Motor Control for Trauma and Advanced Prosthetics
Transcript of Motor Control for Trauma and Advanced Prosthetics
Albert Chi, MD, MS, FACSAssociate Professor, Division of Trauma and Critical Care
Research and Exploratory Development, Johns Hopkins Applied Physics LabCommander, Medical Corps, IRR USN
Motor Control for Traumaand
Advanced Prosthetics
Background• 82% majority of trauma that currently occurs in Iraq and
Afghanistan involves the upper and lower extremities – Wearing of protective body armor – MRAP (Mine resistant Ambush Protected Vehicle)– IED (Improvised Explosive Devices)
• Iraq – 155 artillery rounds• Afghanistan – nitrogen based bombs
During the 1980s, 11 of 469 (2.3%) amputees returned to active duty
The number of amputees returning to duty has increased significantly, from 2.3% to 16.5%, due to advancements in combat casualty care and the establishment of centralized amputee centers
J Trauma. 2010 Jun;68(6):1476-9.
Applied Physics LabModular Prosthetic Limb
• Designed for modularity and 50% male• The robotic arm itself weighs 9 lbs• Capable of 17 degrees of freedom
– Able to move each individual finger and full range of motion of the wrist
– Able of curling 50 Ibs
• Sensory feedback able to measure temperature, pressure, velocity and position
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Modular Prosthetic Limb
DARPA – Revolutionizing Prosthetics Program
• Benefit individuals at all levels of injury– Spinal Cord injury
• Control Strategies– Cortical Control
Bruce Lee an American born martial artist, philosopher and the founder of the Jeet Kune
Do martial arts system
Pete Rose best known for his years with the Cincinnati Reds is the all-time Major
League leader in hits, games played, at bats and outs
Moe Howard was one of The Three Stooges comedy team
who starred in motion pictures and television
5th grade
6th grade
4th grade
Jennifer Chiborn
September 30, 1973
Cortical Control
“Breakthrough”Aired December 21, 2012
• Benefit individuals at all levels of injury– Spinal Cord injury
• Control Strategies– Cortical Control
“Breakthrough”Aired December 21, 2012
• Within 48 hours of injury– Text to speech– Social Media– YouTube– Email– Environmental
Controls
Robotic Eye Control
Activities of Daily Living
Autonomous Grasping
HARMONIE Conceptual Demo(Hybrid Augmented Reality Multimodal Operation Neural Integration Environment)
DARPA – Revolutionizing Prosthetics Program
• Benefit individuals at all levels of injury– Missing upper extremity
• Control Strategies– Surface EMG Control
Targeted Muscle Reinnervation
Pre and Post TMR – Above ElbowCommercially Available Prosthetics
Residual FunctionsMusculocutaneous -> Lateral biceps Elbow flexionProximal Radial -> Long head Triceps Elbow extension
Transfers FunctionsMedian -> Medial head Biceps Hand CloseDistal Radial –> Lateral Triceps Hand OpenUlnar -> Brachialis Wrist/Hand
Pre and Post TMR – ShoulderCommercially Available Prosthetics
Targeted Muscle ReinnervationAdvanced Algorithms
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• Virtual Interactive Environment Real-time control and feedback– Confusion Matrix Performance Feedback – Able to classify multiple grips and finger control
JPO Journal of Prosthetics & Orthotics: January 2013
Virtual Rehabilitation
• Virtual Tasks– Performance
Evaluation• Box and Blocks• Clothespin• Positional• Weight
– Gaming• Strengthening
Exercises
• Pattern Recognition• Intuitive individual
finger control• Accurate prediction
of position and duration in real time
Air Guitar Hero
Bilateral MPL Shoulder Fitting
Pattern Recognition Experience
• Diversity of Patients– Studied all amputation levels– Including all levels of congenital limb loss
• All achieve control which exceeded expectations– Multiple grip classifications– Intuitive control strategies– Individual finger control
• Take home pattern recognition prosthesis using commercial available devices
Osseointegration / October 2015
Targeted Sensory Reinnervation
MPL Sensory Feedback
• Finger discrimination : four trials of 25 repetitions with 91% accuracy
• Object density: Four trials of 27 repetitions was able to distinguish between hard, soft, and no object with 95 % accuracy
Walter Reed – MPL Phase 2
Walter Reed – MPL Phase 2
• Take home MPL study for 1 year
• Goals• Enrolled for wireless
sensory feedback study
• Piano lessons• Feel the sensation of
holding his wife’s hand again
• Open Source designs• Biodegradable Polylactic Acid
polymer derived from corn resin• To print costs around $20US• Tensile Strength 57.8 MPa (8,383 psi)
– The force required to break the plastic exceeds the strength of the human hand
• Melting Temperature 170°C
E-nabling the FutureA network of passionate volunteers using 3D printing to give the World a "Helping Hand"
• Kennedy Krieger Institute / JHH Children’s Center– Fitting patient’s with congenital limb loss
• Enables gross grasp capabilities and stabilization• Psychosocial benefits• Strengthening and prosthetic acceptance
E-nabling the FutureA network of passionate volunteers using 3D printing to give the World a "Helping Hand"
E-nabling the FutureA network of passionate volunteers using 3D printing to give the World a "Helping Hand"
E-nabling the FutureA network of passionate volunteers using 3D printing to give the World a "Helping Hand"
Future Directions
• Surgery– Change surgical approach to upper extremity amputation
• Local Reinnervation and pattern recognition evaluation – TMR approaches for both upper and lower limb loss
• Research– Ossteointegration – Socketless and wireless designs– Sensory Cuff Electrode– IMES (Implantable Myoelectric Sensors)– HARMONIE (Hybrid Augmented Reality Multimodal Operation Neural Integration Environment)
• Center for Neuroprosthetics– Continuum of surgical and prosthetic options– Virtual and physical rehabilitation
Questions?
Johnny MathenyProsthetic Champion
“Testing Arms for a Better Life”