In today’s era, additive manufacturing (AM) is attracting unparalleled attention across the globe. From initial obscurity, today there is practically no sphere of life untouched by this technology. The quantum of research in this field has witnessed overwhelming growth which in turn leads to impressive newer developments at almost regular intervals. AM has emerged from rapid prototyping and is today utilised in fabricating large number of end products. These consistent advancements lead to emergence of newer research fields and challenges that demand attention. It is also interesting to observe the spectrum of AM applications that have grown over years. This article exhaustively reviews the various AM applications in different sectors such as aerospace, repair, automobile, healthcare, retail, etc. and is aimed to provide the readers a deep insight into the probable unexplored areas through an extensive literature analysis. Recent trends and future outlook of AM in various industrial sectors have been suitably discussed.

Additive manufacturing: recent trends, applications and future outlooks

Symptomatic neuromas and pain caused by nerve transection injuries can adversely impact a patient's recovery, while also contributing to increased dependence on opioid and other pharmacotherapy. These sources of pain are magnified following amputation surgeries, inhibiting optimal prosthetic wear and function. Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) represent modern advances in addressing amputated peripheral nerves. These techniques offer solutions by essentially providing neuromuscular targets for transected peripheral nerves "to grow into and reinnervate." Recent described benefits of these techniques include reports on pain reduction or ablation (eg, phantom limb pain, residual limb pain, and/or neuroma pain).1-6 We describe a technical adaptation combining TMR with a "pedicled vascularized RPNI (vRPNI)." The TMR with the vRPNI surgical technique described offers the advantage of having a distal target nerve and a target muscle possessing deinnervated motor end plates which may potentially enhance nerve regeneration and muscle reinnervation, while also decreasing amputated nerve-related pain.

Targeted Muscle Reinnervation Combined with a Vascularized Pedicled Regenerative Peripheral Nerve Interface.

Background Upper limb loss is a devastating condition with dramatic physical, psychological, financial, and social consequences. Improvements in the fields of prosthetics and vascularized composite allotransplantation have opened exciting new frontiers for treatment and rehabilitation following upper limb loss. Each modality offers a unique set of advantages and limitations with regard to the restoration of hand function following amputation. Methods Presented in this article is a discussion outlining the complex considerations and decisions encountered when determining patient appropriateness for either prosthetic rehabilitation or vascularized composite allotransplantation following upper limb loss. In this review, the authors examine how psychosocial factors, nature of injury, rehabilitation course, functional outcomes, and risks and benefits may affect overall patient selection for either rehabilitative approach. Results This review summarizes the current state of the literature. Advancements in both prosthetic and biological strategies demonstrate promise with regard to facilitating rehabilitation following upper limb loss. However, there remains a dearth of research directly comparing outcomes in prosthetic rehabilitation to that following upper extremity transplantation. Conclusions Few studies have performed a direct comparison between patients undergoing vascularized composite allotransplantation and those undergoing prosthetic rehabilitation. Upper extremity transplantation and prosthetic reconstruction should not be viewed as competing options, but rather as two treatment modalities with different risk-to-benefit profiles and indications.

Prosthetic Rehabilitation and Vascularized Composite Allotransplantation following Upper Limb Loss.

The evolution of technological and surgical techniques has made it possible to obtain an even more intuitive control of multiple joints using advanced prosthetic systems. Targeted Muscle Reinnervation (TMR) is considered to be an innovative and relevant surgical technique for improving the prosthetic control for people with different amputation levels of the limb. Indeed, TMR surgery makes it possible to obtain reinnervated areas that act as biological amplifiers of the motor control. On the technological side, a great deal of research has been conducted in order to evaluate various types of myoelectric prosthetic control strategies, whether direct control or pattern recognition-based control. In the literature, different control performance metrics, which have been evaluated on TMR subjects, have been introduced, but no accepted reference standard defines the better strategy for evaluating the prosthetic control. Indeed, the presence of several evaluation tests that are based on different metrics makes it difficult the definition of standard guidelines for comprehending the potentiality of the proposed control systems. Additionally, there is a lack of evidence about the comparison of different evaluation approaches or the presence of guidelines on the most suitable test to proceed for a TMR patients case study. Thus, this review aims at identifying these limitations by examining the several studies in the literature on TMR subjects, with different amputation levels, and proposing a standard method for evaluating the control performance metrics.

https://www.mdpi.com/1424-8220/21/6/1953/pdf

Control Strategies and Performance Assessment of Upper-Limb TMR Prostheses: A Review.

Several works present exoskeletons and devices acting in the hip, the knee and the ankle of patients with some kind of limitation on the lower limbs movement, aiding patients’ locomotion/rehabilitation. The challenges in exoskeletons development for paraplegics’ locomotion are related with obtaining a compact and low-mass design with long battery life.
 Furthermore, the robotic devices to lower limb rehabilitation are very expensive complex systems mainly due to the technology of servomotors, drivers and control system; thus, a simpler device tends to make patients feel more comfortable and safer, which is important to gain their acceptance. Hence, the aim of this paper is developing a new exoskeleton with one degree of freedom, low cost, to locomotion/rehabilitation of subjects with paralysis/motor disability in the lower limbs, powered by the user’s strength, reproducing on them the ability to walk with stability and security. This leads to decreasing the problems related to the lack of movement and the consequent improvement in the paraplegics’ life quality. The proposed device was developed using a combination of simple mechanisms to obtain the approximate human gait movement. In order to achieve the proposed objective, we present the mechanism synthesis, graphical simulations and experimental test of the simplified prototype built. The graphical simulations and the experimental results show that the proposed device performs properly on the hip and knee joints movement but with smaller amplitude.

Conceptual design of a rehabilitation device based on cam-follower and crank-rocker mechanisms hand actioned

Myoelectric control of multifunctional prostheses is challenging for individuals with high-level amputations due to insufficient surface electromyography (sEMG) signals. A surgical technique called targeted muscle reinnervation (TMR) has achieved impressive improvements in myoelectric control by providing more sEMG control signals. In this case, some channels of sEMG signals are coupled after TMR, which limits the performance of conventional amplitude-based control for upper-limb prostheses. In this paper, two different ways (training and algorithms) were attempted to solve the problem in a transhumeral amputee after TMR. Firstly, effect of rehabilitation training on generating independent sEMG signals was investigated. The results indicated that some sEMG signals recorded were still coupled over the targeted muscles after rehabilitation training for about two months. Secondly, pattern recognition (PR) algorithm was then applied to classify the sEMG signals. In the second way, to further improve the real-time performance of prosthetic control, a post-processing method named as mean absolute value-based (MAV-based) threshold switches was utilized. Using the improved algorithms, substantial improvement was shown in a subset of the modified Action Research Arm Test (ARAT). Compared with common PR control without post-processing method, the total scores increased more than 18% with majority vote and more than 58% with MAV-based threshold switches. The amputee was able to finish all the tasks within the allotted time with the standard MAV-based threshold switches. Subjectively the amputee preferred the PR control with MAV-based threshold switches and reported it to be more accurate and much smoother both in experiment and practical use. Although the sEMG signals were still coupled after rehabilitation training on the TMR patient, the online performance of the prosthetic operation was improved through application of PR control with combination of the MAV-based threshold switches. Retrospectively registered http://www.chictr.org.cn/showproj.aspx?proj=22058
 .

/pdf/two-ways-to-improve-myoelectric-control-for-a-transhumeral-22tcsvjjal.pdf

Two ways to improve myoelectric control for a transhumeral amputee after targeted muscle reinnervation: a case study

The invention provides an artificial limb system aiming at upper-limb high amputation patients. The artificial limb system comprises a receiving mechanism, an elbow joint, a wrist joint, a mechanical arm and a control system, wherein the receiving mechanism and the elbow joint are connected through a connecting flange; the elbow joint and the wrist joint are connected through a connecting rod, and a cavity is reserved between the elbow joint and the wrist joint; the elbow joint is used for driving the wrist joint and the mechanical arm to move in the space; the wrist joint is used for adjusting the posture of the mechanical arm in grabbing the object; the mechanical arm comprises 5 fingers, and the fingers can move independently; the control system is used for controlling the receiving mechanism, the elbow joint, the wrist joint and the mechanical arm. Compared with the prior art, the artificial limb system has the beneficial effects that the elbow joint is driven by a brushless motor and adopts a harmonic reducer, the structure is compact, and the noises are small. The wrist joint adopts a conducting ring, and thus a power supply and a communication channel are provided for the power supply of a tactile feedback sensor and a mechanical arm controller.

Artificial limb system aiming at upper-limb high amputation patients

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Two ways to improve myoelectric control for a transhumeral amputee after targeted muscle reinnervation: a case study

Artificial limb system aiming at upper-limb high amputation patients