CIC takes information for control of the prosthetic movement and function from sensors within the device and not in direct communication with the user. This sensor input is sent to the microprocessor, where the next appropriate movement of the prosthetic device is determined by the microprocessor, not the amputee's brain, and the actuator is adjusted to create a change in movement, and so on (Figure 2).
Examples of sensors frequently used in the field to accomplish this are joint angle sensors (hall effect, potentiometers, and encoders), force sensors (strain gauges, pressure pads, and load cells), and motion sensors (accelerometers, gyroscopes, and goniometers). These may be used to provide input directly (i.e., potentiometer reading giving direct correlation to angle of the joint) or indirectly with additional input information (i.e., potentiometer angle reading being used along with time sensor to extrapolate angular acceleration of the joint). For instance, force information collected from a strain gauge during the gait cycle may be used to determine real-time required stiffness data for the joint's movement, or it may be used to indirectly determine the phase of the gait cycle.
CICs may be used to effectively coordinate movement of a prosthetic device through its own internal feedback loop but do not directly communicate with the body's intended movements based off any form of neural interaction. Because there is, and will likely remain for years to come, a limited amount of neural input available for prosthetic control, extrapolating the available input, even if simply a sensor-based input, into as much useful information as possible is critical. Segal et al.15 consented in their evaluation of microprocessor-controlled knees that this sensor information collected is intended for use in achieving as functional of gait as is currently possible. Therefore, it is essential to find creative methods of extrapolating that limited sensor information into a larger group of worthwhile data to control the device.15
There is also a fine balance between giving the prosthesis too much or too little control on its own. CIC may put the user at risk by limiting stability and consistency of prosthetic movement if the sensor-based microprocessor control algorithms incorrectly determine the appropriate response to the ambulated environment. It is essential for the prosthesis to provide consistent and correct movement independent of the user's activities. Any inconsistencies between the intended movement of the user and the movement of the prosthetic device lead to compromised safety, decreased gait efficiency, and ultimately rejection of the device.
A challenge of some current control methods is the inability of the device to determine and replicate movement parameters for activities other than typical gait cycle motions, such as exercising activities or stairs. Using the available sensor information, the prosthesis can readily provide input to the microprocessor to control typical walking motions effectively; however, typical ambulation requires atypical movements, as the user negotiates the “real world.” The more that a prosthetic device is able to produce properly intended and necessary movements, in all environments and conditions, through CIC strategies, the less dependant the system will be on user input and possibly less dependant the user will be on afferent IEC feedback.
In CIC systems, the sensors collect data and correspond that to real-time alterations in the actuator (minus inherent electronics and mechanical actuator delays). The limitation of such a system, however, is that the human anatomical control system also uses prereal-time sensor data. During ambulation of an able-bodied person, visual and auditory cues alert us to our surrounding environment. Several steps ahead, we can see an obstacle in our path and correspond our leg movement to adjust for that obstacle without looking down once we come upon it. Each of these pieces of information is taken into account for our gait before the event.
By using sensor data only, these important prereal-time cues are missing, and safety may be compromised. Another method may help to overcome this limitation, by ultimately allowing for the user to effect the movement of the device, through electromyogram (EMG), neural integration, or similar strategies.
IEC uses human-interacting methods of determining appropriate movement and function of the prosthetic device (Figure 3). These methods, many of which are currently under development, and not used in conventional lower limb prosthetics, use efferent information from the user by means such as EMG sensors, pattern recognition systems, cortical, or peripheral nerve sensors, and can possibly provide afferent information to the user through haptic feedback or cortical or peripheral nerve feedback. These systems often use computational control parameters in conjunction with human-induced input methods, their ability to take information directly or indirectly from the user offers uniqueness in the control feedback loop.
As is found in upper limb prosthetics, the types and methods of available efferent input from the user to the device are often unique to that user. Not every prosthetics user, because of medical, cost, or other considerations, will be able to have neural input associated with their prosthesis. Similarly, the ability and desire for users to have afferent feedback may differ significantly.
For efferent information from the user to the device, the microprocessor may correlate input parameters to the actuators in conjunction with the intended neural input. Some systems may result in a proportional movement such as that in many current upper limb myoelectric devices,19 whereas other system's functions may result in a preselected movement only, as in upper limb chin switch.20 For example, the EMG-controlled prosthetic limbs described by Ryait et al.19 sense electrical impulses generated through user muscle contractions and incorporate the magnitude of these contractions into the speed and grip strength of the resultant motion of the prosthetic. Conversely, the upper limb system described by Lake and Miguelez20 is actuated by a push from the chin; proportional control is lacking.
In using IEC systems, a full closed loop sensory feedback is increasingly beneficial by allowing the user to provide intended movement information to the device (efferent information) and to have the device communicate that movement information back to the user (afferent information). Able-bodied individuals who lack sensory feedback also have limited ability to control coordinated movements.21 A limb dynamic study of normal individuals compared with those lacking appropriate sensory feedback proprioception by Sainburg et al.21 illustrates that individuals experiencing normal proprioceptive feedforward commands effectively coordinate muscle actions and joint interaction torques, whereas deafferented individuals fall short of attaining the balance. As is often found in current upper limb myoelectric systems, while afferent communication may not be intentionally communicated to the user, the user may use indirect cues from the device, such as differences in the motor sounds or motor vibratory cues, to gain a sense of afferent feedback during use. These second-hand cues are often essential to the user to have an understanding of what movements are taking place within the prosthesis, based on their efferent input.
Whether purposely integrated into a device or taken as second-hand cues from the device, afferent IECs stimulate the user in a manner to achieve communication of kinetic or kinematic data. These signals may generally be characterized as sensory feedback mechanisms.
Afferent IECs are becoming increasingly important in this next generation of computer-controlled prosthetics. The movement from these devices may be otherwise disassociated from the user, resulting in a lack of understanding of proprioception, and both spatial orientation and resistance or actuation characteristics. With conventional systems, users often gain extended physiological proprioception (EPP) with their device.22 A tennis player or a golfer experiences EPP in their ability to have a sense of where the end of their “static” racket or club is at in relation to their body. They, in essence, have a sense of proprioception, or spatial orientation, of a nonanatomical static extension of their body. With “adaptable” prosthetics where the position and stiffness of the joint changes, there may be limited association of joint position of the prosthetic as it adapts to the environment.
With conventional static transtibial prosthetics, users may gain an acute awareness of their prosthesis position in space much the same way that a golfer experiences EPP with the club; however, for transfemoral amputees, the ability to know the spatial orientation of the knee joint of conventional designs is not possible because of the greater variability in possible angles and stiffnesses, thus limiting the user's perceived understanding of EPP. As a transfemoral amputee may experience, if the toe of the prosthetic foot catches on a carpet as they attempt to move the prosthesis through the swing phase of gait, the knee may be in excessive flexion just before heel strike, leading to a fall. Similarly, conventional prosthetic knees often cause abnormalities in gait on varied terrain, which the user has limited EPP of until it is too late.
The use of computer-controlled joints offer differences in perceived EPP, or perceived awareness of appropriate positioning of the limb in space, than with conventional systems. As the control software is able to better match the user's intended movement (through either CIC or IEC), the prosthesis will be able to better adapt to environmental changes and, therefore, enable proper biomechanical movement and hence perceived EPP (Figure 4). By not accommodating for environmental factors as effectively as computer-controlled systems, and hence having poorer biomechanical symmetry in varied environmental conditions, conventional prosthetics limit the perceived EPP of the user—the more intelligent control and more proper biomechanical movement of the prosthesis, the more the user will be able to gain confidence in the spatial orientation of the prosthesis correlated with the ambulated environments. Through offering more appropriate biomechanical movement of the device when compared with conventional designs, computer-controlled joints may “filter” both subtleties (stepping on a crack in the sidewalk) and major gait alteration changes (change in terrain slope for instance) during ambulation, allowing the user to ambulate unaffected, not compromising their perceived sense of EPP.
Newer, more advanced, neural integration strategies are being actively pursued to provide that critical efferent and afferent link between the brain and the microprocessor.23 This work will ultimately result in a better ability to control joint movement in daily activities. One example of such initiative is the Defense Advanced Research Projects Agency Revolutionizing Prosthetics 2009 design of a fully functional hand and arm system currently being developed to restore the function of persons who have experienced high-level upper limb amputation. Control of this prosthetic will involve options of targeted reinnervation, implantable sensors, pattern recognition, and peripheral nerve interface (Figure 5).23
It is possible for prosthetics to incorporate both CIC and IEC mechanisms. This is advantageous because it may allow for the user to have a certain level of control over the intended movement of the device (efferent IEC), communication with the device when available and necessary (afferent IEC feedback), and allows for the device to have intelligent control when no neural input is available (internal microprocessor CIC).
Ultimately, the user has to have full confidence in the control of the prosthetic device and have the prosthesis move corresponding to their intended movement, whether it is controlled by CIC or IEC methods. As the input sensor (CIC) and neural integration strategies (IEC) improve, the ability to enhance function of the prosthesis will increase.
CONTROL STRATEGIES AND ACTUATION METHODS
Control strategies of these CIC or IEC input methods are arguably the most difficult technical barrier for the next generation of prosthetics. The movement of the limbs requires precise accommodation for a wide variance of factors, and the ability for the prosthesis to “think, respond, and react” to environmental changes based off the limited number of sensory and neural inputs is challenging.
What makes prosthetics increasingly difficult, when compared with purely robotic systems, is the meshing of man and machine. Although robotic devices have been able to achieve relatively natural bipedal gait, the human factor adds great complexity to the developmental process. Because there is a limited communication platform between the human and the prosthesis, there remains a development challenge to ensure that the “prosthetic brain” (microprocessor/control system) works in conjunction with the human brain (intended movement). Any inconsistencies in movement of the device, compared with the desired movement of the user, result in a disconnect and may lead to asymmetries, impaired balance and safety, and ultimately rejection of the device.
There are many variations in control strategies with the available CIC and IEC input methods. Different available computer-controlled prosthetic devices offer unique abilities and functional parameters (Figure 6). Some of these devices offer a wide range of altering dynamic characteristics, whereas others function within a narrow range of adjustability. In addition, these devices may offer resistive and powered actuation.
In the recent past, lower limb computer-controlled prosthetics have demonstrated greater success in their ability to better adapt to changes in the environment, compared with mechanical-based systems. In a clinical study comparing the two systems, Hafner et al.24 determined the microprocessor-controlled Otto Bock C-Leg to offer superior performance in stair and hill ambulation and lower incidence of stumbling and falling when compared with mechanical-based knees. Many of these computer-controlled systems have the ability to alter their state in angle and resistance to angular change by using sensor technology to provide information to a microprocessor, which in turn changes the resistive actuator to a large range of possible settings, limited only by the response time of the electronics and actuator. Some of these devices have the ability to variably accommodate for alterations of certain characteristics such as force, speed, and terrain changes in the gait cycle.
With the exception of not providing positive energy power to the foot or knee (concentric muscular contractions), this method provides better function during a wide range of ambulatory activities. It provides for a very large variability of angular change within the specified range of motion and a large variability of resistance to angular change. This corresponds to natural kinetic and kinematic requirements of ambulation such as force, speed, and terrain alterations (depending on what the control system accommodates for), at least in eccentric muscular contraction replication. However, this method does not allow for powered spatial orientation of joint placement, which may be essential for certain ambulation activities.
Specific joint angular placement is required to allow for the angular orientation of each joint to be positioned in space at the appropriate angle, independent of specific ambulatory activities, such as descending stairs in which increased plantar flexion angle is desired before foot contact.25 Resistive actuation devices merely restrict joint angular change. These systems may use alternative mechanical methods, such as spring elements or inertial effects, to provide spatial orientation, while using resistance settings of the actuator to control the amount and rate of motion (Figure 7).
Active powered devices may have the ability to provide positive energy into the stance and swing portions of the gait cycle. This acts to mimic concentric muscular contractions found during ambulation. A system such as this could enable a transfemoral amputee to climb stairs step over step, with the prosthesis putting positive energy into the ambulation, or could simply be used for spatial orientation of the prosthetic limb during swing phase of gait.26 For example, in a gait analysis study of the effects of a power knee prosthesis, Cutti et al.26 found that the powered device facilitates knee flexion at the start of the swing phase, promoting foot clearance during the step.
There is a significant functional difference between stance and swing phase powered actuation, but both provide their own benefits to the user.27 Powered actuation of an ankle-foot prosthesis enhances ambulation during stance by adapting joint resistance and providing positive energy, whereas powered actuation during swing enhances ambulation simply by actively controlling the orientation of the foot.27 Some devices may incorporate both stance and swing phase powered actuation.
The use of active powered prosthetics is the most true-to-life system possible, as they mimic each aspect of the anatomical limbs kinematic movement, including both eccentric and concentric muscular contractions. Although not readily implemented into the field, these systems have the potential to use a combination of resistive and active powered actuation to further enhance their power consumption efficiency and gait efficiency of the user. This is comparable with their anatomical counterpart, which uses both resistive and powered movements (concentric and eccentric muscular contractions).28
In considering computer-controlled lower limb products, the actuator technologies of the device used should be considered as well. Considerations for the actuator are weight, noise, size comparison with the anatomical envelope, power efficiency or battery lifespan, and durability. Each of these considerations is a challenge from a development standpoint and often competing requirements. Actuator technologies are also considered in their infancy in many regards. Smaller and more robust hydraulic valve designs are currently under development, for example, in devices such as hydraulic actuation prosthetic hands,29 whereas electric motors and drives are also being improved for use in designs, including powered ankle-foot prostheses.30 The hydraulic actuation artificial hand being developed by researchers at Oak Ridge National Laboratories incorporates very small and power efficient powered actuators that could someday be used in lower limb designs,29 whereas the powered ankle-foot prosthesis in the works at Massachusetts Institute of Technology is being designed to enhance gait symmetry, ambulation speed, and manage energy consumption by providing mechanical power in the stance phase of the gait cycle.30 In addition, state changing materials development is making great strides in becoming practical.31–33 Electroreactive polymers, in particular dielectric elastomers, are being studied by Kornbluh et al.32 for use as artificial muscles that can be implemented to actuate prosthetics someday. As each of these and other actuation technologies improve, they will enable lower limb computer-controlled designs to better mimic the anatomical limb and better meet the requirements and desires of their users.
In the past, mechanical-based systems were able to offer particular benefits to certain populations. Manual lock knees were well suited for lower function-level users who required extra stability, whereas fluid-based designs were generally used for higher functioning levels. With the advent of computer-controlled designs, there becomes a greater distinction between the benefits to the various types of users for this one category of systems (Figure 8). By varying system settings, a microprocessor-controlled knee may have valuable benefit to a broader spectrum of the population. In the past, simple, stable knees were prescribed to lower function users; today, active powered actuation knees may have a significant increase in the benefits to that same population—at least in its potential to offer greater safety and independence. A user who once had difficulty going from a sitting to standing position may now be more apt to perform that task on their own with a power-assist prosthetic. Ambulation potential, such as distance, ease, security, and gait efficiency, are all impacted by the use of intelligent control and actuation methods of the prosthesis.
Various microprocessor-controlled prosthetic designs offer accommodation for different gait characteristics. Although a product may be categorized by its ability to have sensor-based variability in its actuator adjustments—angle, resistance to angular change, powered actuations, etc—each product offers distinct abilities in performance. Some systems are designed to provide joint angle resistance alterations, according to the phase of the gait cycle only, whereas others may accommodate for terrain variances as well.
This is an important factor to consider in determining the most appropriate computer-controlled prosthetic for a given user. If the user rarely alters their gait speed, using a system that alters joint resistance settings for gait cycle phases only may be most appropriate. For users who frequently lift heavy loads, greatly alter gait speed, or walk on varied terrain, the ability of the device to accommodate for those factors should be considered in determining the most appropriate microprocessor-based components.
It is important that the device has the ability to offer real-time functional changes to the prosthetic joint's angle and resistance or actuation, as each step may be significantly different from the previous one. If, for instance, the actuation parameters are in conjunction with sensor-based information from previous steps, the angle and resistance of the joint may not be best suited for the immediate current step. Walking within a typical indoor environment at home or at the office for instance may provide largely even ambulated terrain environment; however, walking along a sidewalk, in the grass, or down a wheelchair ramp may provide significant enough alterations to the ambulated environment step to step, requiring immediate real-time accommodation of those environments. Those that do not may compromise safety and symmetry for the user.
Factors that should be considered are the ability of the device to accommodate for environmental factors (force, speed, and terrain), offer powered actuation in stance, and swing phase (spatial orientation), have dynamic cosmetic effects (such as plantarflexion of the foot during sitting), ability to offer real-time control, and offer a control input method (IEC or CIC) that is well suited for the user.
Inevitably, many advancements will be made and new products will emerge over these next few years in lower limb computer-controlled prosthetics, resulting in vast changes in the way these systems are viewed and used. As new products, exhibiting the many different characteristics of computer-controlled lower limb prosthetics continue to emerge, a greater understanding of how to improve the next generation of prosthetics will surface.
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KEY INDEXING TERMS: lower limb prosthetic; microprocessor control; input method; control system; output actuation
© 2010 American Academy of Orthotists & Prosthetists