Direct Continuous EMG control of a Powered Prosthetic Ankle for Improved Postural Control after Guided Physical Training: a Case Study

Abstract

Background: Despite the promise of powered lower limb prostheses, the existing control of these modern devices is insufficient to assist many daily activities, such as postural control while lifting weight, that require continuous control of prosthetic joints according to human states and environments. The objective of this case study was to investigate the feasibility and potential of direct, continuous electromyographic (dEMG) control of a powered ankle prosthesis, combined with physical therapist (PT)-guided training, for improved standing postural control in an individual with 28 transtibial amputation. Methods: A powered prosthetic ankle was directly controlled by EMG signals of the residual lateral gastrocnemius and tibialis anterior muscles. The participant with transtibial amputation received 4-week PT-guided training on posture while using the dEMG control of powered ankle. A subset of activities in the mini-BESTest (a clinical balance assessment tool) were used in the training and evaluation protocol. We quantified EMG signals in the bilateral shank muscles, biomechanics that captures postural control and stability, and score for the clinical balance evaluation. Results: Compared to the participant's daily passive prosthesis, the dEMG-controlled ankle, combined with the training, yielded improved clinical balance score and reduced compensation from the intact joints. In addition, cross correlation coefficient of bilateral CoP excursions, a metric for quantifying standing postural control, increased to 0.83(+/-0.07) when using dEMG ankle control, compared with 0.39(+/-0.29) when using the passive device. Between-limb coordination was also observed as synchronized activation of homologous muscles in the shank. We witnessed rapid improvement in performance on the first day of the training for load transfer tasks, where bilateral CoP synchronization improvement was significantly related to repetition order (R=0.459, p = 0.045). Finally, the participant further improved this performance significantly across training days. Conclusion: This case study showed the feasibility of dEMG control of powered prosthetic ankle by a transtibial amputee after a PT-guided training to assist postural control. This study's training protocol and dEMG control method that lays the foundation for future study to extend these results through the inclusion of more participants and activities.