Despite recent advancements, existing prosthetic limbs are unable to replicate the dexterity and intuitive control of the human hand. Current control systems for prosthetic hands are often limited to grasping, and commercial prosthetic hands lack the precision needed for dexterous manipulation or applications that require fine finger motions. Thus, there is a critical need for accessible and replicable prosthetic designs that enable individuals to interact with electronic devices and perform precise finger pressing, such as keyboard typing or piano playing, while preserving current prosthetic capabilities. This paper presents a low-cost, lightweight, 3D-printed robotic prosthetic hand, specifically engineered for enhanced dexterity with electronic devices such as a computer keyboard or piano, as well as general object manipulation. The robotic hand features a mechanism to adjust finger abduction/adduction spacing, a 2-D wrist with the inclusion of controlled ulnar/radial deviation optimized for typing, and control of independent finger pressing. We conducted a study to demonstrate how participants can use the robotic hand to perform keyboard typing and piano playing in real time, with different levels of finger and wrist motion. This supports the notion that our proposed design can allow for the execution of key typing motions more effectively than before, aiming to enhance the functionality of prosthetic hands.

Background:Push-ups are performed ubiquitously as a means of strengthening/training and evaluating the upper extremity. However, push-ups performed on the hands with the wrist extended can cause wrist, elbow and shoulder injuries, which may result in disability. Conversely, individuals with a prior wrist or elbow injury are unable to perform push-ups. Our purpose was to evaluate movement patterns in two push-up styles (neutral and extended wrist) at the elbow and shoulder joints. We hypothesized that force-transfer will differ between the two styles, allowing the adjustment of training protocols according to athletic and physiologic needs. Patients and Methods:Fourteen healthy right-handed male volunteers performed push-ups on a neutral wrist and a hyperextended wrist in the gait analysis laboratory. Skin markers were applied over fixed points in the upper extremity. A Vicon motion capture system was used to follow the kinematics. Force vectors were measured using force plates. Results:The movement and transfer of forces through the shoulder and elbow differ between the push-up styles. The shoulder moves more, in general, in a circular direction, when a push-up is performed on a neutral wrist compared to a push-up performed on an extended wrist. The shoulder is exposed to more load when the push-up is performed on a neutral wrist. The elbow moves less in general, and less in the medial and lateral planes, when the push-up is performed on a neutral wrist. The elbow is exposed to less load when the push-up is performed on a neutral wrist. The direction of forces through the joints differs between the two styles and the amount of force traversing the joints is inverse between the two styles. Conclusions:The movement through the elbow and shoulder is distributed differently during different styles of push-ups. The wrist and elbow can be relatively protected from ligament injury when push-ups are performed on a neutral wrist. Conclusions:Understanding the kinematics during different patterns of loading of the upper extremity can enable a tailored approach to strengthening training, treatment, and rehabilitation of the upper extremity. Specifically, differential strengthening and loading certain areas may be used for training protocols for a specific athletic task (such as throwing).

A central challenge in building robotic prostheses is the creation of a sensor-based system able to read physiological signals from the lower limb and instruct a robotic hand to perform various tasks. Existing systems typically perform discrete gestures such as pointing or grasping, by employing electromyography (EMG) or ultrasound (U.S.) technologies to analyze muscle states. While detecting finger activation has been done in the past, we are interested in detection, or inference, done in the context of fine motions that evolve over time. Examples include motions occurring when performing fine and dexterous tasks such as typing on a keyboard or playing a musical instrument. We consider this task as an important step toward higher adoption rates of robotic prostheses among arm amputees, as it has the potential to dramatically increase functionality in performing daily tasks. To this end, we present an end-to-end robotic system, which can successfully infer fine finger motions in real-time. This is achieved by modeling the hand as a robotic manipulator and using it as an intermediate representation to encode muscles' dynamics from U.S. images. We evaluated our method by collecting data from a group of subjects and demonstrating how it can be used to replay music played on the piano or text typed on a computer keyboard. To the best of our knowledge, this is the first study demonstrating these downstream tasks within an end-to-end system.

Many of our activities rely on tactile feedback perceived through mechanoreceptors in our skin. While visual and auditory devices provide immersive experiences, cutaneous feedback devices are typically limited in the range of sensations they provide and are hence usually used and tested on relatively simple synthetic surfaces. We present a device designed in a human-centered process, triggering the mechanoreceptors sensitive to pressure, low-frequency vibrations, and high-frequency vibrations, enabling one to experience touch of complex real-world surfaces. The device is based on a parallel manipulator and a pin-array, that operate simultaneously at 200Hz and emulate coarse and fine geometrical features, respectively. The decomposition into coarse and fine features, alongside the high operation frequency, enable simulation of virtual surfaces. This was corroborated via experiments on complex real-world surfaces via both a quantitative recognition test and a usability questionnaire. We believe that this design can be incorporated in numerous applications.

PurposeAdolescent idiopathic scoliosis (AIS) is a deformity of the spine that results in external asymmetry of the torso in the shoulder, waist, and rib hump. Several patient reported outcome measures (PROMS) including the Trunk Appearance Perception Scale (TAPS) and SRS-22r self-image domain are used to measure the patient's self-perception. The purpose of this study is to investigate the relationship between objective surface topographic measurements of the torso to subjective patient self-perception.Methods131 AIS subjects and 37 controls participated in this study. All subjects completed TAPS and SRS-22r PROMS followed by whole body 3d surface topographic scanning. An automated analysis pipeline was used to compute 57 measurements. Multivariate linear models were developed to predict TAPS and SRS-22r self-image using each unique combination of 3 parameters and leave one out validation where the best combinations were selected.ResultsBack surface rotation, waist crease vertical asymmetry and rib prominence volume were most predictive of TAPS. The final predicted TAPS values from leave one out cross validation was correlated to ground truth TAPS scores with an R value of 0.65. Back surface rotation, silhouette centroid deviation, and shoulder normal asymmetry were most predictive of SRS-22r self-image with a correlation of R = 0.48.ConclusionSurface topographic measurements of the torso are correlated to TAPS and SRS-22r self-image scores in AIS patients and controls, with TAPS exhibiting a stronger relationship, better reflecting the patient's external asymmetries.

A central challenge in building robotic prostheses is the creation of a sensor-based system able to read physiological signals from the lower limb and instruct a robotic hand to perform various tasks. Existing systems typically perform discrete gestures such as pointing or grasping, by employing electromyography (EMG) or ultrasound (US) technologies to analyze muscle states. While estimating finger gestures has been done in the past by detecting prominent gestures, we are interested in detection, or inference, done in the context of fine motions that evolve over time. Examples include motions occurring when performing fine and dexterous tasks such as keyboard typing or piano playing. We consider this task as an important step towards higher adoption rates of robotic prostheses among arm amputees, as it has the potential to dramatically increase functionality in performing daily tasks. To this end, we present an end-to-end robotic system, which can successfully infer fine finger motions. This is achieved by modeling the hand as a robotic manipulator and using it as an intermediate representation to encode muscles' dynamics from a sequence of US images. We evaluated our method by collecting data from a group of subjects and demonstrating how it can be used to replay music played or text typed. To the best of our knowledge, this is the first study demonstrating these downstream tasks within an end-to-end system.

BACKGROUND:Diabetic heel ulceration is a common, detrimental, and costly complication of diabetes. This study investigates a novel "graded-stiffness" offloading method, which consists of a heel support with increasing levels of stiffness materials to better redistribute plantar pressure for heel ulcer prevention and treatment.RESEARCH QUESTION:Is the novel "graded-stiffness" solution better able to redistribute heel pressure and reduce focal stress concentration areas of the heel?METHODS:Twenty healthy young men walked with four, 3D-printed, insole configurations. The configurations included the "graded-stiffness" insoles with and without an offloading hole under the heel tissue at risk for ulcerations and two conventional offloading supports of flat insoles with no offloading and simple holed offloading insoles. In-shoe plantar pressure was measured using the Pedar-X system. Peak pressure and pressure dose were measured at three heel regions: offloaded region, perimeter of offloaded region, and periphery region.RESULTS:The simple offloading configuration reduced pressure at the offloaded region; however, pressure at the perimeter of the offloading region significantly increased. With respect to ANOVA, the "graded-stiffness" offloading configurations were more effective than existing tested solutions in reducing and redistributing heel peak pressure and pressure dose, considering all heel regions.SIGNIFICANCE:The "graded-stiffness" offloading solution demonstrated a novel flexible and customized solution that can be manufactured on-demand through a precise selection of the graded-stiffness offloading location and material properties to fit the shape and size of the ulcer. This study is a follow-up in-vivo pilot study, in a healthy population group, to our previous computation modeling work that reported the efficiency of the "graded-stiffness" configuration, and which emphasizes its potential for streamlining and optimizing the prevention and treatment of diabetic heel ulcers.

The usage of a prosthesis by children who lack an upper limb, is a promising way to improve the quality of life. However, rejection rate amongst users of prosthetic devices is high, besides other causes, due to high cost, high weight, lack of social acceptance and lack of sensory feedback. The growing availability and improvements of 3D printers offer a solution to some of these issues and many designs were created, but to the best of our knowledge without addressing the issue of sensory feedback. In this paper we present a low-cost, 3D printed, motorized prosthetic hand design with a sensory feedback interface based on a modality-matched approach. The design offers an end-to-end solution and was validated using an adapter for able-bodied users and an interface used to log the data. A relation between applied force and feedback signal was verified and was used to optimize and calibrate the sensors and feedback parameters. Moreover, analyzing the feedback when pressing a hard object compared to a soft object, yielded a significant difference in outcome. The entire design and interface are shared online freely and offer a platform for experiments on sensory feedback for prosthetic hands. The promising results show that the low-cost hand and sensory feedback interface performs as expected and based on previous research could potentially improve the functionality of the prosthesis and thereby improve the quality of life of children with an upper limb deficiency.

Lyapunov exponent is a promising parameter to ascertain the stability of the human gait. In this work, we use a time-series model based on a second-order delay-system with inertial measurement units placed on the foot and wrist. Stability is analyzed in a localized sense, with the Lyapunov exponent computed in the temporal region between two heel-strike points, which are determined using a peak-detection algorithm. We have attempted to show correlations between variations in the stride time and stability of the gait under normal and abnormal conditions. In the latter case, we attach a weight on foot to emulate weakness. On comparison between both cases, we observe a statistical significance of p=0.0039 using Wilcoxon’s rank-sum test. Moreover, on observing the correlations between Lyapunov Exponent and Stride Time Variability, we notice a left-shift in the abnormal case, indicating a lower threshold for instability, with the Stride Time Variability being 0.07 as compared to 0.11 in the normal case.The results indicate that by exploiting the correlation between stride time variability and Lyapunov exponents, one can establish a threshold for gait stability.

Diabetic heel ulceration is a serious, destructive, and costly complication of diabetes. In this study, a novel “graded-stiffness” offloading method was proposed. This method consists of heel support with multi-increasing levels of stiffness materials, to prevent and treat heel ulcers. A three-dimensional finite element model of the heel was used to evaluate the novel “graded-stiffness” orthotic device compared to two existing solutions: (1) an insole with a hole under the active ulcer and (2) an insole with a hole filled with a soft material (elastic modulus of 15 kPa). Volumetric exposure evaluation of internal tissues to stress was performed at two volume-of-interests: (1) the area of the heel soft tissues typically at high risk for ulceration, and (2) the soft tissues surrounding the high-risk area. The models predict that the “graded-stiffness” offloading solution is more effective than existing solutions in distributing and reducing heel internal loads, considering both volume-of-interests. Comparing different material gradient combinations for the offloading support reveals considerable variation of the heel stress distribution. In clinical practice, the “graded-stiffness” technological solution enables to form an adaptable and flexible system that can be customized to a specific patient, through adequate selection of the offloading materials, to fit the shape and size of the ulcer. This solution can be made as an off-the-shelf product or alternatively, be manufactured by-demand using 3D printing tools. The proposed novel practical offloading solution has the potential for streamlining and optimizing the prevention and treatment of diabetic heel ulcers.

Purpose This study introduces a novel surface-topographic scanning system capable of automatically generating a suite of objective measurements to characterize torso shape. Research Question: what is the reliability of the proposed system for measurement of trunk alignment parameters in patients with adolescent idiopathic scoliosis (AIS) and controls? Methods Forty-six adolescents (26 with AIS and 20 controls) were recruited for a prospective reliability study. A series of angular, volumetric, and area measures were computed from topographic scans in each of three clinically relevant poses using a fully automated processing pipeline. Intraclass correlation coefficients (ICC(2,1)) were computed within (intra-) and between (inter-) raters. Measurements were also performed on a torso phantom. Results Topographic measurements computed on a phantom were highly accurate (mean RMS error 1.7%) compared with CT. For human subjects, intra- and inter-rater reliability were both high (average ICC > 0.90) with intrinsic (pose-independent) measurements having near-perfect reliability (average ICC > 0.98). Conclusion The proposed system is a suitable tool for topographic analysis of AIS; topographic measurements offer an objective description of torso shape that may complement other imaging modalities. Further research is needed to compare topographic findings with gold standard imaging of spinal alignment, e.g., standing radiography. Conclusion: clinical parameters can be reliably measured in a fully automated system, paving the way for objective analysis of symmetry, body shape pre/post-surgery, and tracking of pathology without ionizing radiation.

Diabetic heel ulceration, a serious, destructive, and costly complication of diabetes, is often treated by custom-made offloading footwear. One common offloading device is a custom-made insole designed with a hole under the damaged site that is intended to reduce local mechanical loads on the ulcer. However, current devices do not take into account the increasing loads at the wound peripheries, and quantitative assessments and scientific guidelines for the optimal design of the offloading hole are lacking. Here, we develop a novel method to determine the volumetric exposure to mechanical loading of a human heel, at two volume of interests (VOIs) during walking in 150 different finite-element footwear configurations. We defined the two VOIs as (1) the area of the heel soft tissues typically at high risk of ulceration, and (2) the soft tissues surrounding the high risk area. For all model variants, three hole-geometry parameters were defined: (1) radius, (2) radius of curvature (ROC) and (3) depth. We found two combinations of the offloading parameters which minimize heel loads in both VOIs. The first is with a large offloading radius, large ROC and large depth, whereas the second is with a large offloading radius, large depth but relatively small ROC. Our novel practical scientific analysis method, that takes into account the ulcer site as well as the peripheral area, has the potential to optimize development of offloading solutions by streamlining the examination of their biomechanical efficiency, and thus may revolutionize prevention and treatment of diabetic ulcers at any foot location.

The proliferation of 3D scanning technology has driven a need for methods to interpret geometric data, particularly for human subjects. In this paper we propose an elegant fusion of regression (bottom-up) and generative (top-down) methods to fit a parametric template model to raw scan meshes. Our first major contribution is an intrinsic convolutional mesh U-net architecture that predicts pointwise correspondence to a template surface. Soft-correspondence is formulated as coordinates in a newly-constructed Cartesian space. Modeling correspondence as Euclidean proximity enables efficient optimization, both for network training and for the next step of the algorithm. Our second contribution is a generative optimization algorithm that uses the U-net correspondence predictions to guide a parametric Iterative Closest Point registration. By employing pre-trained human surface parametric models we maximally leverage domain-specific prior knowledge. The pairing of a mesh-convolutional network with generative model fitting enables us to predict correspondence for real human surface scans including occlusions, partialities, and varying genus (e.g. from self-contact). We evaluate the proposed method on the FAUST correspondence challenge where we achieve 20% (33%) improvement over state of the art methods for inter- (intra-) subject correspondence.

The process of fitting a prosthetic hand that is comfortable, functional, easy to use, has an acceptable appearance and overall improves the amputees' quality of life is a complex, tedious and costly process. The very high price tag due to the time spent on manually fitting the device by a trained specialist makes these devices inaccessible to large portions of the population. We present a concept and preliminary results for a fully automated fitting and manufacturing pipeline for a personalized low-cost prosthetic hand. The hand is personalized in almost every aspect, from appearance to user interface, control and feedback. The pipeline only requires a 3D printer, RealSense cameras, a few basic mechanical components, and basic tools for the model assembly. The user scan-driven data and the user preferences initiate a fully-automated pipeline which culminates in a customized, easy-to-assemble PCB design and ready to print STL files, including the optimized orientation, support and layout, such that the final parts are only one click away. We believe that the proposed pipeline and design can highly impact the accessibility of prosthetic hands and could potentially be expanded to other medical applications.

Diabetic foot ulceration is among the most common, serious, and destructive complications of diabetes. This condition is mainly caused by peripheral neuropathy, leads to difficulties in ambulation, and is detrimental to the quality of life of the affected individuals. If a foot ulcer develops, or if the clinical assessment is that a certain foot region is highly susceptible to tissue breakdown, direct pressure on that plantar site is often reduced by using standard therapeutic shoes or custom-made insoles to off-load the high plantar pressures and to accommodate foot deformities. One specific common medical off-loading device is a custom-made insole designed with a hole under the active wound site, to reduce normal and shear stresses on the ulcer and redistribute them among other more peripheral foot regions. Here we present a patient-specific computational method, based on finite element (FE) analysis and available patient information, to investigate the internal tissue loads induced by off-loading method used in clinical practice. Our present method enables patient-specific examination of the biomechanical efficiency of off-loading solutions to prevent and treat diabetic foot ulcers.

Segregation of objects from the background is a basic and essential property of the visual system. We studied the neural detection of objects defined by orientation difference from background in barn owls (Tyto alba). We presented wide-field displays of densely packed stripes with a dominant orientation. Visual objects were created by orienting a circular patch differently from the background. In head-fixed conditions, neurons in both tecto- and thalamofugal visual pathways (optic tectum and visual Wulst) were weakly responsive to these objects in their receptive fields. However, notably, in freely viewing conditions, barn owls occasionally perform peculiar side-to-side head motions (peering) when scanning the environment. In the second part of the study we thus recorded the neural response from head-fixed owls while the visual displays replicated the peering conditions; i.e., the displays (objects and backgrounds) were shifted along trajectories that induced a retinal motion identical to sampled peering motions during viewing of a static object. These conditions induced dramatic neural responses to the objects, in the very same neurons that where unresponsive to the objects in static displays. By reverting to circular motions of the display, we show that the pattern of the neural response is mostly shaped by the orientation of the background relative to motion and not the orientation of the object. Thus our findings provide evidence that peering and/or other self-motions can facilitate orientation-based figure-ground segregation through interaction with inhibition from the surround.NEW & NOTEWORTHY Animals frequently move their sensory organs and thereby create motion cues that can enhance object segregation from background. We address a special example of such active sensing, in barn owls. When scanning the environment, barn owls occasionally perform small-amplitude side-to-side head movements called peering. We show that the visual outcome of such peering movements elicit neural detection of objects that are rotated from the dominant orientation of the background scene and which are otherwise mostly undetected. These results suggest a novel role for self-motions in sensing objects that break the regular orientation of elements in the scene.

Existing haptic feedback devices are limited in their capabilities and are often cumbersome and heavy. In addition, these devices are generic and do not adapt to the users’ grasping behavior. Potentially, a human-oriented design process could generate an improved design. While current research done on human grasping was aimed at finding common properties within the research population, we investigated the dynamic patterns that make human grasping behavior distinct rather than generalized, i.e. subject specific. Experiments were conducted on 31 subjects who performed grasping tasks on five different objects. The kinematics and kinetics parameters were measured using a motion capture system and force sensors. The collected data was processed through a pipeline of dimensionality reduction and clustering algorithms. Using finger joint angles and reaction forces as our features, we were able to classify these tasks with over 95% success. In addition, we examined the effects of the objects’ mechanical properties on those patterns and the significance of the different features for the differentiation. Our results suggest that grasping patterns are, indeed, subject-specific; this, in turn, could suggest that a device capable of providing personalized feedback can improve the user experience and, in turn, increase the usability in different applications. This paper explores an undiscussed aspect of human dynamic patterns. Furthermore, the collected data offer a valuable dataset of human grasping behavior, containing 1083 grasp instances with both kinetics and kinematics data.

Running-induced fatigue alters foot strike pattern. The purpose of this study was to assess plantar pressure and centre of pressure (CoP) trajectory alterations after a 30-minute run at sub-maximal speed in experienced long-distance runners. Plantar pressure data from 9 experienced heel-to-toe male runners was collected before and after a 30-minute run on a treadmill at a speed 5% above the respiratory compensation point (RCP) of each participant. Significant changes in the plantar-pressure map were found post-run, including increased impulses in the first metatarsal head (9.92%, p < 0.001) and hallux areas (16.19%, p < 0.001), and decreased impulses in the fourth and fifth metatarsal heads (4.95%, p < 0.05). The CoP curve showed a medial shift (p < 0.01). The plantar-pressure map and CoP trajectory were altered following a 30-minute exhausting run. These changes may indicate an increase in stress on joints and tissues when individuals are fatigued and may promote overload injuries.

BACKGROUND:Unstable footwear designs are popular as training devices to strengthen human neuromuscular control, and many studies have evaluated their effect on gait parameters in comparison to conventional footwear designs. However, there is minimal research on variability of gait measures during walking with unstable shoes. Therefore, the study objective was to compare variability of gait measures between stable and unstable shoe configurations, in conjunction with kinematic and kinetic changes.METHODS:Fifteen healthy male subjects walked in both a stable and unstable footwear device configuration while full-body gait kinematic and kinetic data was collected. Averages and standard deviations of gait trials were compared between the two configurations at different stages of each step.RESULTS:Comparison of gait variability between both footwear configurations revealed that variability of frontal-plane foot center of pressure offset, transverse-plane ankle moment, and frontal-plane shoulder angle decreased significantly while walking in the unstable configuration, while transverse-plane spine angle variability increased. No changes in variability of gait measures at the knee, hip, or pelvis were observed. Kinematic and kinetic changes were observed throughout the whole body with the unstable shoe.CONCLUSION:Our findings suggest that the unstable device used in the study may reduce gait variability at the two extremes of the kinematic chain (i.e., foot, ankle, and shoulders), but increase variability of spine rotation angle. This may suggest a compensatory mechanism to maintain both stability and adaptability, and may have potential clinical implications for gait retraining and enhancing dynamic gait stability and joint stability, pending further investigation.