David Brockman, a retired CalFire captain and avid outdoorsman, built a deck in the backyard of his home last year, without the use of his dominant right hand, which he lost in an accident. The prosthetic hand he used instead was a crude but functional steel hook-and-harness device.
Brockman has tried other artificial limbs, including a high-tech prosthesis called a myoelectric. It looks like a hand and works by using electrical signals from muscles in the forearm. But that one just didn鈥檛 work for him.
鈥淚t鈥檚 uncomfortable, and it doesn鈥檛 function well,鈥 Brockman said. 鈥淚t looks nice. It鈥檒l open and close, and I don鈥檛 have to wear a harness. But to be what I am 鈥 very physical 鈥 and to be outside working in the yard, raking, doing things like that, it doesn鈥檛 work.鈥
![David Brockman, a retired firefighter and hand amputee, shows off his new myoelectric prosthetic device.](/sites/default/files/media/images/20221031-prosthetics-9756%20edited.jpg)
Rejecting his myoelectric wasn鈥檛 unusual. Despite the advancements in robotics and other high-tech prosthetics, a found that 44% of arm amputees abandon their devices.
鈥淓ven though there鈥檚 amazing dexterous devices that can move in all sorts of ways and look similar and operate similar to an intact limb, being able to tell all of that robotic system how to move and what you want it to do is really where a big barrier is currently in the field,鈥 said , assistant professor in the Department of Mechanical and Aerospace Engineering at 69成人.
Schofield is part of a at 69成人 working to make life easier for amputees through a combination of surgery, advanced machine learning and smart prosthetics. Their goal is 鈥,鈥 to get these devices to mimic a biological limb so amputees gain better muscle control and sensory feedback without increased complexity.
鈥淲e鈥檙e trying to fill that gap,鈥 Schofield said. 鈥淲e鈥檙e asking how can we allow someone to think about making a pinching motion or think about making a fist with their missing hand and just let the prosthetic limb do that for them.鈥
Brockman is taking part in an experiment to help the 69成人 group and other researchers advance prosthetics. He now has a new myoelectric prosthetic hand, one much closer to the real thing. It looks like a glove and its fingers can move independently.
Brockman said the new prosthetic hand will make a huge difference in his life.
鈥淔or me, I love the outdoors. This is a dream come true because I鈥檒l be able to grab my fishing pole and reel and grab things again instead of trying to hook it and it keeps slipping off,鈥 he said.
Advanced prosthetics difficult to operate
But myoelectric devices, which use muscle activity from the remaining limb to operate, still require a lot of effort to get them to work, said Laduan Smedley, a certified prosthetist orthotist at 69成人 Health.
鈥淚 describe it somewhat like Morse code,鈥 Smedley said. 鈥淎mputees have to memorize these kinds of patterns of flexion and extension or co-contraction to operate the hand.鈥
![A newer myoelectric prosthetic hand sits on a table. It has a long black sleeve with a bionic hand, which looks like a glove. The hand has five fingers that can move independently.](/sites/default/files/media/images/20221031-prosthetics-hand.jpg)
![69成人 Health certified prosthetist orthotist Laduan Smedley works on the fitting for the sleeve of David Brockman's prosthetic hand.](/sites/default/files/media/images/20221031-prosthetics-laduan.jpg)
Some of the more advanced myoelectric hands are more intuitive but require a smartphone app to select the desired type of grasp, such as pinching or gripping.
The 69成人 research group wants to incorporate what scientists know about how humans learn and control movement, said , a neuroscientist and professor in the Department of Neurobiology, Physiology and Behavior in the College of Biological Sciences.
鈥淚f you鈥檙e not utilizing what is a natural ability or natural infrastructure of our motor system to control an external device, it鈥檚 probably going to be incredibly difficult and nonintuitive to learn how to do,鈥 Joiner said.
![an illustration of hands holding over watercolor brush strokes and green background](/sites/default/files/styles/sf_small_width/public/media/images/health-outgrow-uc-davis.jpg?itok=acro2pk-)
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Amputations improved by targeted muscle reinnervation
Surgeons have led the way to make myoelectric devices easier to use. Not long ago, the standard amputation could still leave patients in a lot of pain. Surgeons cut bone, muscle and nerves to remove a limb. They buried those nerves under muscle or in bone to prevent their endings from growing toward the surface of the skin.
鈥淭he idea was that if you bury it far away from the skin then patients don鈥檛 get pain,鈥 said , an associate professor in the Department of Surgery at 69成人 Health. 鈥淲e found that despite doing that, people still get chronic pain and phantom pain.鈥
Phantom pain can feel like cramps or burning where the limb used to be. Many patients still develop neuromas, where nerves can grow to form a lump of painful disorganized nerve tissue. The pain from neuromas can also make wearing a prosthetic device impossible.
![Surgeon Andrew Li shakes the prosthetic hand of former patient David Brockman, a retired fire captain, who had targeted muscle re-innervation surgery on his amputated hand. (Greg Urquiaga/69成人)](/sites/default/files/media/images/20221031-prosthetics-lihandshake.jpg)
![Cliff Pereira and Andrew Li are both with the Department of Surgery at 69成人 Health. They have performed targeted muscle re-innervation surgery to help amputees control prosthetic limbs more intuitively. (Greg Urquiaga/69成人)](/sites/default/files/media/images/20221031-prosthetics-cliff.jpg)
Recently, 69成人 surgeons began using a procedure called . The surgery reroutes severed nerves so that signals from the brain that once controlled the missing limb are picked up by a nearby muscle.
Pereira said it鈥檚 like converting a dumb muscle into a smarter muscle. Amputees only need to think about making a fist or opening their fingers for the movement to occur.
鈥淚t was originally done to increase the number of muscle signals that a patient could generate after an amputation so there could be more degrees of control of a prosthetic device,鈥 said , an assistant professor in the Department of Surgery at 69成人 Health. 鈥淎n unintended benefit was that those patients also tended to have reduced phantom pain and neuroma pain as well.鈥
Artificial intelligence now used in prosthetic technology
Brockman had TMR surgery at 69成人 Health and is now using a smarter prosthetic device.
鈥淭hey actually call it a bionic hand,鈥 Brockman said. 鈥淚t鈥檚 a working, functional hand. It has five fingers. It鈥檚 got like 13 sensors built into the sleeve. And it works off a muscle reaction in my arm. So, when I twitch my thumb nerve, which is still there, the prosthetic senses that and the thumb will move.鈥
The prosthetic hand must first learn how to read these signals. This is where artificial intelligence, or AI, plays a role.
The 69成人 researchers are examining the muscle firing patterns of Brockman and others who have had TMR surgery.
![Neuroscientist Wilsaan Joiner points to an ultrasound machine. Scientists are using both ultrasound and electromyography, combined with AI, to make prosthetics easier to control. (Greg Urquiaga/69成人)](/sites/default/files/media/images/20221102-prosthetics-wilsaan.jpg)
![Engineer Jonathon Schofield, left, and neuroscientist Wilsaan Joiner, right, are both working to make prosthetic limbs more intuitive by incorporating what scientists know about how humans learn and control movement. (Greg Urquiaga/69成人)](/sites/default/files/media/images/20221102-prosthetics-jonathonwilsaan.jpg)
Inside a 69成人 lab, Schofield attached electrodes to Brockman鈥檚 forearm using an electromyography machine, which records the muscle鈥檚 electrical activity. He asked Brockman to make several different hand gestures, and the computer鈥檚 programming begins to recognize those patterns.
Electromyography can sometimes confuse electrical signals from other muscles, so the scientists are also using ultrasound machines that use sound waves to produce images. When Brockman contracts a muscle, it becomes denser and bounces back more sound.
The researchers are combining all this technology and data with AI in the hope that prosthetics will become more intuitive for the user.
鈥淲e鈥檙e leveraging artificial intelligence, machine learning algorithms that are looking at the muscles that remain in that person鈥檚 residual limb,鈥 Schofield said. 鈥淚t鈥檚 learning what that activity looks like when amputees wanted to pinch or make a fist or make a pointing motion.鈥
Can prosthetics 鈥榝eel?鈥
Surgeons are hoping to advance prosthesis embodiment by enabling users who lost their sensory nerves to gauge temperature and pressure. They may be able to do with sensory nerves what they did with motor nerves in the targeted muscle re-innervation surgery 鈥 connect the severed ones with those in the overlying skin. If the artificial hand is touched or gets hot, it sends that signal to the skin of the amputee.
Amputees also have difficulty sensing body position and movement with a prosthetic device. But researchers said one way to overcome that is to integrate prosthetic devices into the body, like a human machine. The concept, called osseointegration, is the next step in smart prosthetics.
![Peyton Young, a 69成人 Ph.D candidate in Jonathon Schofield鈥檚 lab, demonstrates how electromyography works using a robotic arm. The robotic arm recognizes the electrical signals from his forearm muscles and it moves accordingly. (Greg Urquiaga/69成人)](/sites/default/files/media/images/20221102-prosthetics-robotarm.jpg)
鈥淥蝉蝉别辞颈苍迟别驳谤补迟颈辞苍 is making the prosthetic device essentially heal into the bone and become a weight bearing proprioceptive structure,鈥 said Li, the 69成人 hand surgeon. 鈥淵ou can still take it off, but it鈥檚 much more a solid component of your body that could potentially make things a lot more intuitive, a lot more natural, like picking up heavy things, doing pull-ups potentially.鈥
The osseointegrated implant for above knee amputations is Food and Drug Administration approved and allows direct integration between bone and the surface of a prosthetic device. 69成人 is now actively recruiting patients for the surgery.
![David Brockman gives his wife, Tereasa Brockman, a kiss while at 69成人 after David had a fitting for his prosthetic hand. (Greg Urquiaga/69成人)](/sites/default/files/media/images/20221031-prosthetics-couple.jpg)
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