D. J., Kapp, S., &
Gregg, R. (2018). Continuous-phase control of a powered
knee–ankle prosthesis: Amputee experiments across speeds
able series-elastic actuator: Implications for prosthetic knee
design. The International Journal of Robotics Research, 33,
1611–1625.
15. Sup, F., Bohara, A., & Goldfarb, M. (2008). Design and control
of a powered transfemoral prosthesis. The International Journal
of Robotics Research, 27, 263–273.
16. Winter, D. A. (2009). Biomechanics and motor control of human
movement (pp. 139–175). Wiley.
17. Lenzi, T., Cempini, M., Hargrove, L., & Kuiken, T. (2018).
Design, development, and testing of a lightweight hybrid robotic
knee prosthesis. The International Journal of Robotics Research,
37, 953–976.
18. Lee, J. T., & Goldfarb, M. (2020). Swing-assist for enhancing
stair ambulation in a primarily-passive knee prosthesis. In Pro-
ceedings of the IEEE international conference on robotics and
automation, Paris, France, pp. 740–746.
19. Tucker, M. R., Olivier, J., Pagel, A., Bleuler, H., Bouri, M., Lam-
bercy, O., del Millán, R. J., Riener, R., Vallery, H., & Gassert, R.
(2015). Control strategies for active lower extremity prosthetics
and orthotics: a review. Journal of NeuroEngineering and Reha-
bilitation, 12, 1–30.
Intelligent Knee Prostheses: A Systematic Review of Control Strategies
20. El-Sayed, A. M., Hamzaid, N. A., & Osman, N. A. A. (2014).
Technology efficacy in active prosthetic knees for transfemo-
ral amputees: a quantitative evaluation. The Scientific World
Journal, 2014, 297431.
21. Torrealba, R. R., & Fonseca-Rojas, E. D. (2019). Toward
the development of knee prostheses: review of current active
devices. Applied Mechanics Reviews, 71, 030801.
22. Farina, D., Vujaklija, I., Brånemark, R., Bull, A., Dietl, H.,
Graimann, B., Hargrove, L., Hoffmann, K., Huang, H., Ingvars-
son, T., Janusson, H. B., Kristjánsson, K., Kuiken, T., Micera,
S., Stieglitz, T., Sturma, A., Tyler, D., Weir, R., & Aszmann,
O. (2021). Toward higher-performance bionic limbs for wider
clinical use. Nature Biomedical Engineering. https://​doi.​org/​
10.​1038/​s41551-​021-​00732-x
23. Windrich, M., Grimmer, M., Christ, O., Rinderknecht, S., &
Beckerle, P. (2016). Active lower limb prosthetics: A system-
atic review of design issues and solutions. BioMedical Engi-
neering OnLine, 15, 140.
24. Fluit, R., Prinsen, E. C., Wang, S. Q., & van der Kooij, H.
(2020). A comparison of control strategies in commercial and
research knee prostheses. IEEE Transactions on Biomedical
Engineering, 67, 277–290.
25. Jimenez-Fabian, R., & Verlinden, O. (2012). Review of control
algorithms for robotic ankle systems in lower-limb orthoses,
prostheses, and exoskeletons. Medical Engineering & Physics,
34, 397–408.
26. Tepe, V., & Peterson, C. M. (2017). Full stride: Advancing the
state of the art in lower extremity gait systems (pp. 137–153).
Springer.
27. Fleming, A., Stafford, N. E., Huang, S., Hu, X. G., Ferris, D.,
& Huang, H. (2021). Myoelectric control of robotic lower limb
prostheses: A review of electromyography interfaces, control
paradigms, challenges and future directions. Journal of Neural
Engineering. https://​doi.​org/​10.​1088/​1741-​2552/​ac1176
28. Nasr, A., Laschowski, B., & McPhee, J. (2021). Myoelectric
control of robotic leg prostheses and exoskeletons: a review. In
Proceedings of the ASME 2021 international design engineer-
ing technical conferences and computers and information in
engineering conference, Online.
29. Lenzi, T., Hargrove, L., & Sensinger, J. (2014). Speed-adapta-
tion mechanism: Robotic prostheses can actively regulate joint
torque. IEEE Robotics & Automation Magazine, 21, 94–107.
30. Vallery, H., Burgkart, R., Hartmann, C., Mitternacht, J.,
Riener, R., & Buss, M. (2011). Complementary limb motion
estimation for the control of active knee prostheses. Biomedi-
cal Engineering-Biomedizinische Technik, 56, 45–51.
31. Lawson, B., Varol, H. A., Huff, A., Erdemir, E., & Goldfarb,
M. (2013). Control of stair ascent and descent with a powered
transfemoral prosthesis. IEEE Transactions on Neural Systems
and Rehabilitation Engineering, 21, 466–473.
32. Sup, F., Varol, H. A., Mitchell, J., Withrow, T. J., & Goldfarb,
M. (2009). Preliminary evaluations of a self-contained anthro-
pomorphic transfemoral prosthesis. IEEE/ASME Transactions
on Mechatronics, 14, 667–676.
33. Bernal-Torres, M., Medellín-Castillo, H. I., & Arellano-
González, J. C. (2018). Design and control of a new biomi-
metic transfemoral knee prosthesis using an echo-control
scheme. Journal of Healthcare Engineering, 2018, 8783642.
34. Ueyama, Y., Kubo, T., & Shibata, M. (2020). Robotic hip-
disarticulation prosthesis: Evaluation of prosthetic gaits in a
non-amputee individual. Advanced Robotics, 34, 37–44.
35. Borjian, R., Khamesee, M. B., & Melek, W. (2009). Feasibility
study on echo control of a prosthetic knee: Sensors and wire-
less communication. Microsystem Technologies, 16, 257–265.
36. Ranzani, R. (2014). Adaptive human model-based control for
active knee prosthetics. In Master thesis, sensory-motor systems
lab, Swiss Federal Institute of Technology (ETH), Zürich.
37. Zhang, K. G., de Silva, C. W., & Fu, C. L. (2019). Sensor fusion
for predictive control of human-prosthesis-environment dynam-
ics in assistive walking: a survey. arxiv 1903.07674.
38. Lenzi, T., Sensinger, J., Lipsey, J., Hargrove, L., & Kuiken, T.
(2015). Design and preliminary testing of the RIC hybrid knee
prosthesis. In Proceedings of the 37th annual international con-
ference of the IEEE engineering in medicine and biology society,
Milan, Italy, pp. 1683–1686.
39. Tran, M., Gabert, L., Cempini, M., & Lenzi, T. (2019). A light-
weight, efficient fully powered knee prosthesis with actively
variable transmission. IEEE Robotics and Automation Letters,
4, 1186–1193.
40. Mendez, J., Hood, S., Gunnel, A., & Lenzi, T. (2020). Powered
knee and ankle prosthesis with indirect volitional swing control
enables level-ground walking and crossing over obstacles. Sci-
ence Robotics, 5, eaba6635.
41. Gao, H. B., Luo, L., Pi, M., Li, Z. J., Li, Q. J., Zhao, K. K., &
Huang, J. L. (2021). EEG-based volitional control of prosthetic
legs for walking in different terrains. IEEE Transactions on Auto-
mation Science and Engineering, 18, 530–540.
42. Zhao, H. H., Ambrose, E., & Ames, A. (2017). Preliminary
results on energy efficient 3D prosthetic walking with a powered
compliant transfemoral prosthesis. In Proceedings of the 2017
IEEE International Conference on Robotics and Automation,
Singapore, pp. 1140–1147.
43. Gregg, R., Lenzi, T., Fey, N., Hargrove, L., & Sensinger, J.
(2013). Experimental effective shape control of a powered trans-
femoral prosthesis. In Proceedings of the IEEE 13th international
conference on rehabilitation robotics, Seattle, USA, pp. 1–7.
44. Gregg, R., Lenzi, T., Hargrove, L., & Sensinger, J. (2014). Vir-
tual constraint control of a powered prosthetic leg: From simula-
tion to experiments with transfemoral amputees. IEEE Transac-
tions on Robotics, 30, 1455–1471.
45. Gregg, R., & Sensinger, J. (2013). Biomimetic virtual constraint
control of a transfemoral powered prosthetic leg. In Proceedings
of the 2013 American Control Conference, Washington, USA,
pp. 5702–5708.
46. Gregg, R., & Sensinger, J. (2014). Towards biomimetic virtual
constraint control of a powered prosthetic leg. IEEE Transactions
on Control Systems Technology, 22, 246–254.
47. Quintero, D., Lambert, D. J., Villarreal, D. J., & Gregg, R.
(2017). Real-time continuous gait phase and speed estimation
from a single sensor. In Proceedings of the 2017 IEEE confer-
ence on control technology and applications, Maui, USA, pp.
847–852.
48. Rezazadeh, S., Quintero, D., Divekar, N. V., & Gregg, R. (2018).
A phase variable approach to volitional control of powered knee-
ankle prostheses. In Proceedings of the 2018 IEEE/RSJ inter-
national conference on intelligent robots and systems, Madrid,
Spain, pp. 2292–2298.
49. Villarreal, D. J., Poonawala, H. A., & Gregg, R. (2017). A robust
parameterization of human gait patterns across phase-shifting
perturbations. IEEE Transactions on Neural Systems and Reha-
bilitation Engineering, 25, 265–278.
50. Villarreal, D. J., & Gregg, R. (2016). Unified phase variables of
relative degree two for human locomotion. In Proceedings of the
38th Annual international conference of the IEEE engineering in
medicine and biology society, Orlando, USA, pp. 6262–6267.
51. Quintero, D., Martin, A. E., & Gregg, R. (2018). Toward unified
control of a powered prosthetic leg: A simulation study. IEEE
Transactions on Control Systems Technology, 26, 305–312.
52. Quintero, D., Villarreal, D. J., & Gregg, R. (2016). Preliminary
experiments with a unified controller for a powered knee-ankle
13

prosthetic leg across walking speeds. In Proceedings of the 2016
IEEE/RSJ international conference on intelligent robots and sys-
tems, Daejeon, Korea (South), pp. 5427–5433.
53. Quintero, D., Reznick, E., Lambert, D. J., Rezazadeh, S., Gray,
L., & Gregg, R. (2018). Intuitive clinician control interface for
a powered knee-ankle prosthesis: A case study. IEEE Journal of
Translational Engineering in Health and Medicine, 6, 1–9.
54. Fite, K., Mitchell, J., Sup, F., & Goldfarb, M. (2007). Design and
control of an electrically powered knee prosthesis. In Proceed-
ings of the 2007 IEEE 10th international conference on rehabili-
tation robotics, Noordwijk, Netherlands, pp. 902–905.
55. Sup, F., Varol, H. A., Mitchell, J., Withrow, T., & Goldfarb, M.
(2008). Design and control of an active electrical knee and ankle
prosthesis. In Proceedings of the 2008 2nd IEEE RAS & EMBS
international conference on biomedical robotics and biome-
chatronics, Scottsdale, USA, pp. 523–528.
56. Sup, F., Varol, H. A., Mitchell, J. E., Withrow, T., & Goldfarb, M.
(2009). Self-contained powered knee and ankle prosthesis: ini-
tial evaluation on a transfemoral amputee. In Proceedings of the
IEEE international conference on rehabilitation robotics, Kyoto,
Japan, pp. 638–644.
57. Lawson, B., Varol, H. A., & Goldfarb, M. (2011). Standing sta-
bility enhancement with an intelligent powered transfemoral
prosthesis. IEEE Transactions on Biomedical Engineering, 58,
2617–2624.
58. Sup, F., Varol, H. A., & Goldfarb, M. (2011). Upslope walking
with a powered knee and ankle prosthesis: Initial results with
an amputee subject. IEEE Transactions on Neural Systems and
Rehabilitation Engineering, 19, 71–78.
59. Shultz, A., Lawson, B., & Goldfarb, M. (2015). Running with a
powered knee and ankle prosthesis. IEEE Transactions on Neural
Systems and Rehabilitation Engineering, 23, 403–412.
60. Lawson, B., Ruhe, B., Shultz, A., & Goldfarb, M. (2015). A pow-
ered prosthetic intervention for bilateral transfemoral amputees.
IEEE Transactions on Biomedical Engineering, 62, 1042–1050.
61. Chen, G. X., Liu, Z. J., Chen, L. L., & Yang, P. (2015). Control of
powered knee joint prosthesis based on finite-state machine. In:
Proceedings of the 2015 Chinese Intelligent Automation Confer-
ence, China, pp. 395–403.
62. Martinez-Villalpando, E., & Herr, H. (2009). Agonist-antagonist
active knee prosthesis: A preliminary study in level-ground walk-
ing. Journal of Rehabilitation Research and Development, 46,
361–373.
63. Flynn, L., Geeroms, J., Jimenez-Fabian, R., Vanderborght, B., &
Lefeber, D. (2015). CYBERLEGS Beta-prosthesis active knee
system. In Proceedings of the 2015 IEEE international confer-
ence on rehabilitation robotics, Singapore, pp. 410–415.
64. Ambrozic, L., Gorsic, M., Geeroms, J., Flynn, L., Lova, R. M.,
Kamnik, R., Munih, M., & Vitiello, N. (2014). CYBERLEGs:
A user-oriented robotic transfemoral prosthesis with whole-body
awareness control. IEEE Robotics & Automation Magazine, 21,
82–93.
65. Bhakta, K., Camargo, J., Kunapuli, P., Childers, L., & Young,
A. (2020). Impedance control strategies for enhancing sloped
and level walking capabilities for individuals with transfemo-
ral amputation using a powered multi-joint prosthesis. Military
Medicine, 185, 490–499.
66. Wen, Y., Brandt, A., Liu, M., Huang, H., & Si, J. (2017). Com-
paring parallel and sequential control parameter tuning for a
powered knee prosthesis. In Proceedings of the 2017 IEEE inter-
national conference on systems, man, and cybernetics, Banff,
Canada, pp. 1716–1721.
67. Wen, Y., Li, M., Si, J., & Huang, H. (2020). Wearer-prosthesis
interaction for symmetrical gait: A study enabled by reinforce-
ment learning prosthesis control. IEEE Transactions on Neural
Systems and Rehabilitation Engineering, 28, 904–913.
13
L. Li et al.
68. Wen, Y., Si, J., Brandt, A., Gao, X., & Huang, H. (2020).
Online reinforcement learning control for the personalization
of a robotic knee prosthesis. IEEE Transactions on Cybernet-
ics, 50, 2346–2356.
69. Carney, M. E., Shu, T., Stolyarov, R., Duval, J.-F., & Herr,
H. (2021). Design and preliminary results of a reaction force
series elastic actuator for bionic knee and ankle prostheses.
IEEE Transactions on Medical Robotics and Bionics, 3,
542–553.
70. Sup, F., Bohara, A., & Goldfarb, M. (2007). Design and control
of a powered knee and ankle prosthesis. In Proceedings of the
2007 IEEE international conference on robotics and automation,
Rome, Italy, pp. 4134–4139.
71. Flynn, L., Geeroms, J., Jimenez-Fabian, R., Heins, S., Vander-
borght, B., Munih, M., Lova, R. M., Vitiello, N., & Lefeber,
D. (2018). The challenges and achievements of experimental
implementation of an active transfemoral prosthesis based on
biological quasi-stiffness: The CYBERLEGs Beta-prosthesis.
Frontiers in Neurorobotics, 12, 80.
72. Gorsic, M., Kamnik, R., Ambrozic, L., Vitiello, N., Lefeber, D.,
Pasquini, G., & Munih, M. (2014). Online phase detection using
wearable sensors for walking with a robotic prosthesis. Sensors,
14, 2776–2794.
73. Simon, A. M., Ingraham, K. A., Fey, N., Finucane, S., Lipschutz,
R., Young, A., & Hargrove, L. (2014). Configuring a powered
knee and ankle prosthesis for transfemoral amputees within five
specific ambulation modes. PLoS ONE, 9, 1–10.
74. Simon, A. M., Fey, N., Finucane, S., Lipschutz, R., & Hargrove,
L. (2013). Strategies to reduce the configuration time for a
powered knee and ankle prosthesis across multiple ambulation
modes. In Proceedings of the 2013 IEEE 13th international con-
ference on rehabilitation robotics, Seattle, USA, pp. 1–6.
75. Lawson, B., Shultz, A., & Goldfarb, M. (2013). Evaluation of a
coordinated control system for a pair of powered transfemoral
prostheses. In Proceedings of the 2013 IEEE international con-
ference on robotics and automation, Karlsruhe, Germany, pp.
3888–3893.
76. Azocar, A. F., Mooney, L. M., Duval, J.-F., Simon, A. M., Har-
grove, L., & Rouse, E. (2020). Design and clinical implementa-
tion of an open-source bionic leg. Nature Biomedical Engineer-
ing, 4, 941–953.
77. Flynn, L., Geeroms, J., Hoeven, T. V. D., Vanderborght, B., &
Lefeber, D. (2017). VUB-CYBERLEGs CYBATHLON 2016
Beta-prosthesis: case study in control of an active two degree of
freedom transfemoral prosthesis. Journal of NeuroEngineering
and Rehabilitation, 15, 3.
78. Khademi, G., & Simon, D. (2021). Toward minimal-sensing
locomotion mode recognition for a powered knee-ankle prosthe-
sis. IEEE Transactions on Biomedical Engineering, 68, 967–979.
79. Hargrove, L., Simon, A. M., Lipschutz, R., Finucane, S., &
Kuiken, T. (2012). Non-weight-bearing neural control of a pow-
ered transfemoral prosthesis. Journal of NeuroEngineering and
Rehabilitation, 10, 62.
80. Ha, K. H., Varol, H. A., & Goldfarb, M. (2011). Volitional con-
trol of a prosthetic knee using surface electromyography. IEEE
Transactions on Biomedical Engineering, 58, 144–151.
81. Hargrove, L., Simon, A. M., Lipschutz, R., Finucane, S., &
Kuiken, T. (2011). Real-time myoelectric control of knee
and ankle motions for transfemoral amputees. JAMA, 305,
1542–1544.
82. Hargrove, L., Simon, A. M., Young, A., Lipschutz, R., Finucane,
S., Smith, D. G., & Kuiken, T. (2013). Robotic leg control with
EMG decoding in an amputee with nerve transfers. The New
England Journal of Medicine, 369, 1237–1242.
83. Hargrove, L., Young, A., Simon, A. M., Fey, N., Lipschutz,
R., Finucane, S., Halsne, E. G., Ingraham, K. A., & Kuiken,
Intelligent Knee Prostheses: A Systematic Review of Control Strategies
T. (2015). Intuitive control of a powered prosthetic leg during
ambulation: A randomized clinical trial. JAMA, 313, 2244–2252.
84. Spanias, J. A., Perreault, E., & Hargrove, L. (2016). Detection
of and compensation for EMG disturbances for powered lower
limb prosthesis control. IEEE Transactions on Neural Systems
and Rehabilitation Engineering, 24, 226–234.
85. Spanias, J. A., Simon, A. M., Finucane, S., Perreault, E., &
Hargrove, L. (2018). Online adaptive neural control of a robotic
lower limb prosthesis. Journal of Neural Engineering, 15,
016015.
86. Liu, M., Zhang, F., & Huang, H. (2017). An adaptive classifica-
tion strategy for reliable locomotion mode recognition. Sensors,
17, 2020.
87. Hoover, C. D., Fulk, G., & Fite, K. (2013). Stair ascent with a
powered transfemoral prosthesis under direct myoelectric con-
trol. IEEE/ASME Transactions on Mechatronics, 18, 1191–1200.
88. Dawley, J. A., Fite, K., & Fulk, G. (2013). EMG control of a
bionic knee prosthesis: exploiting muscle co-contractions for
improved locomotor function. In Proceedings of the 2013 IEEE
13th international conference on rehabilitation robotics, Seattle,
USA, pp. 1–6.
89. Hoover, C. D., Fite, K., Fulk, G., & Holmes, D. (2011). Myoe-
lectric torque control of an active transfemoral prosthesis during
stair ascent. In Proceedings of the ASME 2011 Dynamic Systems
and Control Conference and Bath/ASME Symposium on Fluid
Power and Motion Control, Arlington, USA, pp. 451–458.
90. Thatte, N., & Geyer, H. (2016). Toward balance recovery with leg
prostheses using neuromuscular model control. IEEE Transac-
tions on Biomedical Engineering, 63, 904–913.
91. Cimolato, A., Milandri, G., Mattos, L., Momi, E., Laffranchi,
M., & Michieli, L. D. (2020). Hybrid machine learning-neuro-
musculoskeletal modeling for control of lower limb prosthetics.
In Proceedings of the 2020 8th IEEE RAS/EMBS international
conference for biomedical robotics and biomechatronics, New
York, USA, pp. 557–563.
92. Hoover, C. D., & Fite, K. (2011). A configuration dependent
muscle model for the myoelectric control of a transfemoral pros-
thesis. In Proceedings of the 2011 IEEE international conference
on rehabilitation robotics, Zurich, Switzerland, pp. 1–6.
93. Grimes, D. L., Flowers, W., & Donath, M. (1977). Feasibility
of an active control scheme for above knee prostheses. Journal
of Biomechanical Engineering-Transactions of The ASME, 99,
215–221.
94. Stein, J. (1983). Design issues in the stance phase control of
above-knee prostheses. In Dept. of Mechanical Engineering PhD
Thesis, MIT.
95. Bédard, S. (2006). Control system and method for controlling an
actuated prosthesis. U.S. Patent No. 7147667.
96. Vallery, H., Asseldonk, E. V. V., Buss, M., & Kooij, H. V. D.
(2009). Reference trajectory generation for rehabilitation robots:
Complementary limb motion estimation. IEEE Transactions on
Neural Systems and Rehabilitation Engineering, 17, 23–30.
97. Vallery, H., Ekkelenkamp, R., Buss, M., & Kooij, H. V. D.
(2007). Complementary limb motion estimation based on inter-
joint coordination: experimental evaluation. In Proceedings of
the 2007 IEEE 10th international conference on rehabilitation
robotics, Noordwijk, Netherlands, pp. 798–803.
98. St-Onge, N., & Feldman, A. G. (2002). Interjoint coordination
in lower limbs during different movements in humans. Experi-
mental Brain Research, 148, 139–149.
99. Zhao, H. H., Horn, J. C., Reher, J., Paredes, V., & Ames, A.
(2017). First steps toward translating robotic walking to prosthe-
ses: A nonlinear optimization based control approach. Autono-
mous Robots, 41, 725–742.
100. Grimmer, M., Zeiss, J., Weigand, F., Zhao, G. P., Lamm,
S., Steil, M., & Heller, A. (2020). Lower limb joint
biomechanics-based identification of gait transitions in
between level walking and stair ambulation. PLoS ONE, 15,
148.
101. Hogan, N. (1984). Impedance control: an approach to manipula-
tion. In Proceedings of the 1984 American Control Conference,
San Diego, USA, pp. 304–313.
102. Rabuffetti, M., Recalcati, M., & Ferrarin, M. (2005). Transfem-
oral amputee gait: Socket-pelvis constraints and compensation
strategies. Prosthetics and Orthotics International, 29, 183–192.
103. Sanderson, D., & Martin, P. E. (1997). Lower extremity kin-
ematic and kinetic adaptations in unilateral below-knee amputees
during walking. Gait & Posture, 6, 126–136.
104. Clancy, E., Liu, L. K., Liu, P., & Moyer, D. V. (2012). Identi-
fication of constant-posture EMG torque relationship about the
elbow using nonlinear dynamic models. IEEE Transactions on
Biomedical Engineering, 59, 205–212.
105. Pfeifer, S., Vallery, H., Hardegger, M., Riener, R., & Perreault, E.
(2012). Model-based estimation of knee stiffness. IEEE Transac-
tions on Biomedical Engineering, 59, 2604–2612.
106. Koller, J. R., Jacobs, D. A., Ferris, D. P., & Remy, C. D. (2015).
Learning to walk with an adaptive gain proportional myoelectric
controller for a robotic ankle exoskeleton. Journal of NeuroEn-
gineering and Rehabilitation, 12, 1–14.
107. Geyer, H., & Herr, H. (2010). A muscle-reflex model that
encodes principles of legged mechanics produces human walk-
ing dynamics and muscle activities. IEEE Transactions on Neural
Systems and Rehabilitation Engineering, 18, 263–273.
108. Desai, R., & Geyer, H. (2012). Robust swing leg placement under
large disturbances. In Proceedings of the 2012 IEEE Interna-
tional Conference on Robotics and Biomimetics, Guangzhou,
China, pp. 265–270.
109. Nasr, A., & McPhee, J. (2020). Control-oriented muscle torque
(COMT) modelfor EMG-based control of assistive robots. In
Proceedings of the 7th international conference of control
dynamic systems, and robotics, virtual conference, p. 144.
110. Parri, A., Martini, E., Geeroms, J., Flynn, L., Pasquini, G., Crea,
S., Molino Lova, R., Lefeber, D., Kamnik, R., Munih, M., &
Vitiello, N. (2017). Whole body awareness for controlling a
robotic transfemoral prosthesis. Frontiers in Neurorobotics, 11,
1–14.
111. Woodward, R. B., Spanias, J. A., & Hargrove, L. (2016). User
intent prediction with a scaled conjugate gradient trained arti-
ficial neural network for lower limb amputees using a powered
prosthesis. In Proceedings of the 2016 38th annual international
conference of the IEEE engineering in medicine and biology
society, Orlando, USA, pp. 6405–6408.
112. Young, A., Simon, A. M., Fey, N., & Hargrove, L. (2013). Clas-
sifying the intent of novel users during human locomotion using
powered lower limb prostheses. In Proceedings of the 2013 6th
international IEEE/EMBS conference on neural engineering, San
Diego, USA, pp. 311–314. https://​doi.​org/​10.​1109/​NER.​2013.​
66959​34.
113. Varol, H. A., Sup, F., & Goldfarb, M. (2010). Multiclass real-
time intent recognition of a powered lower limb prosthesis. IEEE
Transactions on Biomedical Engineering, 57, 542–551.
114. Young, A., Simon, A. M., Fey, N., & Hargrove, L. (2013). Intent
recognition in a powered lower limb prosthesis using time history
information. Annals of Biomedical Engineering, 42, 631–641.
115. Simon, A. M., Ingraham, K. A., Spanias, J. A., Young, A.,
Finucane, S., Halsne, E. G., & Hargrove, L. (2017). Delaying
ambulation mode transition decisions improves accuracy of a
flexible control system for powered knee-ankle prosthesis. IEEE
Transactions on Neural Systems and Rehabilitation Engineering,
25, 1164–1171.
116. Young, A., & Hargrove, L. (2016). A classification method for
user-independent intent recognition for transfemoral amputees
13

using powered lower limb prostheses. IEEE Transactions on
Neural Systems and Rehabilitation Engineering, 24, 217–225.
117. Su, B. Y., Wang, J., Liu, S.-Q., Sheng, M., Jiang, J., & Xiang,
K. (2019). A CNN-based method for intent recognition using
inertial measurement units and intelligent lower limb prosthesis.
IEEE Transactions on Neural Systems and Rehabilitation Engi-
neering, 27, 1032–1042.
118. Lee, U. H., Bi, J., Patel, R., Fouhey, D. F., & Rouse, E. (2020).
Image transformation and CNNs: A strategy for encoding human
locomotor intent for autonomous wearable robots. IEEE Robotics
and Automation Letters, 5, 5440–5447.
119. Zhang, K. G., Luo, J. W., Xiao, W. T., Zhang, W., Liu, H. Y., Zhu,
J. L., Lu, Z. Y., Rong, Y. M., de Silva, C. W., & Fu, C. L. (2021).
A subvision system for enhancing the environmental adaptability
of the powered transfemoral prosthesis. IEEE Transactions on
Cybernetics, 51, 3285–3297.
120. Zhang, K. G., Xiong, C., Zhang, W., Liu, H. H., Lai, D. Y., Rong,
Y. M., & Fu, C. L. (2019). Environmental features recognition for
lower limb prostheses toward predictive walking. IEEE Trans-
actions on Neural Systems and Rehabilitation Engineering, 27,
465–476.
121. Huang, H., Zhang, F., Hargrove, L., Dou, Z., Rogers, D. R., &
Englehart, K. (2011). Continuous locomotion-mode identifi-
cation for prosthetic legs based on neuromuscular-mechanical
fusion. IEEE Transactions on Biomedical Engineering, 58,
2867–2875.
122. Young, A., Kuiken, T., & Hargrove, L. (2014). Analysis of using
EMG and mechanical sensors to enhance intent recognition in
powered lower limb prostheses. Journal of Neural Engineering,
11, 056021.
123. Hu, B. H., Rouse, E., & Hargrove, L. (2018). Fusion of bilateral
lower-limb neuromechanical signals improves prediction of loco-
motor activities. Frontiers in Robotics and AI, 5, 1–16.
124. Zhang, F., Liu, M., & Huang, H. (2015). Investigation of timing
to switch control mode in powered knee prostheses during task
transitions. PLoS ONE, 10, e0133965.
125. Zhang, F., Liu, M., & Huang, H. (2012). Preliminary study of
the effect of user intent recognition errors on volitional control
of powered lower limb prostheses. In Proceedings of the 2012
annual international conference of the IEEE engineering in medi-
cine and biology society, San Diego, USA, pp. 2768–2771.
126. Zhang, F., Liu, M., & Huang, H. (2015). Detection of critical
errors of locomotion mode recognition for volitional control of
powered transfemoral prostheses. In Proceedings of the 2015
37th Annual International Conference of the IEEE Engineer-
ing in Medicine and Biology Society (EMBC), Milan, Italy, pp.
1128–1131.
127. Artemiadis, P., & Kyriakopoulos, K. (2010). An EMG-based
robot control scheme robust to time-varying EMG signal fea-
tures. IEEE Transactions on Information Technology in Biomedi-
cine, 14, 582–588.
128. Young, A., Hargrove, L., & Kuiken, T. (2012). Improving myoe-
lectric pattern recognition robustness to electrode shift by chang-
ing interelectrode distance and electrode configuration. IEEE
Transactions on Biomedical Engineering, 59, 645–652.
129. Kapti, A. O., & Yucenur, M. S. (2006). Design and control of an
active artificial knee joint. Mechanism and Machine Theory, 41,
1477–1485.
130. Wentink, E., Koopman, H., Stramigioli, S., Rietman, J., &
Veltink, P. (2013). Variable stiffness actuated prosthetic knee to
restore knee buckling during stance: A modeling study. Medical
Engineering & Physics, 35, 838–845.
131. Papaioannou, G., Mitrogiannis, C., Nianios, G., & Fiedler, G.
(2010). Assessment of amputee socket-stump-residual bone kin-
ematics during strenuous activities using dynamic roentgen stere-
ogrammetric analysis. Journal of biomechanics, 43, 871–878.
13
L. Li et al.
132. Stachaczyk, M., Atashzar, S. F., & Farina, D. (2020). Adaptive
spatial filtering of high-density EMG for reducing the influence
of noise and artefacts in myoelectric control. IEEE Transac-
tions on Neural Systems and Rehabilitation Engineering, 28,
1511–1517.
133. Graczyk, E. L., Resnik, L., Schiefer, M., Schmitt, M. S., & Tyler,
D. (2018). Home use of a neural-connected sensory prosthesis
provides the functional and psychosocial experience of having a
hand again. Scientific Reports, 8, 9866.
134. Lewis, S., Russold, M., Dietl, H., Ruff, R., Audi, J. C., Hoffmann,
K., Saleh, L. A., Schroeder, D., Krautschneider, W., Westendorff,
S., Gail, A., Meiners, T., & Kaniusas, E. (2013). Fully implant-
able multi-channel measurement system for acquisition of muscle
activity. IEEE Transactions on Instrumentation and Measure-
ment, 62, 1972–1981.
135. Merrill, D. R., Lockhart, J., Troyk, P., Weir, R., & Hankin, D.
(2011). Development of an implantable myoelectric sensor for
advanced prosthesis control. Artificial Organs, 35, 249–252.
136. Ortiz-Catalán, M., Håkansson, B., & Brånemark, R. (2014). An
osseointegrated human-machine gateway for long-term sensory
feedback and motor control of artificial limbs. Science Transla-
tional Medicine, 6, 257re6.
137. Matthis, J., Yates, J., & Hayhoe, M. (2018). Gaze and the control
of foot placement when walking in natural terrain. Current Biol-
ogy, 28, 1224–1233.
138. Blanke, O. (2012). Multisensory brain mechanisms of bodily
self-consciousness. Nature Reviews Neuroscience, 13, 556–571.
139. Ehrsson, H., Rosén, B., Stockselius, A., Ragnö, C., Köhler, P.,
& Lundborg, G. (2008). Upper limb amputees can be induced to
experience a rubber hand as their own. Brain, 131, 3443–3452.
140. Fogelberg, D. J., Allyn, K. J., Smersh, M., & Maitland, M.
(2016). What people want in a prosthetic foot: A focus group
study. Journal of Prosthetics and Orthotics, 28, 145–151.
141. Preatoni, G., Valle, G., Petrini, F., & Raspopovic, S. (2021).
Lightening the perceived prosthesis weight with neural embodi-
ment promoted by sensory feedback. Current Biology, 31,
1065–1071.
142. Witteveen, H. J. B., Rietman, H., & Veltink, P. (2015). Vibrotac-
tile grasping force and hand aperture feedback for myoelectric
forearm prosthesis users. Prosthetics and Orthotics Interna-
tional, 39, 204–212.
143. Dpaen, S., Ninu, A., Yakimovich, T., Dietl, H., & Farina, D.
(2016). A novel method to generate amplitude-frequency modu-
lated vibrotactile stimulation. IEEE Transactions on Haptics, 9,
3–12.
144. Patterson, P., & Katz, J. A. (1992). Design and evaluation of a
sensory feedback system that provides grasping pressure in a
myoelectric hand. Journal of Rehabilitation Research and Devel-
opment, 29, 1–8.
145. Srinivasan, S., Carty, M., Calvaresi, P., Clites, T., Maimon, B.,
Taylor, C. R., Zorzos, A., & Herr, H. (2017). On prosthetic con-
trol: A regenerative agonist-antagonist myoneural interface. Sci-
ence Robotics, 2, 2971.
146. Clites, T., Carty, M., Ullauri, J. B., Carney, M., Mooney, L. M.,
Duval, J.-F., Srinivasan, S., & Herr, H. J. S. T. M. (2018). Pro-
prioception from a neurally controlled lower-extremity prosthe-
sis. Science Translational Medicine, 10, eaap8373.
147. Petrini, F., Valle, G., Bumbasirevic, M., Barberi, F., Bortolotti,
D., Cvancara, P., Hiairrassary, A., Mijovic, P., Sverrisson, A.,
Pedrocchi, A., Divoux, J., Popovj, I., Lechler, K., Mijovic, B.,
Guiraud, D., Stieglitz, T., Alexandersson, A., Micera, S., Lfai,
A., & Raspopovic, S. (2019). Enhancing functional abilities and
cognitive integration of the lower limb prosthesis. Science Trans-
lational Medicine, 11, 512.
148. Petrini, F., Bumbasirevic, M., Valle, G., Ili, V., Mijovic, P.,
Vaoara, P., Barberi, F., Katj, N., Bortolotti, D., Andreu, D.,
Intelligent Knee Prostheses: A Systematic Review of Control Strategies
Lechler, K., Leaj, A., Mazi, S., Mijovic, B., Guiraud, D., Stieg-
litz, T., Alexandersson, A., Micera, S., & Raspopovic, S. (2019).
Sensory feedback restoration in leg amputees improves walking
speed, metabolic cost and phantom pain. Nature Medicine, 25,
1356–1363.
149. Valle, G., Saliji, A., Fogle, E., Cimolato, A., Petrini, F., & Ras-
popovic, S. (2021). Mechanisms of neuro-robotic prosthesis
operation in leg amputees. Science Advances, 7, eabd8354.
150. Charkhkar, H., Shell, C. E., Marasco, P., Pinault, G., Tyler, D.,
& Triolo, R. (2018). High-density peripheral nerve cuffs restore
natural sensation to individuals with lower-limb amputations.
Journal of Neural Engineering, 15, 05602.
151. Ordonez, J., Schuettler, M., Boehler, C., Boretius, T., & Stieglitz,
T. (2012). Thin films and microelectrode arrays for neuropros-
thetics. MRS Bulletin, 37, 590–598.
152. Zelechowski, M., Valle, G., & Raspopovic, S. (2020). A compu-
tational model to design neural interfaces for lower-limb sensory
neuroprostheses. Journal of NeuroEngineering and Rehabilita-
tion, 17, 24.
153. Wanamaker, A. B., Andridge, R. R., & Chaudhari, A. M. (2017).
When to biomechanically examine a lower-limb amputee: A sys-
tematic review of accommodation times. Prosthetics and Orthot-
ics International, 41, 431–445.
154. Zhang, X. Y., Fiedler, G., & Liu, Z. C. (2019). Evaluation of gait
variable change over time as transtibial amputees adapt to a new
prosthesis foot. BioMed Research International, 2019, 6.
155. Fleming, A., Huang, S., & Huang, H. (2019). Proportional myoe-
lectric control of a virtual inverted pendulum using residual
antagonistic muscles: Toward voluntary postural control. IEEE
Transactions on Neural Systems and Rehabilitation Engineering,
27, 1473–1482.
156. Johnson, S. S., & Mansfield, E. (2014). Prosthetic training: Upper
limb. Physical Medicine and Rehabilitation Clinics of North
America, 25, 133–151.
157. Lee, J., Bartlett, H. L., & Goldfarb, M. (2020). Design of a sem-
ipowered stance-control swing-assist transfemoral prosthesis.
IEEE/ASME Transactions on Mechatronics, 25, 175–184.
158. Huang, H., Crouch, D., Liu, M., Sawicki, G., & Wang, D. (2015).
A cyber expert system for auto-tuning powered prosthesis imped-
ance control parameters. Annals of Biomedical Engineering, 44,
1613–1624.
159. Chen, B. J., Zheng, E. H., Wang, Q. N., & Wang, L. (2015).
A new strategy for parameter optimization to improve phase-
dependent locomotion mode recognition. Neurocomputing, 149,
585–593.
160. Khademi, G., Mohammadi, H., & Simon, D. (2019). Gradient-
based multi-objective feature selection for gait mode recognition
of transfemoral amputees. Sensors, 19, 253.
Publisher's Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
13