Editing Prosthesis (section)

===Robotic prostheses===
[[File:An-Electrocorticographic-Brain-Interface-in-an-Individual-with-Tetraplegia-pone.0055344.s009.ogv|thumb|Brain control of 3D prosthetic arm movement (hitting targets). This movie was recorded when the participant controlled the 3D movement of a prosthetic arm to hit physical targets in a research lab.]]
{{Main|Neural prosthetics|Powered exoskeleton#Current products (powered exoskeletons)}}
{{Further|Robotics#Touch|3-D printing|Open-source hardware}}

Robots can be used to generate objective measures of patient's impairment and therapy outcome, assist in diagnosis, customize therapies based on patient's motor abilities, and assure compliance with treatment regimens and maintain patient's records. It is shown in many studies that there is a significant improvement in upper limb motor function after stroke using robotics for upper limb rehabilitation.<ref>{{cite journal | author = Reinkensmeyer David J | year = 2009 | title = Robotic Assistance For Upper Extremity Training After Stroke | journal = Studies in Health Technology and Informatics | volume = 145 | pages = 25–39 | pmid = 19592784 | url = http://computational.eu/emerging//book9/chapter_2.pdf | access-date = 2016-12-28 | archive-url = https://web.archive.org/web/20161228195545/http://computational.eu/emerging//book9/chapter_2.pdf | archive-date = 2016-12-28 | url-status = dead }}</ref>
In order for a robotic prosthetic limb to work, it must have several components to integrate it into the body's function: [[Biosensors]] detect signals from the user's nervous or muscular systems. It then relays this information to a [[microcontroller]] located inside the device, and processes feedback from the limb and actuator, e.g., position or force, and sends it to the controller. Examples include surface electrodes that detect electrical activity on the skin, needle electrodes implanted in muscle, or solid-state electrode arrays with nerves growing through them. One type of these biosensors are employed in [[myoelectric prosthesis|myoelectric prostheses]].

A device known as the controller is connected to the user's nerve and muscular systems and the device itself. It sends intention commands from the user to the actuators of the device and interprets feedback from the mechanical and biosensors to the user. The controller is also responsible for the monitoring and control of the movements of the device.

An [[actuator]] mimics the actions of a muscle in producing force and movement. Examples include a motor that aids or replaces original muscle tissue.

Targeted muscle reinnervation (TMR) is a technique in which [[motor nerve]]s, which previously controlled [[muscle]]s on an amputated limb, are [[surgery|surgically]] rerouted such that they reinnervate a small region of a large, intact muscle, such as the [[pectoralis major]]. As a result, when a patient thinks about moving the thumb of their missing hand, a small area of muscle on their chest will contract instead. By placing sensors over the reinnervated muscle, these contractions can be made to control the movement of an appropriate part of the robotic prosthesis.<ref name="six">{{Cite journal|vauthors=Kuiken TA, Miller LA, Lipschutz RD, Lock BA, Stubblefield K, Marasco PD, Zhou P, Dumanian GA |title=Targeted reinnervation for enhanced prosthetic arm function in a woman with a proximal amputation: a case study |journal=Lancet |date= February 3, 2007 |volume=369 |issue=9559 |pages=371–80 |pmid=17276777 |doi=10.1016/S0140-6736(07)60193-7|s2cid=20041254 }}</ref><ref>{{cite web|url=http://www.technologyreview.com/blog/editors/22730/ |title=Blogs: TR Editors' blog: Patients Test an Advanced Prosthetic Arm |work=Technology Review |date=2009-02-10 |access-date=2010-10-03}}</ref>

A variant of this technique is called targeted sensory reinnervation (TSR). This procedure is similar to TMR, except that [[sensory nerve]]s are surgically rerouted to [[skin]] on the chest, rather than motor nerves rerouted to muscle. Recently, robotic limbs have improved in their ability to take signals from [[Human brain|the human brain]] and translate those signals into motion in the artificial limb. [[DARPA]], the Pentagon's research division, is working to make even more advancements in this area. Their desire is to create an artificial limb that ties directly into the [[nervous system]].<ref name="seven">{{cite web |url=http://www.darpa.mil/dso/solicitations/sn07-43.htm |title=Defense Sciences Office |publisher=Darpa.mil |access-date=2010-10-03 |archive-url=https://web.archive.org/web/20090426080528/http://www.darpa.mil/dso/solicitations/sn07-43.htm |archive-date=2009-04-26 |url-status=dead }}</ref>

====Robotic arms====
Advancements in the processors used in myoelectric arms have allowed developers to make gains in fine-tuned control of the prosthetic. The [[Boston Digital Arm]] is a recent artificial limb that has taken advantage of these more advanced processors. The arm allows movement in five axes and allows the arm to be programmed for a more customized feel. Recently the [[I-LIMB Hand]], invented in Edinburgh, Scotland, by [[David Gow]] has become the first commercially available hand prosthesis with five individually powered digits. The hand also possesses a manually rotatable thumb which is operated passively by the user and allows the hand to grip in precision, power, and key grip modes.<ref>{{Cite journal|last1=Binedell|first1=Trevor|last2=Meng|first2=Eugene|last3=Subburaj|first3=Karupppasamy|date=2020-08-25|title=Design and development of a novel 3D-printed non-metallic self-locking prosthetic arm for a forequarter amputation|url=https://pubmed.ncbi.nlm.nih.gov/32842869/|journal=Prosthetics and Orthotics International|volume=45|pages=94–99|doi=10.1177/0309364620948290|issn=1746-1553|pmid=32842869|s2cid=221326246}}</ref>

Another neural prosthetic is [[Johns Hopkins University Applied Physics Laboratory]] Proto 1. Besides the Proto 1, the university also finished the [[Proto 2]] in 2010.<ref>{{cite web |url=http://www.ric.org/aboutus/mediacenter/press/2007/o501.aspx |title=Proto 1 and Proto 2 |publisher=Ric.org |date=2007-05-01 |access-date=2010-10-03 |archive-url=https://web.archive.org/web/20110727215917/http://www.ric.org/aboutus/mediacenter/press/2007/o501.aspx |archive-date=2011-07-27 |url-status=dead }}</ref> Early in 2013, Max Ortiz Catalan and Rickard Brånemark of the Chalmers University of Technology, and Sahlgrenska University Hospital in Sweden, succeeded in making the first robotic arm which is mind-controlled and can be permanently attached to the body (using [[osseointegration]]).<ref>{{cite web|url=https://www.sciencedaily.com/releases/2013/02/130222075730.htm |title=World premiere of muscle and nerve controlled arm prosthesis |publisher=Sciencedaily.com |date=February 2013 |access-date=2016-12-28}}</ref><ref>{{cite web|url=http://www.gizmag.com/thought-controlled-prosthetic-arm/25216/ |title=Mind-controlled permanently-attached prosthetic arm could revolutionize prosthetics |publisher=Gizmag.com |date=2012-11-30 |access-date=2016-12-28 |author=Williams, Adam }}</ref><ref>{{cite web|last=Ford |first=Jason |url=http://www.theengineer.co.uk/sectors/medical-and-healthcare/news/trials-imminent-for-implantable-thought-controlled-robotic-arm/1014779.article |title=Trials imminent for implantable thought-controlled robotic arm |publisher=Theengineer.co.uk |date=2012-11-28 |access-date=2016-12-28}}</ref>

An approach that is very useful is called arm rotation which is common for unilateral amputees which is an amputation that affects only one side of the body; and also essential for bilateral amputees, a person who is missing or has had amputated either both arms or legs, to carry out activities of daily living. This involves inserting a small permanent magnet into the distal end of the residual bone of subjects with upper limb amputations. When a subject rotates the residual arm, the magnet will rotate with the residual bone, causing a change in magnetic field distribution.<ref>{{cite journal |author1=Li, Guanglin |author2=Kuiken, Todd A | year = 2008 | title = Modeling of Prosthetic Limb Rotation Control by Sensing Rotation of Residual Arm Bone | journal = IEEE Transactions on Biomedical Engineering | volume = 55 | issue = 9| pages = 2134–2142 | doi=10.1109/tbme.2008.923914| pmc=3038244 | pmid=18713682}}</ref> EEG (electroencephalogram) signals, detected using small flat metal discs attached to the scalp, essentially decoding human brain activity used for physical movement, is used to control the robotic limbs. This allows the user to control the part directly.<ref>{{cite journal | author = Contreras-Vidal José L. | year = 2012 | title = Restoration of Whole Body Movement: Toward a Noninvasive Brain-Machine Interface System | journal = IEEE Pulse | volume = 3 | issue = 1| pages = 34–37 | doi=10.1109/mpul.2011.2175635| pmid = 22344949 |display-authors=etal| pmc = 3357625}}</ref>

====Robotic transtibial prostheses ====
The research of robotic legs has made some advancement over time, allowing exact movement and control.

Researchers at the [[Rehabilitation Institute of Chicago]] announced in September 2013 that they have developed a robotic leg that translates neural impulses from the user's thigh muscles into movement, which is the first prosthetic leg to do so. It is currently in testing.<ref>{{cite web|url=http://www.medgadget.com/2013/09/robotic-leg-emg.html |title=Rehabilitation Institute of Chicago First to Develop Thought Controlled Robotic Leg |publisher=Medgadget.com |date=September 2013 |access-date=2016-12-28}}</ref>

Hugh Herr, head of the biomechatronics group at MIT's Media Lab developed a robotic transtibial leg (PowerFoot BiOM).<ref>[https://www.smithsonianmag.com/innovation/future-robotic-legs-180953040/ Is This the Future of Robotic Legs?]</ref><ref>{{cite web|url = https://biomech.media.mit.edu/portfolio_page/powered-ankle-foot-prosthesis/ |title = Transtibial Powered Prostheses|website = Biomechatronics|publisher = MIT Media Lab}}</ref>

The Icelandic company Össur has also created a robotic transtibial leg with motorized ankle that moves through algorithms and sensors that automatically adjust the angle of the foot during different points in its wearer's stride. Also there are brain-controlled bionic legs that allow an individual to move his limbs with a wireless transmitter.<ref>{{Cite news|url=https://www.popsci.com/brain-controlled-bionic-legs-are-here-no-really|title=Brain-Controlled Bionic Legs Are Finally Here|work=Popular Science|access-date=2018-12-01|language=en}}</ref>

====Prosthesis design====
The main goal of a robotic prosthesis is to provide active actuation during gait to improve the biomechanics of gait, including, among other things, stability, symmetry, or energy expenditure for amputees.<ref>{{Cite journal|last1=Liacouras|first1=Peter C.|last2=Sahajwalla|first2=Divya|last3=Beachler|first3=Mark D.|last4=Sleeman|first4=Todd|last5=Ho|first5=Vincent B.|last6=Lichtenberger|first6=John P.|date=2017|title=Using computed tomography and 3D printing to construct custom prosthetics attachments and devices|journal=3D Printing in Medicine|volume=3|issue=1|pages=8|doi=10.1186/s41205-017-0016-1|issn=2365-6271|pmc=5954798|pmid=29782612 |doi-access=free }}</ref> There are several powered prosthetic legs currently on the market, including fully powered legs, in which actuators directly drive the joints, and semi-active legs, which use small amounts of energy and a small actuator to change the mechanical properties of the leg but do not inject net positive energy into gait. Specific examples include The emPOWER from BionX, the Proprio Foot from Ossur, and the Elan Foot from Endolite.<ref>{{Cite web|url=http://www.bionxmed.com/|title=Home – BionX Medical Technologies|website=www.bionxmed.com|language=en-US|access-date=2018-01-08|archive-date=2017-12-03|archive-url=https://web.archive.org/web/20171203114709/http://www.bionxmed.com/|url-status=dead}}</ref><ref>{{Cite web|url=https://www.ossur.com/prosthetic-solutions/products/dynamic-solutions/proprio-foot|title=PROPRIO FOOT|last=Össur|website=www.ossur.com|language=en-us|access-date=2018-01-08}}</ref><ref>{{Cite news|url=http://www.endolite.com/products/elan|title=Elan – Carbon, Feet, Hydraulic – Endolite USA – Lower Limb Prosthetics|work=Endolite USA – Lower Limb Prosthetics|access-date=2018-01-08|language=en-US}}</ref> Various research groups have also experimented with robotic legs over the last decade.<ref>{{cite journal |last1=Windrich |first1=Michael |last2=Grimmer |first2=Martin |last3=Christ |first3=Oliver |last4=Rinderknecht |first4=Stephan |last5=Beckerle |first5=Philipp |title=Active lower limb prosthetics: a systematic review of design issues and solutions |journal=BioMedical Engineering OnLine |date=19 December 2016 |volume=15 |issue=S3 |pages=140 |doi=10.1186/s12938-016-0284-9 |pmid=28105948 |pmc=5249019 |doi-access=free }}</ref> Central issues being researched include designing the behavior of the device during stance and swing phases, recognizing the current ambulation task, and various mechanical design problems such as robustness, weight, battery-life/efficiency, and noise-level. However, scientists from [[Stanford University]] and [[Seoul National University of Science and Technology|Seoul National University]] has developed artificial nerves system that will help prosthetic limbs feel.<ref>{{Cite web|url=https://www.engineering.com/DesignerEdge/DesignerEdgeArticles/ArticleID/17049/Researchers-Create-Artificial-Nerve-System.aspx|title=Researchers Create Artificial Nerve System|last=ENGINEERING.com|website=www.engineering.com|language=en-US|access-date=2018-06-08}}</ref> This synthetic nerve system enables prosthetic limbs sense [[braille]], feel the sense of touch and respond to the environment.<ref>{{Cite web|url=http://www.xinhuanet.com/english/2018-06/01/c_137223459.htm|archive-url=https://web.archive.org/web/20180607021506/http://www.xinhuanet.com/english/2018-06/01/c_137223459.htm|url-status=dead|archive-date=June 7, 2018|title=Stanford researchers create artificial nerve system for robots – Xinhua {{!}} English.news.cn|website=www.xinhuanet.com|access-date=2018-06-08}}</ref><ref>{{Cite news|url=https://news.stanford.edu/2018/05/31/artificial-nerve-system-gives-prosthetic-devices-robots-sense-touch/|title=An artificial nerve system gives prosthetic devices and robots a sense of touch {{!}} Stanford News|last=University|first=Stanford|date=2018-05-31|work=Stanford News|access-date=2018-06-08|language=en-US}}</ref>