Mind-controlled prosthetic arms that work in daily life are now a reality

In January 2013 a Swedish arm amputee was the first person in the world to receive a prosthesis with a direct connection to bone, nerves and muscles. An article about this achievement and its long-term stability will now be published in the Science Translational Medicine journal.

“Going beyond the lab to allow the patient to face real-world challenges is the main contribution of this work,” says Max Ortiz Catalan, research scientist at Chalmers University of Technology and leading author of the publication.

“We have used osseointegration to create a long-term stable fusion between man and machine, where we have integrated them at different levels. The artificial arm is directly attached to the skeleton, thus providing mechanical stability. Then the human’s biological control system, that is nerves and muscles, is also interfaced to the machine’s control system via neuromuscular electrodes. This creates an intimate union between the body and the machine; between biology and mechatronics.”

The direct skeletal attachment is created by what is known as osseointegration, a technology in limb prostheses pioneered by associate professor Rickard Brånemark and his colleagues at Sahlgrenska University Hospital. Rickard Brånemark led the surgical implantation and collaborated closely with Max Ortiz Catalan and Professor Bo Håkansson at Chalmers University of Technology on this project.

The patient’s arm was amputated over ten years ago. Before the surgery, his prosthesis was controlled via electrodes placed over the skin. Robotic prostheses can be very advanced, but such a control system makes them unreliable and limits their functionality, and patients commonly reject them as a result.

Now, the patient has been given a control system that is directly connected to his own. He has a physically challenging job as a truck driver in northern Sweden, and since the surgery he has experienced that he can cope with all the situations he faces; everything from clamping his trailer load and operating machinery, to unpacking eggs and tying his children’s skates, regardless of the environmental conditions (read more about the benefits of the new technology below).

The patient is also one of the first in the world to take part in an effort to achieve long-term sensation via the prosthesis. Because the implant is a bidirectional interface, it can also be used to send signals in the opposite direction – from the prosthetic arm to the brain. This is the researchers’ next step, to clinically implement their findings on sensory feedback.

“Reliable communication between the prosthesis and the body has been the missing link for the clinical implementation of neural control and sensory feedback, and this is now in place,” says Max Ortiz Catalan. “So far we have shown that the patient has a long-term stable ability to perceive touch in different locations in the missing hand. Intuitive sensory feedback and control are crucial for interacting with the environment, for example to reliably hold an object despite disturbances or uncertainty. Today, no patient walks around with a prosthesis that provides such information, but we are working towards changing that in the very short term.”

The researchers plan to treat more patients with the novel technology later this year.

“We see this technology as an important step towards more natural control of artificial limbs,” says Max Ortiz Catalan. “It is the missing link for allowing sophisticated neural interfaces to control sophisticated prostheses. So far, this has only been possible in short experiments within controlled environments.”

The Next Big Thing You Missed: 3-D Printing Promises Better Bionic Limbs for the War-Wounded

David Sengeh grew up in Sierra Leone during the African country’s decade-long civil war. The horribly bloody conflict was defined not just by the enormous death toll, but by the way rebel armies systematically severed the limbs of their enemies, leaving thousands of men, women, and children with missing arms and legs. Though the war ended more than a decade ago, Sengeh says, many victims are still struggling through life with artificial limbs that are too uncomfortable to wear.

But at the famed MIT Media Lab, the 27-year-old doctoral student is now using 3-D printing and advanced math to create a new kind of artificial limb he believes can significantly improve the lives of amputees in Sierra Leone and across the rest of the world. Sengeh relies on data-backed digital models to fashion prosthetics that he says better match the contours of the human body. And because these prosthetics are fabricated by 3-D printers, he says, they become far easier to produce.

The key problem with today’s prosthetics, Sengeh says, is that they don’t fit. Many people who have lost limbs — whether they’re Sierra Leone civilians or U.S. war vets — don’t wear their prostheses because the sockets aren’t tailored to their bodies. The tools needed to make well-fitting artificial limbs today are neither affordable nor widespread. “It does not matter how powerful your prosthetic ankle is,” Senghe said on Monday during a talk at TED, the global ideas conference being held this year in Vancouver, British Columbia. “If your prosthetic socket is uncomfortable, you will not use your leg.”

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Robotic advances promise artificial legs that emulate healthy limbs

Recent advances in robotics technology make it possible to create prosthetics that can duplicate the natural movement of human legs. This capability promises to dramatically improve the mobility of lower-limb amputees, allowing them to negotiate stairs and slopes and uneven ground, significantly reducing their risk of falling as well as reducing stress on the rest of their bodies.

That is the view of Michael Goldfarb, the H. Fort Flowers Professor of Mechanical Engineering, and his colleagues at Vanderbilt University’s Center for Intelligent Mechatronics expressed in a perspective’s article in the Nov. 6 issue of the journal Science Translational Medicine.

For the last decade, Goldfarb’s team has been doing pioneering research in lower-limb prosthetics. It developed the first robotic prosthesis with both powered knee and ankle joints. And the design became the first artificial leg controlled by thought when researchers at the Rehabilitation Institute of Chicago created a neural interface for it.

In the article, Goldfarb and graduate students Brian Lawson and Amanda Shultz describe the technological advances that have made robotic prostheses viable. These include lithium-ion batteries that can store more electricity, powerful brushless electric motors with rare-Earth magnets, miniaturized sensors built into semiconductor chips, particularly accelerometers and gyroscopes, and low-power computer chips.

The size and weight of these components is small enough so that they can be combined into a package comparable to that of a biological leg and they can duplicate all of its basic functions. The electric motors play the role of muscles. The batteries store enough power so the robot legs can operate for a full day on a single charge. The sensors serve the function of the nerves in the peripheral nervous system, providing vital information such as the angle between the thigh and lower leg and the force being exerted on the bottom of the foot, etc. The microprocessor provides the coordination function normally provided by the central nervous system. And, in the most advanced systems, a neural interface enhances integration with the brain.

Unlike passive artificial legs, robotic legs have the capability of moving independently and out of sync with its user’s movements. So the development of a system that integrates the movement of the prosthesis with the movement of the user is “substantially more important with a robotic leg,” according to the authors.

Not only must this control system coordinate the actions of the prosthesis within an activity, such as walking, but it must also recognize a user’s intent to change from one activity to another, such as moving from walking to stair climbing.

Identifying the user’s intent requires some connection with the central nervous system. Currently, there are several different approaches to establishing this connection that vary greatly in invasiveness. The least invasive method uses physical sensors that divine the user’s intent from his or her body language. Another method – the electromyography interface – uses electrodes implanted into the user’s leg muscles. The most invasive techniques involve implanting electrodes directly into a patient’s peripheral nerves or directly into his or her brain. The jury is still out on which of these approaches will prove to be best. “Approaches that entail a greater degree of invasiveness must obviously justify the invasiveness with substantial functional advantage,” the article states.

There are a number of potential advantages of bionic legs, the authors point out.

Studies have shown that users equipped with the lower-limb prostheses with powered knee and heel joints naturally walk faster with decreased hip effort while expending less energy than when they are using passive prostheses.

In addition, amputees using conventional artificial legs experience falls that lead to hospitalization at a higher rate than elderly living in institutions. The rate is actually highest among younger amputees, presumably because they are less likely to limit their activities and terrain. There are several reasons why a robotic prosthesis should decrease the rate of falls: Users don’t have to compensate for deficiencies in its movement like they do for passive legs because it moves like a natural leg. Both walking and standing, it can compensate better for uneven ground. Active responses can be programmed into the robotic leg that helps users recover from stumbles.

Before individuals in the U.S. can begin realizing these benefits, however, the new devices must be approved by the U.S. Food and Drug Administration (FDA).

Single-joint devices are currently considered to be Class I medical devices, so they are subject to the least amount of regulatory control. Currently, transfemoral prostheses are generally constructed by combining two, single-joint prostheses. As a result, they have also been considered Class I devices.

In robotic legs the knee and ankle joints are electronically linked. According to the FDA that makes them multi-joint devices, which are considered Class II medical devices. This means that they must meet a number of additional regulatory requirements, including the development of performance standards, post-market surveillance, establishing patient registries and special labeling requirements.

Another translational issue that must be resolved before robotic prostheses can become viable products is the need to provide additional training for the clinicians who prescribe prostheses. Because the new devices are substantially more complex than standard prostheses, the clinicians will need additional training in robotics, the authors point out.

In addition to the robotics leg, Goldfarb’s Center for Intelligent Mechatronics has developed an advanced exoskeleton that allows paraplegics to stand up and walk, which led Popular Mechanics magazine to name him as one of the 10 innovators who changed the world in 2013, and a robotic hand with a dexterity that approaches that of the human hand.

Bionic leg is controlled by brain power

A team of specialists has designed a bionic prosthetic leg that can reproduce a full range of ambulatory movements by communicating with the brain of the person wearing it.

The act of walking may not seem like a feat of agility, balance, strength and brainpower. But lose a leg, as Zac Vawter did after a motorcycle accident in 2009, and you will appreciate the myriad calculations that go into putting one foot in front of the other.

Taking on the challenge, a team of software and biomedical engineers, neuroscientists, surgeons and prosthetists has designed a prosthetic limb that can reproduce a full repertoire of ambulatory tricks by communicating seamlessly with Vawter’s brain.

A report published Wednesday in the New England Journal of Medicine describes how the team fit Vawter with a prosthetic leg that has learned — with the help of a computer and some electrodes — to read his intentions from a bundle of nerves that end above his missing knee.

For the roughly 1 million Americans who have lost a leg or part of one due to injury or disease, Vawter and his robotic leg offer the hope that future prosthetics might return the feel of a natural gait, kicking a soccer ball or climbing into a car without hoisting an inert artificial limb into the vehicle.

Vawter’s prosthetic is a marvel of 21st century engineering. But it is Vawter’s ability to control the prosthetic with his thoughts that makes the latest case remarkable. If he wants his artificial toes to curl toward him, or his artificial ankle to shift so he can walk down a ramp, all he has to do is imagine such movements.

The work was done at the Rehabilitation Institute of Chicago under an $8-million grant from the Army. The armed forces hope to apply findings from such studies to the care of about 1,200 service personnel who have lost a lower limb in Iraq and Afghanistan.

"We want to restore full capabilities" to people who’ve lost a lower limb, said Levi J. Hargrove, lead author of the new report. "While we’re focused and committed to developing this system for our wounded warriors, we’re very much thinking of this other, much larger population that could benefit as well."

The report describes advances across a wide range of disciplines: in orthopedic and peripheral nerve surgery, neuroscience, and the application of pattern-recognition software to the field of prosthetics.

Weighing just over 10 pounds, the leg has two independent engines powering movement in the ankle and knee. And it bristles with sensors, including an accelerometer and gyroscope, each capable of detecting and measuring movement in three dimensions.

Most prosthetics in use today require the physical turn of a key to transition from one movement to another. But with the robotic leg, those transitions are effortless, Vawter said.

"With this leg, it just flows," said the 32-year-old software engineer, who spends most of his days using a typical prosthetic but travels to Chicago several times a year from his home in Yelm, Wash. "The control system is very intuitive. There isn’t anything special I have to do to make it work right."

Before Vawter could strap on the bionic lower limb, engineers in Chicago had to “teach” the prosthetic how to read his motor intentions from tiny muscle contractions in his right thigh.

At the institute’s Center for Bionic Medicine, Vawter spent countless hours with his thigh wired up with electrodes, imagining making certain movements on command with his missing knee, ankle and foot.

Using pattern-recognition software, engineers discerned, distilled and digitized those recorded electrical signals to catalog an entire repertoire of movements. The prosthetic could thus be programmed to recognize the subtlest contraction of a muscle in Vawter’s thigh as a specific motor command.

Given surgical practices still in wide use, the prospects for such a connection between a patient’s prosthetic and his or her peripheral nerves are generally dim. In most amputations, the nerves in the thigh are left to languish or die.

Dr. Todd Kuiken, a neurosurgeon at the rehabilitation institute, pioneered a practice called “reinervation” of nerves severed by amputation, and Vawter’s orthopedic surgeon at the University of Washington Medical Center was trained to conduct the delicate operation. Dr. Douglas Smith rewired the severed nerves to control some of the muscles in Vawter’s thigh that would be used less frequently in the absence of his lower leg.

Within a few months of the amputation, those nerves had recovered from the shock of the injury and begun to regenerate and carry electrical impulses. When Vawter thought about flexing his right foot in a particular way, the rerouted nerve endings would consistently cause a distinctive contraction in his hamstring. When he pondered how he would position his foot on a stair step and ready it for the weight of his body, the muscle contraction would be elsewhere — but equally consistent.

Compared with prosthetics that were not able to “read” the intent of their wearers, the robotic leg programmed to follow Vawter’s commands reduced the kinds of errors that cause unnatural movements, discomfort and falls by as much as 44%, according to the New England Journal of Medicine report.

Vawter said he had “fallen down a whole bunch of times” while wearing his everyday prosthetic, but not once while moving around on his bionic leg.

He said he could move a lot faster too — which would be helpful for keeping up with his 5-year-old son and 3-year-old daughter. But first, Vawter added, he needs to persuade Hargrove’s team to let him wear it home.

Mind-controlled artificial limb gives patients sense of touch again

Artificial limbs and prosthetics have come a long way from the 1963 CO2 gas-powered artificial arms exhibited at the Wellcome Trust in 2012.

In the 21st century, the Pentagon’s research division, Darpa, has been at the cutting edge of prosthetics development, in no small part due to the wars in Iraq and Afghanistan.

Darpa’s touch-sensitive artificial prosthetic, described in a statement on 30 May, interfaces directly with the wearer’s neural system and shows just how far we’ve come.

Unlike direct brain neural interfaces, the prosthetic connects with nerves in the patient’s limb, therefore requiring less serious and less risky surgery.

It doesn’t require any visual information to operate, allowing the wearer to control it without maintaining visual contact. This makes “blind” tasks, like rummaging through a bag, much easier.

A flat interface nerve electrode (Fine) provides direct sensory feedback to the patient. Fine is a way of hacking into the body’s nervous system by flattening a nerve. This exposes more of the nerve to electrical contact, making it easier to interface with it. Researchers at Case Western Reserve University, involved with the touch-sensitive prosthetic, previously used Fine to reactivate paralysed limbs.

In the video, the wearer of the prosthetic hand is able to identify which finger researchers at Case Western Reserve University are touching without looking.

Groups across the world are engaged in similar research, including a team at the École Polytechnique Fédérale de Lausanne in France which announced in February that it would be trialling a touch-sensitive prosthetic this year.

Startlingly natural prosthetic movement, including bouncing and catching a tennis ball with a fully artificial arm and hand, is also described in Darpa’s 30 May statement.

Using a type of neural connection called targeted muscle re-innervation (TMR), researchers at the Rehabilitation Institute of Chicago (RIC) were able to achieve simultaneous control of the shoulder, elbow and wrist.

TMR involves re-wiring nerves from amputated limbs so that existing muscles, like those in the shoulder, for example, can be used to control the prosthetic arm.

Last year, Zac Vawter climbed the 442m Willis Tower in Chicago with an artificial leg that used TMR. He was fundraising for the RIC.

This video shows former Army Staff Sgt Glen Lehman, injured in Iraq, demonstrating the full range of fluid motions enabled by the TMR prosthetic arm.

World premiere of muscle and nerve controlled arm prosthesis

For the first time an operation has been conducted, at Sahlgrenska University Hospital, where electrodes have been permanently implanted in nerves and muscles of an amputee to directly control an arm prosthesis. The result allows natural control of an advanced robotic prosthesis, similarly to the motions of a natural limb.

A surgical team led by Dr Rickard Brånemark, Sahlgrenska University Hospital, has carried out the first operation of its kind, where neuromuscular electrodes have been permanently implanted in an amputee. The operation was possible thanks to new advanced technology developed by Max Ortiz Catalan, supervised by Rickard Brånemark at Sahlgrenska University Hospital and Bo Håkansson at Chalmers University of Technology.

“The new technology is a major breakthrough that has many advantages over current technology, which provides very limited functionality to patients with missing limbs,” says Rickard Brånemark.

Big challenges
There have been two major issues on the advancement of robotic prostheses: 1) how to firmly attach an artificial limb to the human body; 2) how to intuitively and efficiently control the prosthesis in order to be truly useful and regain lost functionality.

“This technology solves both these problems by combining a bone anchored prosthesis with implanted electrodes,” said Rickard Brånemark, who along with his team has developed a pioneering implant system called Opra, Osseointegrated Prostheses for the Rehabilitation of Amputees.

A titanium screw, so-called osseointegrated implant, is used to anchor the prosthesis directly to the stump, which provides many advantages over a traditionally used socket prosthesis.

“It allows complete degree of motion for the patient, fewer skin related problems and a more natural feeling that the prosthesis is part of the body. Overall, it brings better quality of life to people who are amputees,” says Rickard Brånemark.

How it works
Presently, robotic prostheses rely on electrodes over the skin to pick up the muscles electrical activity to drive few actions by the prosthesis. The problem with this approach is that normally only two functions are regained out of the tens of different movements an able-body is capable of. By using implanted electrodes, more signals can be retrieved, and therefore control of more movements is possible. Furthermore, it is also possible to provide the patient with natural perception, or “feeling”, through neural stimulation.

“We believe that implanted electrodes, together with a long-term stable human-machine interface provided by the osseointegrated implant, is a breakthrough that will pave the way for a new era in limb replacement,” says Rickard Brånemark.

The patient
The first patient has recently been treated with this technology, and the first tests gave excellent results. The patient, a previous user of a robotic hand, reported major difficulties in operating that device in cold and hot environments and interference from shoulder muscles. These issues have now disappeared, thanks to the new system, and the patient has now reported that almost no effort is required to generate control signals. Moreover, tests have shown that more movements may be performed in a coordinated way, and that several movements can be performed simultaneously.

“The next step will be to test electrical stimulation of nerves to see if the patient can sense environmental stimuli, that is, get an artificial sensation. The ultimate goal is to make a more natural way to replace a lost limb, to improve the quality of life for people with amputations,” says Rickard Brånemark.

A sensational breakthrough: the first bionic hand that can feel

The first bionic hand that allows an amputee to feel what they are touching will be transplanted later this year in a pioneering operation that could introduce a new generation of artificial limbs with sensory perception.

The patient is an unnamed man in his 20s living in Rome who lost the lower part of his arm following an accident, said Silvestro Micera of the Ecole Polytechnique Federale de Lausanne in Switzerland.

The wiring of his new bionic hand will be connected to the patient’s nervous system with the hope that the man will be able to control the movements of the hand as well as receiving touch signals from the hand’s skin sensors.

Dr Micera said that the hand will be attached directly to the patient’s nervous system via electrodes clipped onto two of the arm’s main nerves, the median and the ulnar nerves.

This should allow the man to control the hand by his thoughts, as well as receiving sensory signals to his brain from the hand’s sensors. It will effectively provide a fast, bidirectional flow of information between the man’s nervous system and the prosthetic hand.

“This is real progress, real hope for amputees. It will be the first prosthetic that will provide real-time sensory feedback for grasping,” Dr Micera said.

“It is clear that the more sensory feeling an amputee has, the more likely you will get full acceptance of that limb,” he told the American Association for the Advancement of Science meeting in Boston.

“We could be on the cusp of providing new and more effective clinical solutions to amputees in the next year,” he said.