INTRODUCTION - Lincoln Repository



SIMPA: Soft-Grasp Infant Myoelectric Prosthetic ArmD. De Barrie, R. Margetts, and K. GoherAbstract— Myoelectric prosthetic arms have primarily focused on adults, despite evidence showing the benefits of early adoption. This work presents SIMPA, a low-cost 3D-printed prosthetic arm with soft grippers. The arm has been designed using CAD and 3D-scanning, and manufactured using predominantly 3D-printing techniques. A voluntary opening control system utilizing an armband-based sEMG has been developed concurrently. Grasp tests have resulted in an average effectiveness of 87%, with objects in excess of 400g being securely grasped. The results highlight the effectiveness of soft grippers as an end device in prosthetics, as well as the viability of toddler scale myoelectric devices.Index Terms— Prosthetics and Exoskeletons, Soft Robot Applications, Additive Manufacturing.UINTRODUCTIONPPER limb reduction defects occur congenitally in 4.1-5 per 10,000 births ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1471-2474-14-323", "ISSN" : "14712474", "PMID" : "24237863", "abstract" : "BACKGROUND: Reported birth prevalences of congenital limb defects (CLD) vary between countries: from 13/10,000 in Finland for the period 1964-1977 to 30.4/10,000 births in Scotland from 1964-1968. Epidemiological studies permit the timely detection of trends in CLD and of associations with other birth defects. The aim of this study is to describe the birth prevalence of CLD in the northern Netherlands.\\n\\nMETHODS: In a population-based, epidemiological study we investigated the birth prevalences of CLD for 1981-2010. Data were collected by the European Surveillance of Congenital Anomalies in the northern Netherlands (EUROCAT-NNL). We excluded malpositions, club foot, and dislocation/dysplasia of hips or knees. Trends were analysed for the 19-year period 1992-2010 using \u03c7\u00b2 tests, as well as CLD association with anomalies affecting other organs.\\n\\nRESULTS: The birth prevalence of CLD was 21.1/10,000 births for 1981-2010. There was an overall decrease in non-syndromic limb defects (P = 0.023) caused by a decrease in the prevalence of non-syndromic syndactyly (P < 0.01) in 1992-2010. Of 1,048 children with CLD, 55% were males, 57% had isolated defects, 13% had multiple congenital anomalies (MCA), and 30% had a recognised syndrome. The upper:lower limb ratio was 2:1, and the left:right side ratio was 1.2:1. Cardiovascular and urinary tract anomalies were common in combination with CLD (37% and 25% of cases with MCA). Digestive-tract anomalies were significantly associated with CLD (P = 0.016).\\n\\nCONCLUSIONS: The birth prevalence of CLD in the northern Netherlands was 21.1/10,000 births. The birth prevalence of non-syndromic syndactyly dropped from 5.2/10,000 to 1.1/10,000 in 1992-2010.", "author" : [ { "dropping-particle" : "", "family" : "Vasluian", "given" : "Ecaterina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sluis", "given" : "Corry K.", "non-dropping-particle" : "Van Der", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Essen", "given" : "Anthonie J.", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bergman", "given" : "Jorieke E.H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dijkstra", "given" : "Pieter U.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reinders-Messelink", "given" : "Heleen A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Walle", "given" : "Hermien E.K.", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMC Musculoskeletal Disorders", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "title" : "Birth prevalence for congenital limb defects in the northern Netherlands: A 30-year population-based study", "type" : "article-journal", "volume" : "14" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[1]", "plainTextFormattedCitation" : "[1]", "previouslyFormattedCitation" : "[1]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[1]. Factoring in non-congenital amputations is problematic, though one long term study showed dysvascular, trauma-related, and cancer-related conditions had a respective frequency of 2.25, 2.65, and 0.15 per 100,000 between the ages of 0-14 years ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/00007611-200208000-00018", "ISBN" : "0038-4348 (Print)\\r0038-4348 (Linking)", "ISSN" : "00384348", "PMID" : "12190225", "abstract" : "Background. The purpose of this study was to provide a comprehensive perspective on the epidemiology and time trends in the incidence of limb amputations and limb deficiency in the United States. Methods. Data from the Healthcare Cost and Utilization Project from 1988 through 1996 were used to calculate rates of congenital deficiency, trauma-related, cancer-related, and dysvascular amputations in the United States. Trends over time in adjusted rates were then examined using linear regression techniques. Results. Dysvascular amputations accounted for 82% of limb loss discharges and increased over the period studied. Over all years, the estimated increase in the rate of dysvascular amputations was 27%. Rates of trauma-related and cancer-related amputations both declined by approximately half. The incidence of congenital deficiencies remained stable. Conclusions. The risk of amputations increased with age for all causes and was highest among blacks having dysvascular amputations. Increasing risk of dysvascular amputations, particularly among elderly and minority populations, is of concern and warrants further investigation.", "author" : [ { "dropping-particle" : "", "family" : "Dillingham", "given" : "Timothy R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pezzin", "given" : "Liliana E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "MacKenzie", "given" : "Ellen J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Southern Medical Journal", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2002" ] ] }, "page" : "875-883", "title" : "Limb amputation and limb deficiency: Epidemiology and recent trends in the United States", "type" : "article-journal", "volume" : "95" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[2]", "plainTextFormattedCitation" : "[2]", "previouslyFormattedCitation" : "[2]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[2]. Despite these figures, active prosthetic devices are routinely only given to adults, with the assumption that myoelectric devices (those controlled by electrical signals generated in the muscles) are difficult to scale down, as well as being too expensive, especially with the frequent replacement schedule that a growing child necessitates ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00264-008-0615-y", "ISBN" : "1432-5195 (Electronic)\\r0341-2695 (Linking)", "ISSN" : "03412695", "PMID" : "18636257", "abstract" : "Myoelectric prostheses have generally been provided for adolescent or adult patients. The availability of smaller-sized electric hands has enabled the introduction of myoelectric prostheses to preschool children, mainly in the Scandinavian countries. This study evaluates the acceptance of myoelectric prostheses in 41 children with unilateral upper limb deficiency between the ages of two and five years. The prosthesis was used for an average time of 5.8 hours per day. The level of amputation was found to influence the acceptance rate. Furthermore, prosthetic use training by an occupational therapist is related to successful use of the prosthesis. The general drop-out rate in preschool children is very low compared to adults. Therefore, infants can profit from myoelectric hand prostheses. Since a correct indication and an intense training program significantly influence the acceptance rate, introduction of myoelectric prostheses to preschool children should take place at specialised centres with an interdisciplinary team.", "author" : [ { "dropping-particle" : "", "family" : "Egermann", "given" : "Marcus", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kasten", "given" : "Philip", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thomsen", "given" : "Marc", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Orthopaedics", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "1101-1105", "title" : "Myoelectric hand prostheses in very young children", "type" : "article-journal", "volume" : "33" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[3]", "plainTextFormattedCitation" : "[3]", "previouslyFormattedCitation" : "[3]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[3].In cases where young children with upper limb amputation (ULA) utilize a prosthetic device, the child will often develop their own methods of grasping objects ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/0309364617718411", "ISBN" : "1746-1553", "ISSN" : "17461553", "PMID" : "28718362", "abstract" : "BACKGROUND: The dysfunction of individuals with upper limb deficiencies affects their daily lives and social participation. OBJECTIVES: To clarify the adaptive behaviours and motor skills of children with upper limb deficiencies. STUDY DESIGN: Cross-sectional survey. METHODS: The subjects were 10 children ranging from 1 to 6 years of age with unilateral upper limb deficiencies at the level distal to the elbow who were using only cosmetic or passive prostheses or none at all. To measure their adaptive behaviour and motor skills, the Vineland Adaptive Behavior Scales, Second Edition was used. They were evaluated on the domains of communication, daily living skills, socialization and motor skills. We also examined the relationship of the scores with age. RESULTS: There were no statistically significant scores for domains or subdomains. The domain standard score of motor skills was significantly lower than the median scores of the domains and was negatively correlated with age. CONCLUSION: Children with upper limb deficiencies have individual weaknesses in motor skill behaviours, and these weaknesses increase with age. It may be helpful in considering approaches to rehabilitation and the prescription of prostheses to consider the characteristics and course of children's motor skill behaviours. Clinical relevance Even if children with unilateral upper limb deficiencies seem to compensate well for their affected limb function, they have or will experience individual weaknesses in motor skills. We should take this into consideration to develop better strategies for rehabilitation and prostheses prescriptions.", "author" : [ { "dropping-particle" : "", "family" : "Mano", "given" : "Hiroshi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fujiwara", "given" : "Sayaka", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Haga", "given" : "Nobuhiko", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Prosthetics and Orthotics International", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2018" ] ] }, "page" : "236-240", "title" : "Adaptive behaviour and motor skills in children with upper limb deficiency", "type" : "article-journal", "volume" : "42" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[4]", "plainTextFormattedCitation" : "[4]", "previouslyFormattedCitation" : "[4]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[4]. This causes later difficulty adapting to methods using a prosthetic device as the child’s motor neural skills and proprioception will have only developed up to the base of the stump. This adaptive grasping can also cause physiological issues in the long term, such as asymmetric posture and muscular-skeletal pain ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/s40779-016-0102-5", "ISSN" : "20549369", "PMID" : "27891243", "abstract" : "BACKGROUND Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation. METHODS The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees (206 amputations) from the Iran-Iraq war were evaluated, and a detailed questionnaire was also administered. RESULTS The most common level of amputation was the finger or wrist level (108, 52.4\u00a0%). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis (65, 31.6\u00a0%), rotator cuff injury (24, 11.7\u00a0%), bicipital tendonitis (69, 33.5\u00a0%), shoulder drop (42, 20.4\u00a0%) and muscle atrophy (19, 9.2\u00a0%). Peripheral nerve disorders included carpal tunnel syndrome in 13 (6.3\u00a0%) and unilateral brachial plexus injury in 1 (1\u00a0%). Fifty-three (51.5\u00a0%) were diagnosed with facet joint syndrome at the level of the cervical spine (the most frequent site). Using a prosthesis was reported by 65 (63.1\u00a0%), both left and right sides. The back was the most common site of pain (71.8\u00a0%). CONCLUSION The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.", "author" : [ { "dropping-particle" : "", "family" : "Allami", "given" : "Mostafa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mousavi", "given" : "Batool", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Masoumi", "given" : "Mehdi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Modirian", "given" : "Ehsan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shojaei", "given" : "Hadi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mirsalimi", "given" : "Fatemeh", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hosseini", "given" : "Maryam", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pirouzi", "given" : "Pirouz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Military Medical Research", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "1-8", "publisher" : "Military Medical Research", "title" : "A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees", "type" : "article-journal", "volume" : "3" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[5]", "plainTextFormattedCitation" : "[5]", "previouslyFormattedCitation" : "[5]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[5] due to an overreliance on the residual limb and off balance center of mass ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "9789036795456", "author" : [ { "dropping-particle" : "", "family" : "Postema", "given" : "Sietke", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "title" : "Upper limb absence: Effects on body functions and structures, musculoskeletal complaints, and functional capacity", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[6]", "plainTextFormattedCitation" : "[6]", "previouslyFormattedCitation" : "[6]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[6]. Despite the benefits of prosthetic use, rejection remains a major issue. Early fitting has been shown to reduce this risk ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/03093640600731710", "ISBN" : "0309-3646 (Print)\\n0309-3646 (Linking)", "ISSN" : "03093646", "PMID" : "16990227", "abstract" : "BACKGROUND: The prosthetic rejection rates in children with an upper limb transversal reduction deficiency are considerable. It is unclear whether the timing of the first prescription of the prosthesis contributes to the rejection rates. OBJECTIVE: To reveal whether scientific evidence is available in literature to confirm the hypothesis that the first prosthesis of children with an upper limb deficiency should be prescribed before two years of age. We expect lower rejection rates and better functional outcomes in children fitted at young age. METHODS: A computerized search was performed in several databases (Medline, Embase, Cinahl, Amed, Psycinfo, PiCarta and the Cochrane database). A combination of the following keywords and their synonyms was used: \"prostheses, upper limb, upper extremity, arm and congenital\". Furthermore, references of conference reports, references of most relevant studies, citations of most relevant studies and related articles were checked for relevancy. RESULTS: The search yielded 285 publications, of which four studies met the selection criteria. The methodological quality of the studies was low. All studies showed a trend of lower rejection rates in children who were provided with their first prosthesis at less than two years of age. The pooled odds ratio of two studies showed a higher rejection rate in children who were fitted over two years of age (pooled OR = 3.6, 95% CI 1.6 - 8.0). No scientific evidence was found concerning the relation between the age at which a prosthesis was prescribed for the first time and functional outcomes. CONCLUSION: In literature only little evidence was found for a relationship between the fitting of a first prosthesis in children with a congenital upper limb deficiency and rejection rates or functional outcomes. As such, clinical practice of the introduction of a prosthesis is guided by clinical experience rather than by evidence-based medicine.", "author" : [ { "dropping-particle" : "", "family" : "Meurs", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Maathuis", "given" : "C. G.B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lucas", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hadders-Algra", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sluis", "given" : "C. K.", "non-dropping-particle" : "van der", "parse-names" : false, "suffix" : "" } ], "container-title" : "Prosthetics and Orthotics International", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "165-173", "title" : "Prescription of the first prosthesis and later use in children with congenital unilateral upper limb deficiency: A systematic review", "type" : "article-journal", "volume" : "30" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[7]", "plainTextFormattedCitation" : "[7]", "previouslyFormattedCitation" : "[7]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[7], with one study showing a rejection rate for fitting before and after the age of 2 years of 22% and 58% respectively ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1302/0301-620X.65B3.6841409", "ISBN" : "0301-620X", "ISSN" : "0301-620X", "PMID" : "6841409", "abstract" : "A long-term review of 131 children fitted with upper limb prostheses at the Ontario Crippled Children's Centre between 1965 and 1975 is reported. There were 116 children with congenital deficiencies and 15 who had had amputations. Follow-up ranged from 7 to 17 years. A total of 42 children had abandoned their prostheses, 37 of whom had congenital deformities and five were amputees. The level of deficiency was of fundamental importance in determining whether the prosthesis would be accepted; in the forearm, the longer the stump, the more likely it was that the child would discard the prosthesis. Overall, 50 per cent of children fitted over the age of two years abandoned their prostheses compared with only 22 per cent of patients who had been fitted before the age of two years. The highest drop-out rate was at the age of 13 years when the children became more conscious of their cosmetic appearance. Suggestions for reducing the high drop-out rate in the early teens are put forward.", "author" : [ { "dropping-particle" : "", "family" : "Scotland", "given" : "TR", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Galway", "given" : "HR", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Journal of Bone and Joint Surgery. British volume", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "1983" ] ] }, "page" : "346-349", "title" : "A long-term review of children with congenital and acquired upper limb deficiency", "type" : "article-journal", "volume" : "65-B" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[8]", "plainTextFormattedCitation" : "[8]", "previouslyFormattedCitation" : "[8]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[8]. If the usefulness of the device is demonstrated to the child, the rejection rate is greatly reduced ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1191/026921599668801945", "ISBN" : "0269-2155", "ISSN" : "02692155", "PMID" : "10392651", "abstract" : "Objective: To determine the rate of rejection for prosthetic use in children and to investigate reasons for this rejection. Design: Cross-sectional study of a cohort of children. Setting: Rehabilitation centre, St Maartenskliniek, Nijmegen, the Netherlands. Subjects: Thirty-two children (0\u201318 years) with a unilateral congenital arm defect who visited the clinic between September 1991 and December 1996. Methods: Parents of all children and 19 children (\u22656 years) completed a questionnaire. Results: Eleven children (34%) rejected the prosthesis. A survival function shows that the rejection can be characterized by three periods: 0\u201340 months, 40\u2013162 months and after 162 months. In the first and last period a high rate of rejection is seen, while in the second period a low rate exists. Fitting for the first time after 2 years of age seems to be related with higher rejection rate. Lack of functional gain with the prosthesis, as perceived by the subjects and the parents, is significantly associated with increased rejection rate. Increased rejection rate is associated with the parents\u2019 disappointment, insufficient involvement of the parents in treatment, and dissatisfaction pertaining to emotional and social guidance. Conclusions: Rejection seems to occur in two main periods: within 3.5 years after being provided with a prosthesis and after 13.5 years of prosthetic use, when most children experience puberty. Fitting before the age of 2 years seems to reduce rejection rate. Preventing the parents\u2019 disappointment about prosthetic benefits as well as providing them with sufficient involvement in treatment and adequate guidance are essential for optimal results of prosthetic rehabilitation.", "author" : [ { "dropping-particle" : "", "family" : "Postema", "given" : "K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Donk", "given" : "V.", "non-dropping-particle" : "Van Der", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limbeek", "given" : "J.", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rijken", "given" : "R. A J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Poelma", "given" : "M. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Rehabilitation", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "1999" ] ] }, "page" : "243-249", "title" : "Prosthesis rejection in children with a unilateral congenital arm defect", "type" : "article-journal", "volume" : "13" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[9]", "plainTextFormattedCitation" : "[9]", "previouslyFormattedCitation" : "[9]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[9]; a functional myoelectric device should therefore aid in reducing rejection rates. The cost of an active prosthetic in high-income nations, such as the USA, is upwards of $20,000 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "prosthetics in developing nations, 5 feet", "author" : [ { "dropping-particle" : "", "family" : "McGimpsey", "given" : "Grant", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bradford", "given" : "Tc", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Bioengineering Institute Center for Neuroprosthetics", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "page" : "1-35", "title" : "Limb Prosthetics Services and Devices: Critical Unmet Need: Market Analysis", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[10]", "plainTextFormattedCitation" : "[10]", "previouslyFormattedCitation" : "[10]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[10], with even simple cosmetic options costing around $3,000-$5,000. In low-income nations an expense on this scale for a custom fit prosthetic device is totally unfeasible, especially with many families already facing hardship as a result of the amputation ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Nicolas E. Walsh", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wendy S. Walsh", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issue" : "03", "issued" : { "date-parts" : [ [ "2003" ] ] }, "page" : "665-670", "title" : "Developing, war-torn countries-with damaged infrastruc-tures at government and community levels-lack systems for rehabilitation", "type" : "article-journal", "volume" : "81" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[11]", "plainTextFormattedCitation" : "[11]", "previouslyFormattedCitation" : "[11]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[11]. The use of additive manufacturing introduces the prospect of rapidly producing low-cost custom prosthetic devices, such as the Rehand ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1109/EMBC.2015.7318894", "ISBN" : "9781424492718", "ISSN" : "1557170X", "abstract" : "Myoelectric prosthetic hands provide an appearance with five fingers and a grasping function to forearm amputees. However, they have problems in weight, appearance, and cost. This paper reports on the Rehand, a realistic electric prosthetic hand created with a 3D printer. It provides a realistic appearance that is same as the cosmetic prosthetic hand and a grasping function. A simple link mechanism with one linear actuator for grasping and 3D printed parts achieve low cost, light weight, and ease of maintenance. An operating system based on a distance sensor provides a natural operability equivalent to the myoelectric control system. A supporter socket allows them to wear the prosthetic hand easily. An evaluation using the Southampton Hand Assessment Procedure (SHAP) demonstrated that an amputee was able to operate various objects and do everyday activities with the Rehand.", "author" : [ { "dropping-particle" : "", "family" : "Yoshikawa", "given" : "Masahiro", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sato", "given" : "Ryo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Higashihara", "given" : "Takanori", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ogasawara", "given" : "Tsukasa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kawashima", "given" : "Noritaka", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "2470-2473", "publisher" : "IEEE", "title" : "Rehand: Realistic electric prosthetic hand created with a 3D printer", "type" : "article-journal", "volume" : "2015-Novem" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[12]", "plainTextFormattedCitation" : "[12]", "previouslyFormattedCitation" : "[12]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[12] with a production cost below $1250; this cost may be reduced further should 3D-printing be used in conjunction with injection molding for standardized parts ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1109/GHTC.2015.7343955", "ISBN" : "9781467365611", "abstract" : "3D printing is a manufacturing method that holds much promise for customized prosthetic devices, particularly in developing countries. There are many open-source prosthetic hands designed specifically for the additive manufacturing process. However, the excessive time (i.e., 32-53 hours) required for printing and assembly hinders scale up. This article analyzes 3D printing and injection molding strategies to determine the optimal manufacturing method that balances manufacturing time and cost. While injection molding is less suited to individualization of prosthetic hands due to high upfront costs and long development times associated with the creation of each new mold, production time and cost significantly decrease thereafter. After analyzing manufacturing costs and times as well as anthropometric data, a hybridized process was selected in which the palm would be 3D printed and other parts injection molded. For the injection molded components, a set of three standard sizes was selected to fit the majority of the population by analyzing anthropometric data from both the U.S. military and general populations.", "author" : [ { "dropping-particle" : "", "family" : "King", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Phillips", "given" : "Brienna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shively", "given" : "Marc", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Raman", "given" : "Venkatesh", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fleishman", "given" : "Aaron", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ritter", "given" : "Sarah", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mehta", "given" : "Khanjan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Proceedings of the 5th IEEE Global Humanitarian Technology Conference, GHTC 2015", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "59-65", "title" : "Optimization of prosthetic hand manufacturing", "type" : "article-journal", "volume" : "6" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[13]", "plainTextFormattedCitation" : "[13]", "previouslyFormattedCitation" : "[13]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[13]. The technology has already been proven as means of producing myoelectric prosthetics ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/17483107.2016.1253117", "ISSN" : "17483115", "abstract" : "GOAL: This paper aims to provide an overview with quantitative information of existing 3D-printed upper limb prostheses. We will identify the benefits and drawbacks of 3D-printed devices to enable improvement of current devices based on the demands of prostheses users. METHODS: A review was performed using Scopus, Web of Science and websites related to 3D-printing. Quantitative information on the mechanical and kinematic specifications and 3D-printing technology used was extracted from the papers and websites. RESULTS: The overview (58 devices) provides the general specifications, the mechanical and kinematic specifications of the devices and information regarding the 3D-printing technology used for hands. The overview shows prostheses for all different upper limb amputation levels with different types of control and a maximum material cost of $500. CONCLUSION: A large range of various prostheses have been 3D-printed, of which the majority are used by children. Evidence with respect to the user acceptance, functionality and durability of the 3D-printed hands is lacking. Contrary to what is often claimed, 3D-printing is not necessarily cheap, e.g., injection moulding can be cheaper. Conversely, 3D-printing provides a promising possibility for individualization, e.g., personalized socket, colour, shape and size, without the need for adjusting the production machine. Implications for rehabilitation Upper limb deficiency is a condition in which a part of the upper limb is missing as a result of a congenital limb deficiency of as a result of an amputation. A prosthetic hand can restore some of the functions of a missing limb and help the user in performing activities of daily living. Using 3D-printing technology is one of the solutions to manufacture hand prostheses. This overview provides information about the general, mechanical and kinematic specifications of all the devices and it provides the information about the 3D-printing technology used to print the hands.", "author" : [ { "dropping-particle" : "", "family" : "Kate", "given" : "Jelle", "non-dropping-particle" : "ten", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smit", "given" : "Gerwin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Breedveld", "given" : "Paul", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Disability and Rehabilitation: Assistive Technology", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2017" ] ] }, "page" : "300-314", "title" : "3D-printed upper limb prostheses: a review", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[14]", "plainTextFormattedCitation" : "[14]", "previouslyFormattedCitation" : "[14]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[14], though thus far the pediatric devices have predominantly been open-source body-powered devices, with very limited functionality. This work presents a myoelectric device for toddlers that can be produced at a low cost, whilst maintaining high grasp performance levels. To achieve this, cable-driven soft-grippers have been integrated into the design, with the intention of improving the grasp contact surface. The soft grippers also aim to provide a more even distribution of the grasp force, mimicking the grip force distribution of a human hand ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/09638280410001704278", "ISSN" : "09638288", "abstract" : "PURPOSE: The aim of this study is to analyse the grip force distribution for different prosthetic hand designs and the human hand fulfilling a functional task. METHOD: A cylindrical object is held with a power grasp and the contact forces are measured at 20 defined positions. The distributions of contact forces in standard electric prostheses, in a experimental prosthesis with an adaptive grasp, and in human hands as a reference are analysed and compared. Additionally, the joint torques are calculated and compared. RESULTS: Contact forces of up to 24.7 N are applied by the middle and distal phalanges of the index finger, middle finger, and thumb of standard prosthetic hands, whereas forces of up to 3.8 N are measured for human hands. The maximum contact forces measured in a prosthetic hand with an adaptive grasp are 4.7 N. The joint torques of human hands and the adaptive prosthesis are comparable. CONCLUSIONS: The analysis of grip force distribution is proposed as an additional parameter to rate the performance of different prosthetic hand designs.", "author" : [ { "dropping-particle" : "", "family" : "Kargov", "given" : "Artem", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pylatiuk", "given" : "Christian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "Jan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schulz", "given" : "Stefan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "D\u00f6derlein", "given" : "Leonhard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Disability and Rehabilitation", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "705-711", "title" : "A comparison of the grip force distribution in natural hands and in prosthetic hands", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[15]", "plainTextFormattedCitation" : "[15]", "previouslyFormattedCitation" : "[15]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[15]. The device has been named SIMPA: Soft-grasp Infant Myoelectric Prosthetic Arm.Prosthetic Design and RealizationThe prosthetic device considered in this work was designed using Autodesk Inventor 2019 (Autodesk, Inc.), with the intention of using fused deposition modelling (FDM) 3D-printing for the main structure, only sourcing additional components where necessary. The Ultimaker S5 (Ultimaker B.V.) was used to produce the parts due to its large print area and dual material extrusion. The dimensions of the arm are based on data, sourced from a volunteer, which represents the size of a 4-year-old male forearm. A 3D-scan of the stump used for modelling was also sourced from this individual. Socket modelling utilized the ‘Mesh’ feature along with a 3D-scan of the stump, to create an accurate socket that can then be 3D-printed (Figure 1). This avoids the need for traditional stump plaster-casting, a process that is both time consuming and often uncomfortable to the individual. Fig. SEQ Figure \* ARABIC 1.3D- Mesh (left), Constructed Socket CAD Model (right) The end device of prosthetic utilizes wire-driven soft grippers, loosely based on the appearance of human fingers. The grippers are a composite, manufactured out of two different silicon rubbers. The malleable material Dragon Skin? 30 (Smooth-On, Inc.) acts as the grip surface, whilst the more rigid Smooth-Sil? 960 (Smooth-On, Inc.) provides the elastic tension required to return the hand to its open position once tension is released from the cables. The grippers were formed using a 3D-printed mold. This mold was printed in slightly flexible TPU-95, to ensure easy removal of the component. In the final device, three grippers are used: a two-segment ‘thumb’ and, two three-segment ‘fingers’ (Figure 2) offset 90° from the ‘thumb’. A variant with a three-segment ‘thumb’ was also produced. The decision to use three fingers, rather than five, was predominantly due the difficultly in manufacturing grippers small enough for five to fit within the 50mm width of the hand. The use of three grippers in robotics has been shown to achieve a stable grasp rate of 90% ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-94-007-4522-3_9", "author" : [ { "dropping-particle" : "", "family" : "Lenar\u010di\u010d", "given" : "Jadran", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bajd", "given" : "Tadej", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stani\u0161i\u0107", "given" : "Michael M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Robot Mechanisms", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "291-311", "title" : "Robot Grasp", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[16]", "plainTextFormattedCitation" : "[16]", "previouslyFormattedCitation" : "[16]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[16] and this was deemed sufficient, given the size restrictions in place. Fig. SEQ Figure \* ARABIC 2. 3-Segment Soft GripperThe kinematics of the grippers is defined in Equations (1) and (2), using the variables displayed in REF _Ref25491331 \h \* MERGEFORMAT Fig. 2.x=l0x+l1cos(θ1)+l2cosθ2(1)y=l0y+l1sin(θ1)+l2sinθ2(2)These equations are based on the three-segment gripper, for the two-segment variant l2 and θ2 would be defined as 0. As the grippers are by design flexible, there is a lateral deformation of up to approximately ±15° that is not defined in these kinematic equations. This deformation occurs only went contact with an object has occurred, as it relative to surface’s geometry. Figure 3 shows the hand in a semi-closed and closed position to highlight the soft-grippers’ range of motion. Fig. 3. From Left to Right: 2-Segment Thumb Semi-Closed, 2-Segment Thumb Closed, 3-Segment Thumb Semi-Closed, and 3-Segment Thumb ClosedThe main body of the arm was printed in Acrylonitrile Butadiene Styrene (ABS), a strong and durable polymer, commonly used in functional additively manufactured products. The arm houses two Actuonix PQ12-P Micro Linear Actuators (Actuonix Motion Devices, Inc.), which provide a maximum driving force of 30N each. One solely actuates the ‘thumb’, whilst the second drives the two ‘fingers’. The actuators contain a built-in potentiometer for determining the extension of the shaft. The system controller is an Arduino Nano which, along with a motor driver, controls the two actuators. The system is powered by a 7.5V Lithium-Ion battery placed close to the socket. The system draws 2.5W and 0.5W during actuation and rest respectively. This allows for between 6.6 and 33 hours of use with the rated 16.5Wh battery, depending on the number of actuations. The user operates the system via surface-electromyography (sEMG). Typically, sensor pads would be attached to the skin via an adhesive. The present design, however, utilizes the OYMotion Gravity: Analog EMG Sensor (OYMotion Technologies, Inc.). This armband-based device allows the user to quickly attach and detach the device, whilst providing accurate sEMG recordings. The prototype device comprises three 3D-printed components assembled using M3 bolts (Figure 4). All of the electrical components are housed inside the body the arm, excluding the sEMG armband. The total weight of the device, including the armband, is around 395g. For comparison, the approximate weight of a biological forearm is around 314g for a 4 –year-old male ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/02701367.1983.10605290", "ISSN" : "0270-1367", "author" : [ { "dropping-particle" : "", "family" : "Plagenhoef", "given" : "Stanley", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Evans", "given" : "F Gaynor", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abdelnour", "given" : "Thomas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Research Quarterly for Exercise and Sport", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1983", "6", "1" ] ] }, "note" : "doi: 10.1080/02701367.1983.10605290", "page" : "169-178", "publisher" : "Routledge", "title" : "Anatomical Data for Analyzing Human Motion", "type" : "article-journal", "volume" : "54" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.4274/jcrpe.2183", "ISSN" : "13085735", "PMID" : "26777039", "abstract" : "OBJECTIVE This study aimed to integrate the existing updated reference standards for the growth of Turkish infants and children and to compare these values with World Health Organization (WHO) reference data, data from some European countries, and also with previous local data. Weight, height, and head circumference measurements were obtained on 2,391 boys and 2,102 girls who were regular attenders of a well child clinic and on 1,100 boys and 1,020 girls attending schools in relatively well-off districts in \u0130stanbul. Mean number of measurements per child was 8.2\u00b13.6 in the age group 0-5 years and 5.5\u00b13.3 in the age group 6-18 years. All children were from well-to-do families and all were healthy. All measurements with the exception of measurements at birth, which were based on reported values, were done by trained personnel. METHODS The LMS method was used in the analyses and in the construction of the percentile charts. There is an increase in weight for age and body mass index values for age starting in prepubertal ages, indicating an increasing trend for obesity. RESULTS Compared to WHO reference data, weight and height values in Turkish children were slightly higher in infants and in children younger than 5 years, while they showed similarity to those reported for children from Norway and Belgium. Head circumference values, which were slightly higher than the WHO references in the first 5 years, were comparable to the data on Belgian and Norwegian children in the first 9 years of life. At older ages, Turkish children showed higher values for head circumference. CONCLUSION The relatively larger head circumference values were interpreted to reflect a genetic characteristic.", "author" : [ { "dropping-particle" : "", "family" : "Neyzi", "given" : "Olcay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bundak", "given" : "R\u00fcveyde", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "G\u00f6k\u00e7ay", "given" : "G\u00fclbin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "G\u00fcn\u00f6z", "given" : "H\u00fclya", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Furman", "given" : "Andrzej", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Darendeliler", "given" : "Feyza", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ba\u015f", "given" : "Firdevs", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JCRPE Journal of Clinical Research in Pediatric Endocrinology", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "280-293", "title" : "Reference values for weight, height, head circumference, and body mass index in Turkish children", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[17], [18]", "plainTextFormattedCitation" : "[17], [18]", "previouslyFormattedCitation" : "[17], [18]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[17], [18]. Fig. SEQ Figure \* ARABIC 4.Functional SIMPA PrototypeA certain level of modularity is present in the device (Figure 5). All of the electrical components and grippers could be transferred to a new printed arm once the child has outgrown the current one. The soft-grippers too can easily be replaced, should they become damaged or excessively worn. Fig. 5. Exploded CAD ModelControl System DesignThe control system utilizes an Arduino Nano based circuit (Figure 6). The system is controlled by the user via the armband-based sEMG unit. The actuators provide position feedback using built-in potentiometers. A motor driver and voltage regulator are also incorporated into the system. Fig. 6.Circuit LayoutA voluntary opening single site sEMG control system was utilized. This style of system is given the term ‘cookie-crusher’ in ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-3-642-18812-1", "ISBN" : "3540404066", "abstract" : "Powered Upper Limb Prostheses deals with the concept, implementation and clinical application of utilizing inherent electrical signals within normally innervated residual muscles under voluntary control of an upper limb amputee. This amplifies these signals by battery-powered electrical means to make a terminal device, the prosthetic hand, move to perform intended function. The reader is introduced to various facets of upper limb amputations and their clinical management in both children and adults. The authors from Canada, USA and Great Britain are well known practicioners, academics and researchers in the field. The book has over 130 illustrations and contains an extensive bibliography.", "author" : [ { "dropping-particle" : "", "family" : "Muzumdar", "given" : "Ashok", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2004" ] ] }, "number-of-pages" : "212", "publisher-place" : "Berlin", "title" : "Powered Upper Limb Prostheses: Control, Implementation and Clinical Application", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[19]", "plainTextFormattedCitation" : "[19]", "previouslyFormattedCitation" : "[19]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[19] and is the most simplistic form of myoelectric prosthetic control: it is intended to be simple as it would likely be a child’s first device, acting as a building block for more advanced, multi-site, multi-action systems. This single-site approach was also used in ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00264-008-0615-y", "ISBN" : "1432-5195 (Electronic)\\r0341-2695 (Linking)", "ISSN" : "03412695", "PMID" : "18636257", "abstract" : "Myoelectric prostheses have generally been provided for adolescent or adult patients. The availability of smaller-sized electric hands has enabled the introduction of myoelectric prostheses to preschool children, mainly in the Scandinavian countries. This study evaluates the acceptance of myoelectric prostheses in 41 children with unilateral upper limb deficiency between the ages of two and five years. The prosthesis was used for an average time of 5.8 hours per day. The level of amputation was found to influence the acceptance rate. Furthermore, prosthetic use training by an occupational therapist is related to successful use of the prosthesis. The general drop-out rate in preschool children is very low compared to adults. Therefore, infants can profit from myoelectric hand prostheses. Since a correct indication and an intense training program significantly influence the acceptance rate, introduction of myoelectric prostheses to preschool children should take place at specialised centres with an interdisciplinary team.", "author" : [ { "dropping-particle" : "", "family" : "Egermann", "given" : "Marcus", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kasten", "given" : "Philip", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thomsen", "given" : "Marc", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Orthopaedics", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "1101-1105", "title" : "Myoelectric hand prostheses in very young children", "type" : "article-journal", "volume" : "33" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[3]", "plainTextFormattedCitation" : "[3]", "previouslyFormattedCitation" : "[3]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[3], one of the only studies demonstrating prosthetic use in young children. The prosthetic could, with relative ease, be reconfigured for this multi-site approach should this perform better with the end user. The system was designed using Simulink Support Package for Arduino Hardware (The MathWorks, Inc.). The system can be broken down into two constituent parts, the sEMG and the grasp detection. The OYMotion Gravity was used to record the sEMG signals. The armband was attached approximately at the center of the bicep. The sEMG location is due to this prototype design being based around a high-level transradial amputee, with an insufficiently sized residual limb for forearm-based recording. The author, a 23-year-old male of average build, was used during the development and initial testing of the system, in order to prove the concept. Future validation with an age-appropriate subject is planned. Raw data was collected of the muscle flexing and relaxing over a period of approximately 10s, as shown in Figure 7. The plots were all created in real time using scopes at significant locations on the Simulink model. The serial refresh rate was set to 0.01s, as this provides enough accuracy without being too computationally demanding. The raw recording averages around 300 on the Arduino’s analog input scale (10-bit ADC, 0-1023). The raw data was first normalized around 0 and set to an absolute scale, so that the activity is contained within the positive region. This normalized data still contains a large amount of noise. A moving average filter has been incorporated here to smoothen the data, resulting in the plot shown in Figure 8. Fig. 7.Raw sEMG RecordingFig. SEQ Figure \* ARABIC 8.Filtered sEMG RecordingThe final step in the processing of the sEMG recording was to incorporate an Interval Test Block. This determines if the average value over a given amount of time is within set boundaries, producing a binary output. This boundary condition would be adjusted per the individual’s recorded muscular activity. In instances where a child is first exposed to the system, a low sensitivity value might aid in initially presenting the function of the device, with the sensitivity later being reduced as the user familiarizes themselves with the system and its required muscle flexion/relaxation. The final binary output is shown in Figure 9, by comparing it to Figure 7 we can see that the periods of activity line up with the active phases in the raw sEMG recording. Fig. SEQ Figure \* ARABIC 9.Final Binary Output When the sEMG system outputs a HIGH signal, the ‘hand’ begins to open and this will continue until the set maximum limit of the actuator is met. For the ‘fingers,’ the actuator traverses between 0 mm extension for fully closed and 19 mm for fully open. The ‘thumb,’ meanwhile, has limits of 5 mm to 19 mm for closed and open respectively. This open-close hand transition takes approximately 2.3s, with closed to open averaging 2.1s.When the muscle is relaxed and the sEMG outputs a LOW signal, the hand will begin to close, ending once the limit is reached. If an obstruction is present during this process, such as one caused from grasping an object, the motor would ordinarily continue to be powered, draining the battery and reducing the life span of the actuator. For this reason, a method of obstruction detection has been employed.Fig. 10.Grasp Detection System: Threshold Switch (top), Rate of Shaft Extension (bottom)The built-in potentiometer detects the position of the shaft: if the difference from a previous reading is considered, then the speed and direction of the shaft extension can be determined. The system utilizes this so that when an obstruction, i.e. a grasp, occurs and the speed of the shaft is slowed below a set value, the system shuts off the power to the motors to hold them in their current position. Figure 10 shows the speed of the shaft (bottom) and the binary output for this subsystem (top). The system can be adjusted so that even a slight obstruction causes the motors to stall. In its current set-up, objects such as a soft toy will be detected as a grasp once the object has experienced a small amount of deformation. Experimental Procedure and ResultsFor the grasping experiments, the arm was connected to an Arduino Uno based circuit, running essentially the same script as shown in Section III. The only change is that the arm is controlled using buttons, rather than the sEMG, to simplify the experimental process. The tests also compared a variant of the hand that replaces the two segment ‘thumb’ with a three segment ‘finger,’ so that all the digits match.Object GraspsTwelve objects, shown in Figure 11, were selected to test the grasp effectiveness of the prosthetic. These objects range from items a toddler might interact with, such as toys, to geometric shapes designed to illustrate the range of grasps available on account of the soft grippers.Each object was grasped 10 times and the failure or success noted, as well as the orientation of the object. For a grasp to be classified as successful, the object must remain stable in the ‘hand’ for a period of 10s whilst the arm is steadily shaken. This test was performed with both the two and three-segment ‘thumb’ variants, in order to facilitate comparison. The results of the test (Table I) show that across all the objects the three-segment ‘thumb’ performed slightly better on average, particularly with large objects or those with complex geometry, such as the set of keys. TABLE IResults from Object Grasp TestsTest itemObject Mass (g)Grasp Success RateThree SegmentTwo SegmentPlastic water bottle (empty)20.6100%100%Plastic water bottle (250ml)270.6100%100%Pen11.5100%100%Wooden stick2.760%60%Sponge ball23.7100%100%Set of Keys94.280%50%Soft Toy21.3100%90%Hard Plastic Toy5690%80%Cube31100%100%Cone960%50%Pyramid13.260%60%Tri-Prism13.280%80%Cylinder20.4100%100%Average87%82%Fig. 11.Object grasp testing: Plastic Bottle (A), Pen (B), Wooden Stick (C), Sponge Ball (D), Set of Keys (E), Soft Toy (F), Hard Plastic Toy (G), Cube (H), Cone (I), Pyramid (J), Triangular Prism (K), Cylinder (L)Fig. 11.Object grasp testing: Plastic Bottle (A), Pen (B), Wooden Stick (C), Sponge Ball (D), Set of Keys (E), Soft Toy (F), Hard Plastic Toy (G), Cube (H), Cone (I), Pyramid (J), Triangular Prism (K), Cylinder (L)Grasping ForceTo determine the approximate grasping force of the hand, three methods have been employed. The first takes modified geometric objects from the previous subsection and attaches a series of weights to the grasped objects (Figure 12). The objects consist of 45mm and 22.5 mm diameter cylinders, a triangular prism, and a 10 mm wide rectangular segment that is held in a pinch grasp. The point where the grippers experience lateral deformation, the point of slippage due to movement, and the point of absolute slippage when the arm is stationary (Figure 13) are documented. The tests compare the use of the two segment and three-segment ‘thumb,’ with the two-segment showing an increased grasping capability in three of the four shapes tested. This is likely down to the superior contact pad distribution seen when using the two-segment thumb. Fig. 12.22.5mm Diameter Cylinder Weight Test (left), objects used in weight test (right)Fig. 13.Point of Absolute SlippageThe second test used a set of high accuracy scales to measure the approximate pinch force of the hand. The scales were rested on a raised platform, allowing the overhanging edge to be pinched by the grippers. This test was performed under three conditions: the motor powered, the motor unpowered, and the system with the grasp detection active. Each test was conducted 10 times, with the average force then being calculated (Table II.). The difference between the two-segment and three-segment ‘thumb’ was negligible. With the motor running, the highest pinch force of 8.5N is noted. This is 35% (5.5N) higher than when the motor is unpowered, and 54.8% (3.9N) higher than when the grasp detection is active. TABLE IIMean Average Pinch ForceGrasp TypeMass (g)Force (N)Motor Powered869.88.5Motor Unpowered565.15.5Grasp Detection Active 3933.9The final test method utilized the Takei Physical Fitness Test: Grip-A (Takei Scientific Instruments Co., Ltd). This test is designed to measure the grip force of biological hands. The size can be adjusted to accommodate child-size hands, allowing the prosthetic’s grip force to be measured. The readings from the analogue dial, show around 0.5kg (4.9N) when the maximum grip force is applied. With the grip detection system active, the reading is between 0.2kg (1.96N) and 0.3kg (2.94N). The test provides a guide to average grip strength by age: for a 4-year-old child the grip strength is given as 6.5kg (63.8N) and 4.4kg (43.2N), for males and females respectively. The main constraint on grasping force is the motor. Due to the tight size and weight restrictions in place, the grasping power will be limited. This continues to be an issue, even with larger adult devices.Discussion and ConclusionsThe work presented here demonstrates the viability of a prosthetic device at a scale suitable for toddlers. The design and manufacturing process utilized CAD and additive manufacturing as an alternative to the traditional method of producing prosthetic devices using techniques such as stump casting. The process of manufacturing prosthetic devices can be decentralized, utilizing a remote CAD designer in cases where the client is unable physically to visit a prosthetist, such as in low-income nations. The material cost of producing this device was around ?500, including scrappages and prototypes. This represents a significant reduction in cost compared to the current production myoelectric devices, though it is worth noting that the overheads have not been considered here. The final cost on the device would vary slightly depending on the specific configuration based around the end user and the production scalability of standard parts, such as the grippers. The outlined control system demonstrates that a simple system utilizing an armband sEMG device can produce consistent results. The linear actuator’s built in potentiometer allows for a rudimentary grasp detection system to be integrated into the design of the prosthetic. The use of Simulink permits easy editing of the detection parameters as well as real-time monitoring to assist in determining them. The system has only been tested on an able-bodied adult, and further investigation is required to determine the effectiveness of the system when used with a child presenting an upper limb reduction, due to the expectedly weaker sEMG signal. From the experimental data a mean average grasp effectiveness of 87% and 82%, for the three and two-segment ‘thumb’ respectively, has been demonstrated. The close performance of the variants leads to the decision to use the two-segment ‘thumb,’ as it is a more cosmetically pleasing design. The malleable nature of the grippers has been shown to be effective in these tests: this is twofold, primarily by providing a supple contact surface that mimics the feel of human skin, whilst secondarily allowing the grippers to deform laterally, providing a more encompassing grasp as presented in Figure 11.The weighted tests too show the effectiveness of the prosthetic, with masses under 400g proving to be stable in all but the pinch grasp, where slippage under movement occurs at 220g. This is due to the lateral deformation in the grips caused by the moment acting on the pinch point. This highlights a potentially limiting factor with the design of the grippers, should this style of gripper be utilized. The pinch grip tests give a maximum force between 8.5N and 3.9N, depending on the configuration: this - when compared to published literature on the pinch force of adult prosthetic hands - demonstrates that the presented device performs competitively, with pinch strength ranging between 1.71N and 16.11N ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1109/ICRA.2015.7140105", "ISBN" : "9781479969234", "ISSN" : "10504729", "abstract" : "\u00a9 2015 IEEE. This paper presents the Tact hand - an anthropomorphic, open-source, myoelectric prosthetic hand that was designed for use by people with transradial amputations in developing countries. This hand matches or exceeds the performance of other state-of-the-art myoelectric prosthetic hands, but costs two orders of magnitude less ($250) and is easy to manufacture with a 3D printer and off-the-shelf parts. We describe our design process, evaluate the Tact hand with both qualitative and quantitative measures of performance, and show examples of using this hand to grasp household objects.", "author" : [ { "dropping-particle" : "", "family" : "Slade", "given" : "Patrick", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Akhtar", "given" : "Aadeel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nguyen", "given" : "Mary", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bretl", "given" : "Timothy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Proceedings - IEEE International Conference on Robotics and Automation", "id" : "ITEM-1", "issue" : "June", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "6451-6456", "publisher" : "IEEE", "title" : "Tact: Design and performance of an open-source, affordable, myoelectric prosthetic hand", "type" : "article-journal", "volume" : "2015-June" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[20]", "plainTextFormattedCitation" : "[20]", "previouslyFormattedCitation" : "[20]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[20]. The Takei test gives a maximum force of 4.9N: comparing this to the manufacturer’s given data of 63.8N for a 4-year-old boy, represents a 92.3% reduction in grip force. The cause for this is primarily the actuators, which individually produce a maximum rated force of 30N. As the device is designed for toddlers, there are strict size limitations on all components, including the actuators. Even within larger adult devices, grip strength proves to be an issue. However, the use of an improved end device such as the presented soft grippers, aims to increase the grasp effectiveness by negating the need to rely on shear grip force to securely grasp objects.The aim of this project was to showcase the feasibility of a 3D-printed upper limb prosthetic device for toddlers that utilizes soft grippers. In this endeavor great promise has been shown, with the final device performing well in the devised tests. The reduction in lead time and financial cost demonstrated by the presented design opens up the possibility of such a device becoming available from healthcare providers in high-income nations. Correspondingly, in low-income nations, there is the opportunity for adoption due to the decentralized and low-cost nature of 3D-printing techniques. This initial design is used as a proof of concept. Due to restrictions on the project, the device has not been verified on the target audience of young children. The next stage would be to focus on end-user engagement, which would include qualitative data around functionality, acceptability, and cosmetic appearance. Subsequent design improvements would then be based on the results of such a study. ReferencesADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY [1]E. Vasluian, C. K. Van Der Sluis, A. J. Van Essen, J. E. H. Bergman, P. U. Dijkstra, H. A. Reinders-Messelink, and H. E. K. De Walle, “Birth prevalence for congenital limb defects in the northern Netherlands: A 30-year population-based study,” BMC Musculoskelet. Disord., vol. 14, 2013.[2]T. R. Dillingham, L. E. Pezzin, and E. J. MacKenzie, “Limb amputation and limb deficiency: Epidemiology and recent trends in the United States,” South. Med. J., vol. 95, no. 8, pp. 875–883, 2002.[3]M. Egermann, P. Kasten, and M. Thomsen, “Myoelectric hand prostheses in very young children,” Int. Orthop., vol. 33, no. 4, pp. 1101–1105, 2009.[4]H. Mano, S. Fujiwara, and N. Haga, “Adaptive behaviour and motor skills in children with upper limb deficiency,” Prosthet. Orthot. Int., vol. 42, no. 2, pp. 236–240, 2018.[5]M. Allami, B. Mousavi, M. Masoumi, E. Modirian, H. Shojaei, F. Mirsalimi, M. Hosseini, and P. Pirouzi, “A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees,” Mil. Med. Res., vol. 3, no. 1, pp. 1–8, 2016.[6]S. Postema, Upper limb absence: Effects on body functions and structures, musculoskeletal complaints, and functional capacity. 2017.[7]M. Meurs, C. G. B. Maathuis, C. Lucas, M. Hadders-Algra, and C. K. van der Sluis, “Prescription of the first prosthesis and later use in children with congenital unilateral upper limb deficiency: A systematic review,” Prosthet. Orthot. Int., vol. 30, no. 2, pp. 165–173, 2006.[8]T. Scotland and H. Galway, “A long-term review of children with congenital and acquired upper limb deficiency,” J. Bone Joint Surg. Br., vol. 65–B, no. 3, pp. 346–349, 1983.[9]K. Postema, V. Van Der Donk, J. Van Limbeek, R. A. J. Rijken, and M. J. Poelma, “Prosthesis rejection in children with a unilateral congenital arm defect,” Clin. Rehabil., vol. 13, no. 3, pp. 243–249, 1999.[10]G. McGimpsey and T. Bradford, “Limb Prosthetics Services and Devices: Critical Unmet Need: Market Analysis,” Bioeng. Inst. Cent. Neuroprosthetics, pp. 1–35, 2017.[11]Nicolas E. Walsh and Wendy S. Walsh, “Developing, war-torn countries-with damaged infrastruc-tures at government and community levels-lack systems for rehabilitation,” vol. 81, no. 3, pp. 665–670, 2003.[12]M. Yoshikawa, R. Sato, T. Higashihara, T. Ogasawara, and N. Kawashima, “Rehand: Realistic electric prosthetic hand created with a 3D printer,” Proc. Annu. Int. Conf. IEEE Eng. Med. Biol. Soc. EMBS, vol. 2015–Novem, pp. 2470–2473, 2015.[13]M. King, B. Phillips, M. Shively, V. Raman, A. Fleishman, S. Ritter, and K. Mehta, “Optimization of prosthetic hand manufacturing,” Proc. 5th IEEE Glob. Humanit. Technol. Conf. GHTC 2015, vol. 6, pp. 59–65, 2015.[14]J. ten Kate, G. Smit, and P. Breedveld, “3D-printed upper limb prostheses: a review,” Disabil. Rehabil. Assist. Technol., vol. 12, no. 3, pp. 300–314, 2017.[15]A. Kargov, C. Pylatiuk, J. Martin, S. Schulz, and L. D?derlein, “A comparison of the grip force distribution in natural hands and in prosthetic hands,” Disabil. Rehabil., vol. 26, no. 12, pp. 705–711, 2004.[16]J. Lenar?i?, T. Bajd, and M. M. Stani?i?, “Robot Grasp,” in Robot Mechanisms, 2013, pp. 291–311.[17]S. Plagenhoef, F. G. Evans, and T. Abdelnour, “Anatomical Data for Analyzing Human Motion,” Res. Q. Exerc. Sport, vol. 54, no. 2, pp. 169–178, Jun. 1983.[18]O. Neyzi, R. Bundak, G. G?k?ay, H. Gün?z, A. Furman, F. Darendeliler, and F. Ba?, “Reference values for weight, height, head circumference, and body mass index in Turkish children,” JCRPE J. Clin. Res. Pediatr. Endocrinol., vol. 7, no. 4, pp. 280–293, 2015.[19]A. Muzumdar, Powered Upper Limb Prostheses: Control, Implementation and Clinical Application. Berlin, 2004.[20]P. Slade, A. Akhtar, M. Nguyen, and T. Bretl, “Tact: Design and performance of an open-source, affordable, myoelectric prosthetic hand,” Proc. - IEEE Int. Conf. Robot. Autom., vol. 2015–June, no. June, pp. 6451–6456, 2015. ................
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