Neuromusculoskeletal hand prosthesis. Credit: Ortiz-Catalan et al
Karin's life took a dramatic turn when a farming accident claimed her right
arm more than 20 years ago. Since then, she has endured excruciating phantom
limb pain. "It felt like I constantly had my hand in a meat grinder, which
created a high level of stress and I had to take high doses of various
painkillers."
In addition to her intractable pain, she found that conventional prostheses
were uncomfortable and unreliable, and thus of little help in daily life. All
this changed when she received groundbreaking bionic technology that allowed
her to wear a much more functional prosthesis comfortably all day. The higher
integration between the bionics and Karin's residual limb also relieved her
pain. "For me, this research has meant a lot, as it has given me a better life."
A remarkable fusion of human and machine
Mechanical attachment and reliable control are two of the biggest
challenges in artificial limb replacement. People with limb loss often reject
even the sophisticated prostheses commercially available due to these reasons,
after experiencing painful and uncomfortable attachment with limited and
unreliable controllability.
A multidisciplinary group of engineers and surgeons solved these problems
by developing a human–machine interface that allows the prosthesis to be
comfortably attached to the user's skeleton via osseointegration, while also
enabling electrical connection with the nervous system via
electrodes implanted in nerves and muscles. This research is now published in
the journal Science Robotics.
Description and demonstration of the first
below-elbow neuromusculoskeletal prosthesis. Credit: Science Robotics (2023).
DOI: 10.1126/scirobotics.adf7360.
https://www.science.org/doi/10.1126/scirobotics.adf7360
The research was led by Prof. Max Ortiz Catalan, head of neural prosthetics
research at the Bionics Institute in Australia and founder of the Center for
Bionics and Pain Research (CBPR) in Sweden.
"Karin was the first person with below-elbow amputation who received
this new concept of a highly integrated bionic hand that can be used
independently and reliably in daily life. The fact that she has been able to
use her prosthesis comfortably and effectively in daily activities for years is
a promising testament to the potential life-changing capabilities of this novel
technology for individuals facing limb loss."
The challenges at this level of amputation are that the two bones (radius
and ulna) that should be aligned and loaded equally, and that not much space is
available for implanted and prosthetic components. The research team
nevertheless managed to develop a suitable neuromusculoskeletal implant that
connects the user's biological control system (the nervous system) with the
electronic control system of the prosthesis.
"Our integrated surgical and engineering approach also explains the reduction in pain, as Karin is now using somewhat the same neural resources to control the prosthesis as she did for her missing biological hand." Treatment and prevention of post-amputation pain is another major goal for Prof. Ortiz Catalan's team. Karin says, "[I now have] better control over my prosthesis, but above all, my pain has decreased. Today, I need much less medication."
First person with a below-elbow amputation who
received a bionic hand directly connected to her neuromusculoskeletal system.
Credit: Science Robotics (2023). DOI: 10.1126/scirobotics.adf7360.
https://www.science.org/doi/10.1126/scirobotics.adf7360
A key feature
of the new bionic technology is the skeletal attachment of the prosthesis via
osseointegration—the process by which bone tissue embraces titanium creating a
strong mechanical connection.
Prof. Rickard Brånemark, research affiliate at MIT,
associate professor at Gothenburg University, and CEO of Integrum, led the
surgery and has worked with osseointegration for limb prosthesis since they
were first used in humans. "The biological integration of titanium
implants into bone tissue creates opportunities to further advance amputee
care," said Prof. Brånemark.
"By combining osseointegration with
reconstructive surgery, implanted electrodes, and AI, we can restore human
function in an unprecedented way. The below-elbow amputation level has
particular challenges, and the level of functionality achieved marks an
important milestone for the field of advanced extremity reconstructions as a
whole."
The nerves and muscles in the residual limb were
re-arranged to provide more sources of motor control information for the
prosthesis. Dr. Paolo Sassu conducted this part of the surgery that took place
at the Sahlgrenska University Hospital in Sweden, where he also led the first
hand transplantation performed in Scandinavia.
Dr. Sassu said, "Depending on the clinical
conditions, we can offer the best solution for our patients which sometimes is
biological with a hand transplantation, and sometimes is bionic with
neuromusculoskeletal prosthesis. We are continuously improving in both."
Dr. Sassu is presently with the Istituto Ortopedico Rizzoli in Italy, and the
Center for Bionics and Pain Research in Sweden.
"The DeTOP project, funded by the European Commission," says Coordinator Prof. Christian Cipriani, from Scuola Sant'Anna, Pisa, "offered a great opportunity of collaboration which made possible the consolidation of state-of-art prosthetic and robotic technologies available in our institutions, that may have a terrific impact on people's life."
Karin with her integrated bionic hand and Prof. Max
Ortiz Catalan. Credit: Science Robotics (2023). DOI: 10.1126/scirobotics.adf7360.
https://www.science.org/doi/10.1126/scirobotics.adf7360
The highly integrated bionic hand in use. Credit: Science Robotics (2023). DOI: 10.1126/scirobotics.adf7360.
https://www.science.org/doi/10.1126/scirobotics.adf7360
A highly integrated bionic hand in between many
others. Credit: Science Robotics (2023). DOI: 10.1126/scirobotics.adf7360.
https://www.science.org/doi/10.1126/scirobotics.adf7360
The robotic
hand developed by Prensilia, namely Mia Hand, featured unique motor and sensory
components that allowed the user to carry out 80% of the activities of daily
living. "The acceptance of the prosthesis is critical for its successful
use," says Dr. Francesco Clemente, Managing Director of Prensilia.
"Besides technical performance, Prensilia
struggled to develop a hand that could be fully customizable aesthetically. Mia
Hand was born to be shown and not hidden. We wanted the users to be proud of
what they are, rather than ashamed of what was lost."
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