A review of user needs to drive the development of lower limb prostheses

Abstract

Background The development of bionic legs has seen substantial improvements in the past years but people with lower-limb amputation still suffer from impairments in mobility (e.g., altered balance and gait control) due to significant limitations of the contemporary prostheses. Approaching the problem from a human-centered perspective by focusing on user-specific needs can allow identifying critical improvements that can increase the quality of life. While there are several reviews of user needs regarding upper limb prostheses, a comprehensive summary of such needs for those affected by lower limb loss does not exist. Methods We have conducted a systematic review of the literature to extract important needs of the users of lower-limb prostheses. The review included 56 articles in which a need (desire, wish) was reported explicitly by the recruited people with lower limb amputation (N = 8149). Results An exhaustive list of user needs was collected and subdivided into functional, psychological, cognitive, ergonomics, and other domain. Where appropriate, we have also briefly discussed the developments in prosthetic devices that are related to or could have an impact on those needs. In summary, the users would like to lead an independent life and reintegrate into society by coming back to work and participating in social and leisure activities. Efficient, versatile, and stable gait, but also support to other activities (e.g., sit to stand), contribute to safety and confidence, while appearance and comfort are important for the body image. However, the relation between specific needs, objective measures of performance, and overall satisfaction and quality of life is still an open question. Conclusions Identifying user needs is a critical step for the development of new generation lower limb prostheses that aim to improve the quality of life of their users. However, this is not a simple task, as the needs interact with each other and depend on multiple factors (e.g., mobility level, age, gender), while evolving in time with the use of the device. Hence, novel assessment methods are required that can evaluate the impact of the system from a holistic perspective, capturing objective outcomes but also overall user experience and satisfaction in the relevant environment (daily life).

A hybrid sensory feedback system for thermal nociceptive warning and protection in prosthetic hand

“…Perceiving nociceptive sensations and avoiding potential dangers for amputees is valuable, but it is not clear whether a nociceptive temperature warning and protection could be achieved in current prosthetic hand solutions ( Bensmaia and Miller, 2014 ; Manz et al, 2022 ). In response to this need, we proposed reconstructing a sensorimotor circuit for nociceptive temperature detection in a prosthetic hand to restore the amputees’ ability to warn and protect against noxious temperatures.…”

Exploration of sensations evoked during electrical stimulation of the median nerve at the wrist level

“…Artificially eliciting somatotopically matched sensations is a desirable feature in many applications within the field of neuroengineering. Providing a natural-like sensation is beneficial for amputees using prosthetic devices [33,34], persons undergoing rehabilitation following peripheral nerve injury [17], stroke [35,36], or being affected by neurodegenerative disorders [37].…”

Advances in prosthetic technology: a perspective on ethical considerations for development and clinical translation

“…Arguably the most critical aspect of technology translation into prosthetic patient care is device coverage. To prosthetic users and clinicians alike, cost is a crucial concern and must be accounted for in prosthetic technology development ( 31 , 36 , 41 , 42 , 71 ). As all authors are based in the US, only US coverage guidelines will be discussed, though international challenges in prosthetic coverage have also been reported ( 72 ).…”