A pin-array method for capturing tissue deformation under defined pressure distributions and its application to prosthetic socket design.

The Fit4Purpose project aims to develop upper limb prosthetic devices which are suitable for deployment in lower- and middle-income countries (LMIC's). Open-frame trans-radial socket designs are being considered, formed of several, linked components, including pads which interface directly with the skin surface. A mechanical tool has been developed to aid the design of pad shapes, using an array of square brass bars of varying lengths (i.

Skill assessment in upper limb myoelectric prosthesis users: Validation of a clinically feasible method for characterising upper limb temporal and amplitude variability during the performance of functional tasks.

Upper limb myoelectric prostheses remain challenging to use and are often abandoned. A proficient user must be able to plan/execute arm movements while activating the residual muscle(s), accounting for delays and unpredictability in prosthesis response. There is no validated, low cost measure of skill in performing such actions.

A review of the design and clinical evaluation of the ShefStim array-based functional electrical stimulation system.

Functional electrical stimulation has been shown to be a safe and effective means of correcting foot drop of central neurological origin. Current surface-based devices typically consist of a single channel stimulator, a sensor for determining gait phase and a cuff, within which is housed the anode and cathode. The cuff-mounted electrode design reduces the likelihood of large errors in electrode placement, but the user is still fully responsible for selecting the correct stimulation level each time the system is donned.

Functional electrical stimulation versus ankle foot orthoses for foot-drop: A meta-analysis of orthotic effects.

Objective: To compare the effects on walking of functional electrical stimulation (FES) and ankle foot orthoses for foot-drop of central neurological origin, assessed in terms of unassisted walking behaviours compared with assisted walking following a period of use (combined-orthotic effects).

Data Sources: MEDLINE, AMED, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination and clinicaltrials.gov, plus reference list, journal, author and citation searches.

The effects of prosthetic ankle stiffness on stability of gait in people with transtibial amputation.

The ability to control balance during walking is a critical precondition for minimizing fall risk, but this ability is compromised in persons with lower-limb absence because of reduced sensory feedback mechanisms and inability to actively modulate prosthesis mechanical function. Consequently, these individuals are at increased fall risk compared with nondisabled individuals. A number of gait parameters, including symmetry and temporal variability in step/stride characteristics, have been used as estimates of gait stability and fall risk.

Feasibility study of a take-home array-based functional electrical stimulation system with automated setup for current functional electrical stimulation users with foot-drop.

Objective: To investigate the feasibility of unsupervised community use of an array-based automated setup functional electrical stimulator for current foot-drop functional electrical stimulation (FES) users.

Design: Feasibility study.

Setting: Gait laboratory and community use.

Visuomotor behaviours when using a myoelectric prosthesis.

Background: A recent study showed that the gaze patterns of amputee users of myoelectric prostheses differ markedly from those seen in anatomically intact subjects. Gaze behaviour is a promising outcome measures for prosthesis designers, as it appears to reflect the strategies adopted by amputees to compensate for the absence of proprioceptive feedback and uncertainty/delays in the control system, factors believed to be central to the difficulty in using prostheses. The primary aim of our study was to characterise visuomotor behaviours over learning to use a trans-radial myoelectric prosthesis.

The effects of prosthetic ankle stiffness on ankle and knee kinematics, prosthetic limb loading, and net metabolic cost of trans-tibial amputee gait.

Background: Previous studies of commercially-available trans-tibial prosthetic components have been unable to provide clear insight into the relationships between prosthetic mechanical properties and user performance (i.e., gait quality and energy expenditure), the understanding of which is key to improving prosthesis design and prescription.

A sock for foot-drop: a preliminary study on two chronic stroke patients.

Background: Foot-drop is a common motor impairment of chronic stroke patients, which may be addressed with an ankle foot orthosis. Although there is reasonable evidence of effectiveness for ankle foot orthoses, user compliance is sometimes poor. This study investigated a new alternative to the ankle foot orthosis, the dorsiflex sock.

Automated detection of instantaneous gait events using time frequency analysis and manifold embedding.

Accelerometry is a widely used sensing modality in human biomechanics due to its portability, non-invasiveness, and accuracy. However, difficulties lie in signal variability and interpretation in relation to biomechanical events. In walking, heel strike and toe off are primary gait events where robust and accurate detection is essential for gait-related applications.

Stance phase mechanical characterization of transtibial prostheses distal to the socket: a review.

Achieving the required functionality of a transtibial prosthesis during the stance phase of gait (e.g., shock absorption, close to normal roll-over characteristics, and smooth transition into swing) depends on the Amputee Independent Prosthesis Properties (AIPPs), defined here as the mechanical properties of the prosthesis that directly influence the performance of the amputee.

Amputee Independent Prosthesis Properties--a new model for description and measurement.

A model is presented for describing the Amputee Independent Prosthesis Properties (AIPP) of complete assemblies of trans-tibial prosthetic components distal to the socket. This new AIPP model includes features of both lumped parameter and roll-over models and describes prosthesis properties that are of importance in stance phase, including prosthetic foot geometry, normal stiffness, shear stiffness, and damping (energy dissipation). Methods are described for measuring the parameters of the AIPP model using a custom test-rig, commercial load-cell, and a motion capture system.

Automatic identification of gait events using an instrumented sock.

Background: Textile-based transducers are an emerging technology in which piezo-resistive properties of materials are used to measure an applied strain. By incorporating these sensors into a sock, this technology offers the potential to detect critical events during the stance phase of the gait cycle. This could prove useful in several applications, such as functional electrical stimulation (FES) systems to assist gait.

A comparative evaluation of sonomyography, electromyography, force, and wrist angle in a discrete tracking task.

We have previously used the real-time change of muscle thickness detected using ultrasound, namely sonomyography (SMG), for prosthesis motor control purposes. In the present study, we further compared subjects' performance using SMG and surface electromyography (EMG) in a series of discrete tracking tasks, both with and without a concurrent auditory attention task. Sixteen healthy subjects used different signals in a random order to control the cursor on a personal computer screen to cancel the letter "E" in a sequence of vertically arranged letters.

The use of hydrogel as an electrode-skin interface for electrode array FES applications.

Functional electrical stimulation is commonly used to restore function in post-stroke patients in upper and lower limb applications. Location of the electrodes can be a problem hence some research groups have begun to experiment with electrode arrays. Electrode arrays are interfaced with a thin continuous hydrogel sheet which is high resistivity to reduce transverse currents between electrodes in the array.

Evaluation of sonomyography (SMG) for control compared with electromyography (EMG) in a discrete target tracking task.

Most of the commercial upper-limb externally powered prosthetic devices are controlled by electromyography (EMG) signals. We previously proposed using the real-time change of muscle thickness detected using ultrasound, namely sonomyography (SMG), for the control of prostheses. In this study, we compared the performance of subjects using 1-D SMG signal and surface EMG signal, using a discrete target tracking protocol involving a series of letter cancellation tasks.

Simulating acceleration from stereophotogrammetry for medical device design.

When designing a medical device based on lightweight accelerometers, the designer is faced with a number of questions in order to maximize performance while minimizing cost and complexity: Where should the inertial unit be located? How many units are required? How is performance affected if the unit is not correctly located during donning? One way to answer these questions is to use position data from a single trial, captured with a nonportable measurement system (e.g., stereophotogrammetry) to simulate measurements from multiple accelerometers at different locations on the body.

Activity identification using body-mounted sensors--a review of classification techniques.

With the advent of miniaturized sensing technology, which can be body-worn, it is now possible to collect and store data on different aspects of human movement under the conditions of free living. This technology has the potential to be used in automated activity profiling systems which produce a continuous record of activity patterns over extended periods of time. Such activity profiling systems are dependent on classification algorithms which can effectively interpret body-worn sensor data and identify different activities.

A comparison of feature extraction methods for the classification of dynamic activities from accelerometer data.

Driven by the demands on healthcare resulting from the shift toward more sedentary lifestyles, considerable effort has been devoted to the monitoring and classification of human activity. In previous studies, various classification schemes and feature extraction methods have been used to identify different activities from a range of different datasets. In this paper, we present a comparison of 14 methods to extract classification features from accelerometer signals.

Movement variability in stroke patients and controls performing two upper limb functional tasks: a new assessment methodology.

Background: In the evaluation of upper limb impairment post stroke there remains a gap between detailed kinematic analyses with expensive motion capturing systems and common clinical assessment tests. In particular, although many clinical tests evaluate the performance of functional tasks, metrics to characterise upper limb kinematics are generally not applicable to such tasks and very limited in scope. This paper reports on a novel, user-friendly methodology that allows for the assessment of both signal magnitude and timing variability in upper limb movement trajectories during functional task performance.

A finite element model to identify electrode influence on current distribution in the skin.

Discomfort experienced during surface functional electrical stimulation (FES) is thought to be partly a result of localized high current density in the skin underneath the stimulating electrode. This article describes a finite element (FE) model to predict skin current density distribution in the region of the electrode during stimulation and its application to the identification of electrode properties that may act to reduce sensation. The FE model results show that the peak current density was located in an area immediately under the stratum corneum, adjacent to a sweat duct.

An instance-based algorithm with auxiliary similarity information for the estimation of gait kinematics from wearable sensors.

Wearable human movement measurement systems are increasingly popular as a means of capturing human movement data in real-world situations. Previous work has attempted to estimate segment kinematics during walking from foot acceleration and angular velocity data. In this paper, we propose a novel neural network [GRNN with Auxiliary Similarity Information (GASI)] that estimates joint kinematics by taking account of proximity and gait trajectory slope information through adaptive weighting.

The sensitivity and selectivity of an implantable two-channel peroneal nerve stimulator system for restoration of dropped foot.

The objective of this study was to evaluate the stimulation responses on each channel of an implantable two-channel stimulator that stimulates the peroneal nerve branches innervating the muscles for dorsiflexion and eversion movements. Currently five Dutch patients and five English patients have been implanted with this system. Isometric ankle torque measurements were carried out in the patient with the longest follow-up period (1 y).