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Myoelectric Pattern Recognition Outperforms Direct Control for Transhumeral Amputees with Targeted Muscle Reinnervation: A Randomized Clinical Trial

Published on Dec 1, 2017in Scientific Reports4.011
· DOI :10.1038/s41598-017-14386-w
Levi J. Hargrove33
Estimated H-index: 33
(NU: Northwestern University),
Laura A. Miller16
Estimated H-index: 16
(NU: Northwestern University)
+ 1 AuthorsTodd A. Kuiken43
Estimated H-index: 43
(NU: Northwestern University)
Sources
Abstract
Recently commercialized powered prosthetic arm systems hold great potential in restoring function for people with upper-limb loss. However, effective use of such devices remains limited by conventional (direct) control methods, which rely on electromyographic signals produced from a limited set of muscles. Targeted Muscle Reinnervation (TMR) is a nerve transfer procedure that creates additional recording sites for myoelectric prosthesis control. The effects of TMR may be enhanced when paired with pattern recognition technology. We sought to compare pattern recognition and direct control in eight transhumeral amputees who had TMR in a balanced randomized cross-over study. Subjects performed a 6–8 week home trial using direct and pattern recognition control with a custom prostheses made from commercially available parts. Subjects showed statistically better performance in the Southampton Hand Assessment Procedure (p = 0.04) and the Clothespin relocation task (p = 0.02). Notably, these tests required movements along 3 degrees of freedom. Seven of 8 subjects preferred pattern recognition control over direct control. This study was the first home trial large enough to establish clinical and statistical significance in comparing pattern recognition with direct control. Results demonstrate that pattern recognition is a viable option and has functional advantages over direct control.
  • References (30)
  • Citations (30)
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References30
Newest
#1Janne M. HahneH-Index: 9
#2Marko MarkovicH-Index: 11
Last. Dario Farina (Imperial College London)H-Index: 76
view all 3 authors...
State of the art clinical hand prostheses are controlled in a simple and limited way that allows the activation of one function at a time. More advanced laboratory approaches, based on machine learning, offer a significant increase in functionality, but their clinical impact is limited, mainly due to lack of reliability. In this study, we analyse two conceptually different machine learning approaches, focusing on their robustness and performance in a closed loop application. A classification (fi...
31 CitationsSource
#1Ivan Vujaklija (Imperial College London)H-Index: 11
#2Aidan D. Roche (Medical University of Vienna)H-Index: 10
Last. Oskar C. Aszmann (Medical University of Vienna)H-Index: 25
view all 7 authors...
Missing an upper limb dramatically impairs daily-life activities. Efforts in overcoming the issues arising from this disability have been made in both academia and industry, although their clinical outcome is still limited. Translation of prosthetic research into clinics has been challenging because of the difficulties in meeting the necessary requirements of the market. In this perspective, we suggest that one relevant factor determining the relatively small clinical impact of myocontrol algori...
22 CitationsSource
Myoelectric signals (MES) have been used in various applications, in particular, for identification of user intention to potentially control assistive devices for amputees, orthotic devices, and exoskeleton in order to augment capability of the user. MES are also used to estimate force and, hence, torque to actuate the assistive device. The application of MES is not limited to assistive devices, and they also find potential applications in teleoperation of robots, haptic devices, virtual reality...
56 CitationsSource
#1Todd A. Kuiken (Rehabilitation Institute of Chicago)H-Index: 43
#2Laura A. Miller (Rehabilitation Institute of Chicago)H-Index: 16
Last. Levi J. Hargrove (Rehabilitation Institute of Chicago)H-Index: 33
view all 4 authors...
With existing conventional prosthesis control (direct control), individuals with a transradial amputation use two opposing muscle groups to control each prosthesis motor. As component complexity increases, subjects must switch the prosthesis into different modes to control each component in sequence. Pattern recognition control offers the ability to control multiple movements in a seamless manner without switching. In this paper, three individuals with a transradial amputation completed a home t...
25 CitationsSource
#1Jason M. Souza (NU: Northwestern University)H-Index: 9
#2Jennifer E. Cheesborough (NU: Northwestern University)H-Index: 7
Last. Gregory Ara Dumanian (NU: Northwestern University)H-Index: 29
view all 6 authors...
Background Postamputation neuroma pain can prevent comfortable prosthesis wear in patients with limb amputations, and currently available treatments are not consistently effective. Targeted muscle reinnervation (TMR) is a decade-old technique that employs a series of novel nerve transfers to permit intuitive control of upper-limb prostheses. Clinical experience suggests that it may also serve as an effective therapy for postamputation neuroma pain; however, this has not been explicitly studied.
61 CitationsSource
#1Dennis C. Tkach (NU: Northwestern University)H-Index: 1
#2Aaron J. Young (NU: Northwestern University)H-Index: 20
Last. Levi J. Hargrove (Rehabilitation Institute of Chicago)H-Index: 33
view all 5 authors...
Targeted muscle reinnervation (TMR) is a surgical technique that creates myoelectric prosthesis control sites for high-level amputees. The electromyographic (EMG) signal patterns provided by the reinnervated muscles are well-suited for pattern recognition control. Pattern recognition allows for control of a greater number of degrees of freedom (DOF) than the conventional, EMG amplitude-based approach. Previous pattern recognition studies have shown benefit in placing electrodes directly over the...
25 CitationsSource
#1Erik Scheme (UNB: University of New Brunswick)H-Index: 20
#2Blair A. Lock (Rehabilitation Institute of Chicago)H-Index: 19
Last. Kevin Englehart (UNB: University of New Brunswick)H-Index: 39
view all 6 authors...
This paper describes two novel proportional control algorithms for use with pattern recognition-based myoelectric control. The systems were designed to provide automatic configuration of motion-specific gains and to normalize the control space to the user's usable dynamic range. Class-specific normalization parameters were calculated using data collected during classifier training and require no additional user action or configuration. The new control schemes were compared to the standard method...
56 CitationsSource
#1Todd A. KuikenH-Index: 43
Last. Ann K. BarlowH-Index: 2
view all 3 authors...
Introduction to Targeted Reinnervation, Todd A. Kuiken The Scientific Basis of Targeted Muscle Reinnervation, Todd A. Kuiken Principles of Targeted Muscle Reinnervation Optimization of the EMG Signal Surgical Techniques for Targeted Muscle Reinnervation, Gregory A. Dumanian and Jason M. Souza Fundamentals of Targeted Musscle Reinnervation Surgery Targeted Muscle Reinnervation for the Transhumeral Amputee Targeted Muscle Reinnervation for the Shoulder Disarticulation Amputee Targeted Sensory Rein...
12 CitationsSource
Jul 1, 2013 in EMBC (International Conference of the IEEE Engineering in Medicine and Biology Society)
#1Levi J. Hargrove (Rehabilitation Institute of Chicago)H-Index: 33
#2Blair A. Lock (Rehabilitation Institute of Chicago)H-Index: 19
Last. Ann M. Simon (Rehabilitation Institute of Chicago)H-Index: 17
view all 3 authors...
Pattern recognition myoelectric control shows great promise as an alternative to conventional amplitude based control to control multiple degree of freedom prosthetic limbs. Many studies have reported pattern recognition classification error performances of less than 10% during offline tests; however, it remains unclear how this translates to real-time control performance. In this contribution, we compare the real-time control performances between pattern recognition and direct myoelectric contr...
29 CitationsSource
#1Ning JiangH-Index: 29
#2Strahinja DosenH-Index: 21
Last. Dario FarinaH-Index: 76
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In this article, the basic concept of myoelectric control and the state of the art in both industry and academia will be presented. It will emerge that there is a gap between industrial and academic achievements and that this gap will continue to expand unless a change of focus in systems for myoelectric control occurs.
184 CitationsSource
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#1Philip P. Vu (UM: University of Michigan)H-Index: 3
#2Cynthia A. ChestekH-Index: 23
Last. Paul S. Cederna (UM: University of Michigan)H-Index: 27
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: The loss of upper limb motor function can have a devastating effect on people's lives. To restore upper limb control and functionality, researchers and clinicians have developed interfaces to interact directly with the human body's motor system. In this invited review, we aim to provide details on the peripheral nerve interfaces and brain-machine interfaces that have been developed in the past 30 years for upper extremity control, and we highlight the challenges that still remain to transition...
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#1Mark Brinton (Elizabethtown College)
Last. Gregory A. Clark (UofU: University of Utah)H-Index: 25
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This paper describes a portable, prosthetic control system for at-home use of an advanced bionic arm. The system uses a modified Kalman filter to provide 6 degree-of-freedom, real-time, proportional control. We describe (a) how the system trains motor control algorithms for use with an advanced bionic arm, and (b) the system9s ability to record an unprecedented and comprehensive dataset of EMG, hand positions and force sensor values. Intact participants and a transradial amputee used the system ...
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#1Andrea Gigli (DLR: German Aerospace Center)
#1Andrea GigliH-Index: 3
Last. Claudio CastelliniH-Index: 26
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: Natural myocontrol is the intuitive control of a prosthetic limb via the user's voluntary muscular activations. This type of control is usually implemented by means of pattern recognition, which uses a set of training data to create a model that can decipher these muscular activations. A consequence of this approach is that the reliability of a myocontrol system depends on how representative this training data is for all types of signal variability that may be encountered when the amputee puts...
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#1Jacob L. Segil (CU: University of Colorado Boulder)H-Index: 7
#2Ivana Cuberovic (Case Western Reserve University)
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Multiple sources of sensory information are combined to develop hand posture percepts in the intact system, but the combination of multiple artificial somatosensory percepts by human prosthesis users has not been studied. Here, we report on a case study in which a person with transradial amputation identified prosthetic hand postures using artificial somatosensory feedback. He successfully combined five artificial somatosensory percepts to achieve above-chance performance of 95.0% and 75.7% in i...
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Shortcomings in capabilities of below-knee (transtibial) prostheses, compared to their biological counterparts, still cause medical complications and functional deficit to millions of amputees around the world. Although active (powered actuation) transtibial prostheses have the potential to bridge these gaps, the current control solutions limit their efficacy. Here we describe the development of a novel interface for two degrees-of-freedom position and stiffness control for below-knee amputees. ...
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#1Agamemnon Krasoulis (Edin.: University of Edinburgh)H-Index: 4
#2Kianoush Nazarpour (Newcastle University)H-Index: 18
Objective: We aim to develop a paradigm for simultaneous and independent control of multiple degrees of freedom (DOFs) for upper-limb prostheses. Approach: We introduce action control, a novel method to operate prosthetic digits with surface electromyography (EMG) based on multi-label, multi-class classification. At each time step, the decoder classifies movement intent for each controllable DOF into one of three categories: open, close, or stall (i.e., no movement). We implemented a real-time m...
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Peripheral nerves provide a promising source of motor control signals for neuroprosthetic devices. Unfortunately, the clinical utility of current peripheral nerve interfaces is limited by signal amplitude and stability. Here, we showed that the regenerative peripheral nerve interface (RPNI) serves as a biologically stable bioamplifier of efferent motor action potentials with long-term stability in upper limb amputees. Ultrasound assessments of RPNIs revealed prominent contractions during phantom...
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#1Jacob L. Segil (CU: University of Colorado Boulder)H-Index: 7
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The bottleneck in upper limb prosthetic design is the myoelectric control algorithm. We studied the clinical readiness of the myoelectric postural control algorithm in a laboratory setting with two transradial amputees utilizing a commercially available prosthetic limb system. The postural control algorithm was integrated into prosthetic limb systems using standard-of-care components. A comparison between a commercial state-of-the-art system (the i-limb revolution statebased myoelectric controll...
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#1Marko Bumbasirevic (University of Belgrade)H-Index: 18
#2Aleksandar Lesic (University of Belgrade)H-Index: 13
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Amputations have a devastating impact on patients’ health with consequent psychological distress, economic loss, difficult reintegration into society, and often low embodiment of standard prostheti...
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