The missing link: How is the phantom limb influenced by prosthesis wearing in people with lower-limb amputation?

Background: Recent therapeutic and technological solutions aim to improve the daily living of people with limb amputation by considering various aspects of the phantom limb, in particular painless phantom sensations (PS) and voluntary phantom movements (VPM).

Objective: Although previous research has explored these phenomena mostly without considering the prosthesis, this study investigates the influence of prosthesis wearing on painless PS, painful PS, and VPM, in people with lower-limb amputation.

Study Design: Cross-sectional study based on semi-directed interviews.

New insights into muscle activity associated with phantom hand movements in transhumeral amputees.

Introduction: Muscle activity patterns in the residual arm are systematically present during phantom hand movements (PHM) in transhumeral amputees. However, their characteristics have not been directly investigated yet, leaving their neurophysiological origin poorly understood. This study pioneers a neurophysiological perspective in examining PHM-related muscle activity patterns by characterizing and comparing them with those in the arm, forearm, and hand muscles of control participants executing intact hand movements (IHM) of similar types.

Phantom Sensations Influenced by Global and Local Modifications of the Prosthetic Socket as a Potential Solution for Natural Somatosensory Feedback During Walking: A Preliminary Study of a Single Case.

Following lower limb amputation, amputees are trained to walk with a prosthesis. The loss of a lower limb deprives them of essential somatosensory information, which is one of the causes of the difficulties of walking with a prosthesis. We here explored whether a solution to this lack of somatosensory feedback could come from natural sensations of the phantom limb, present in most amputees, instead of from substitutive technologies.

Measuring mental workload in assistive wearable devices: a review.

As wearable assistive devices, such as prostheses and exoskeletons, become increasingly sophisticated and effective, the mental workload associated with their use remains high and becomes a major challenge to their ecological use and long-term adoption. Numerous methods of measuring mental workload co-exist, making analysis of this research topic difficult. The aim of this review is to examine how mental workload resulting from the use of wearable assistive devices has been measured, in order to gain insight into the specific possibilities and limitations of this field.

Phantom-Mobility-Based Prosthesis Control in Transhumeral Amputees Without Surgical Reinnervation: A Preliminary Study.

Transhumeral amputees face substantial difficulties in efficiently controlling their prosthetic limb, leading to a high rate of rejection of these devices. Actual myoelectric control approaches make their use slow, sequential and unnatural, especially for these patients with a high level of amputation who need a prosthesis with numerous active degrees of freedom (powered elbow, wrist, and hand). While surgical muscle-reinnervation is becoming a generic solution for amputees to increase their control capabilities over a prosthesis, research is still being conducted on the possibility of using the surface myoelectric patterns specifically associated to voluntary Phantom Limb Mobilization (PLM), appearing naturally in most upper-limb amputees without requiring specific surgery.

Characteristics of phantom upper limb mobility encourage phantom-mobility-based prosthesis control.

There is an increasing need to extend the control possibilities of upper limb amputees over their prosthetics, especially given the development of devices with numerous active joints. One way of feeding pattern recognition myoelectric control is to rely on the myoelectric activities of the residual limb associated with phantom limb movements (PLM). This study aimed to describe the types, characteristics, potential influencing factors and trainability of upper limb PLM.

Voluntary phantom hand and finger movements in transhumerai amputees could be used to naturally control polydigital prostheses.

An arm amputation is extremely invalidating since many of our daily tasks require bi-manual and precise control of hand movements. Perfect hand prostheses should therefore offer a natural, intuitive and cognitively simple control over their numerous biomimetic active degrees of freedom. While efficient polydigital prostheses are commercially available, their control remains complex to master and offers limited possibilities, especially for high amputation levels.

Reachability and the sense of embodiment in amputees using prostheses.

Amputated patients are hardly satisfied with upper limb prostheses, and tend to favour the use of their contralateral arm to partially compensate their disability. This may seem surprising in light of recent evidences that external objects (rubber hand or tool) can easily be embodied, namely incorporated in the body representation. We investigated both implicit body representations (by evaluating the peripersonal space using a reachability judgement task) and the quality of bodily integration of the patient's prosthesis (assessed via questionnaires).

Inkjet-Printed PEDOT:PSS Electrodes on Paper for Electrocardiography.

Inkjet-printed PEDOT:PSS electrodes are shown to record cutaneous electrophysiological signals such as electrocardiograms via a simple finger-to-electrode contact. The recordings are of high quality and show no deterioration over a 3 month period, paving the way for the development of the next generation of low-cost, convenient-to-use healthcare monitoring devices.

Classification of Phantom Finger, Hand, Wrist, and Elbow Voluntary Gestures in Transhumeral Amputees With sEMG.

Decoding finger and hand movements from sEMG electrodes placed on the forearm of transradial amputees has been commonly studied by many research groups. A few recent studies have shown an interesting phenomenon: simple correlations between distal phantom finger, hand and wrist voluntary movements and muscle activity in the residual upper arm in transhumeral amputees, i.e.

Flexible Inkjet-Printed Multielectrode Arrays for Neuromuscular Cartography.

Unlabelled: Flexible Poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (

Pedot: PSS) conductive-polymer multielectrode arrays (MEAs) are fabricated without etching or aggressive lift-off processes, only by additive solution processes. Inkjet printing technology has several advantages, such as a customized design and a rapid realization time, adaptability to different patients and to different applications. In particular, inkjet printing technology, as additive and "contactless" technology, can be easily inserted into various technological fabrication steps on different substrates at low cost.

TMS reveals a direct influence of spinal projections from human SMAp on precise force production.

The corticospinal (CS) system plays an important role in fine motor control, especially in precision grip tasks. Although the primary motor cortex (M1) is the main source of the CS projections, other projections have been found, especially from the supplementary motor area proper (SMAp). To study the characteristics of these CS projections from SMAp, we compared muscle responses of an intrinsic hand muscle (FDI) evoked by stimulation of human M1 and SMAp during an isometric static low-force control task.

Functional corticospinal projections from human supplementary motor area revealed by corticomuscular coherence during precise grip force control.

The purpose of the present study was to investigate whether corticospinal projections from human supplementary motor area (SMA) are functional during precise force control with the precision grip (thumb-index opposition). Since beta band corticomuscular coherence (CMC) is well-accepted to reflect efferent corticospinal transmission, we analyzed the beta band CMC obtained with simultaneous recording of electroencephalographic (EEG) and electromyographic (EMG) signals. Subjects performed a bimanual precise visuomotor force tracking task by applying isometric low grip forces with their right hand precision grip on a custom device with strain gauges.

Preparing for a motor perturbation: early implication of primary motor and somatosensory cortices.

Although preparation of voluntary movement has been extensively studied, very few human neuroimaging studies have examined preparation of an intentional reaction to a motor perturbation. This latter type of preparation is fundamental for adaptive motor capabilities in everyday life because it allows a desired motor output to be maintained despite changes in external forces. Using fMRI, we studied how the sensorimotor cortical network is implicated in preparing to react to a mechanical motor perturbation.

High level of dexterity: differential contributions of frontal and parietal areas.

In the present functional magnetic resonance imaging experiment, study participants performed a dynamic tracking task in a precision grip configuration. The precision level of the force control was varied while the mean force level of 5 N was kept constant. Contrasts cancelling error rate differences between the conditions showed activation of nonprimary motor areas and other frontal structures in response to increasing precision constraints when the precision of force control could still be increased, and of right primary and associative parietal areas when the precision of the produced force control reached its maximum.

Interactions between cognitive and sensorimotor functions in the motor cortex: evidence from the preparatory motor sets anticipating a perturbation.

The many signs of cognitive processes in the activation pattern of the primary motor cortex or in corticospinal (CS) excitability gave rise to the idea that the motor cortex is a crucial node in the processing of cognitive information related to sensorimotor functions. Moreover, it became clear that the preparatory motor sets offer a privileged window to investigate the interaction between cognitive and sensorimotor function in the motor cortex. In the present review, we examine how the study of the preparatory motor sets anticipating a mechanical movement perturbation contributes to enlightening this question.

Awareness of muscular force during movement production: an fMRI study.

Awareness of the muscular forces we produce during voluntary movement must be distinguished from awareness of motor outcome itself. Indeed, there is no univocal relationship between produced muscle force and movement outcome because of external forces. In the present study, we performed a functional magnetic resonance imaging study to investigate the neural bases underlying the awareness we can have of the muscular forces we put into our voluntary movements.

Direct evidence for a binding between cognitive and motor functions in humans: a TMS study.

During voluntary motor actions, the cortico-spinal (CS) excitability is known to be modulated, on the one hand by cognitive (intention-related) processes and, on the other hand, by motor (performance-related) processes. Here, we studied the way these processes interact in the tuning of CS excitability during voluntary wrist movement. We used transcranial magnetic stimulation (TMS) both as a reliable tool for quantifying the CS excitability, through the motor-evoked potentials (MEPs), and as a central perturbation evoking a movement (because the stimulation intensity was above threshold) with subjects instructed to prepare (without changing their muscle activation) either to "let go" or to "resist" to this evoked movement.