The Modular Prosthetic Limb (MPL) was developed as part of a four-year program by the Johns Hopkins Applied Physics Laboratory, along with Walter Reed National Military Medical Center and the Uniformed Services University of the Health Sciences. The brain-controlled prosthetic has nearly as much dexterity as a natural limb, and allows independent movement of fingers. The MPL was used by wounded warriors at the Walter Reed National Military Medical Center for the first time Jan. 24, 2012. (U.S. Navy photo by Sarah Fortney/Released)
Researchers are exploring new approaches to designing prosthetic hands capable of providing “sensory feedback.” Advances toward developing prostheses with a sense of touch are presented in a special topic article in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Emerging sensory feedback techniques will provide some sensation and enable more natural, intuitive use of hand prostheses, according to the review by ASPS Member Surgeon Paul S. Cederna, MD, of University of Michigan, Ann Arbor, and colleagues. They write, “These breakthroughs pave the way to the development of a prosthetic limb with the ability to feel.”
‘Nerve Interfaces’ May Allow Feeling in Prosthetic Hands
Upper limb loss is a “particularly devastating” form of amputation, since “a person’s hands are their tools for everyday function, expressive communication, and other uniquely human attributes,” according to Dr. Cederna and coauthors. The functional, psychological, economic, and social impact is even greater since most upper limb amputations occur in young, otherwise healthy individuals.
Current robotic prostheses approach the fine dexterity provided by the human hand—but these advances have outpaced developments in providing sensory feedback from artificial limb. “The lack of sensation…is the key limitation to reestablishing the full functionality of the natural limb,” Dr. Cederna and colleagues write.
Providing some sense of touch to the artificial hand would lessen the “cognitive burden” of relying solely on vision to initiate and monitor movements—while also providing “tremendous psychological benefits” for patients. The review focuses on recent and emerging technologies to create “sensory interfaces” with the peripheral nerves to provide feeling to prostheses.
Already in use is a technique called sensory substitution, in which one type of sensation is substituted for another. For example, vibration applied to skin on the remaining limb, or to another part of the body, is used to convey touch from sensors on the prosthesis.
Other techniques use various types of implanted neural interfaces—electrodes placed in or around the nerves—which are stimulated by sensors on the prosthesis. Thesedirect neural stimulation approaches show promise in enabling patients to feel object characteristics such as stiffness, shape, and size, or to control fine-motor movements without visual cues.
A promising newer technique is targeted muscle reinnervation (TMR), in which nerves are transferred to provide sensation to intact muscles and overlying skin. Originally developed to improve control of the prosthesis, TMR approaches are being studied to elicit sensory feedback from the prostheses.
The Latest on: Feedback from Artificial Limbs
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The Latest on: Feedback from Artificial Limbs
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