Background Advanced motorized prosthetic devices are currently controlled by EMG signals generated by residual muscles and recorded by surface electrodes on the skin. These surface recordings are often inconsistent and unreliable, leading to high prosthetic abandonment rates for individuals with upper limb amputation. Surface electrodes are limited because of poor skin contact, socket rotation, residual limb sweating, and their ability to only record signals from superficial muscles, whose function frequently does not relate to the intended prosthetic function. More sophisticated prosthetic devices require a stable and reliable interface between the user and robotic hand to improve upper limb prosthetic function. New Method Implantable Myoelectric Sensors (IMES®) are small electrodes intended to detect and wirelessly transmit EMG signals to an electromechanical prosthetic hand via an electromagnetic coil built into the prosthetic socket. This system is designed to simultaneously capture EMG signals from multiple residual limb muscles, allowing the natural control of multiple degrees of freedom simultaneously. Results We report the status of the first FDA-approved clinical trial of the IMES® System. This study is currently in progress, limiting reporting to only preliminary results. Comparison with Existing Methods Our first subject has reported the ability to accomplish a greater variety and complexity of tasks in his everyday life compared to what could be achieved with his previous myoelectric prosthesis. Conclusion The interim results of this study indicate the feasibility of utilizing IMES® technology to reliably sense and wirelessly transmit EMG signals from residual muscles to intuitively control a three degree-of-freedom prosthetic arm.
BackgroundMirror therapy has been demonstrated to reduce phantom limb pain (PLP) experienced by unilateral limb amputees. Research suggests that the visual feedback of observing a limb moving in the mirror is critical for therapeutic efficacy.ObjectiveSince mirror therapy is not an option for bilateral lower limb amputees, the purpose of this study was to determine if direct observation of another person’s limbs could be used to relieve PLP.MethodsWe randomly assigned 20 bilateral lower limb amputees with PLP to visual observation (n = 11) or mental visualization (n = 9) treatment. Treatment consisted of seven discrete movements which were mimicked by the amputee’s phantom limbs moving while visually observing the experimenter’s limbs moving, or closing the eyes while visualizing and attempting the movements with their phantom limbs, respectively. Participants performed movements for 20 min daily for 1 month. Response to therapy was measured using a 100-mm visual analog scale (VAS) and the McGill Short-Form Pain Questionnaire (SF-MPQ).ResultsDirect visual observation significantly reduced PLP in both legs (P < 0.05). Amputees assigned to the mental visualization condition did not show a significant reduction in PLP.InterpretationDirect visual observation therapy is an inexpensive and effective treatment for PLP that is accessible to bilateral lower limb amputees.
Introduction Combat-related lower-limb amputations challenge prosthetic device prescription and rehabilitation practices. Moreover, wounded warriors are relatively young and lived highly active lifestyles before injury, underscoring their eagerness to quickly regain independent mobility and higher levels of physical function. Methods Four US military service members with combat-related unilateral amputation were fit with the PowerKnee™ as their initial prosthesis. Results All patients achieved significant mobility milestones more rapidly than historical norms of similarly injured patients using other prosthetic knees. Level-ground gait analysis of each patient was comparable with historical normative data of patients using advanced microprocessor variable dampening knee (MPK) prostheses, although the PowerKnee users generated less power in their intact limb hip and knee, suggesting less strain on intact joints. Each patient was also subsequently fit with an MPK and offered a hydraulic knee prosthesis for higher-level activities. Two of the four patients ultimately chose an alternative prosthesis as their primary knee, citing weight, ability to run, and battery life as key determinants. All patients, however, perceived the PowerKnee prosthesis to be valuable during their rehabilitation. Conclusion: The PowerKnee may be a viable option for the initial prosthetic fitting of individuals with transfemoral amputation. Further research is necessary to better understand the advantages or disadvantages of powered prosthetic technology, including their biomechanical effects on intact limbs, especially for high-level activities, and their ability to enhance early rehabilitation and optimal patient selection and timing of fitting.
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