Neural prosthesis control restores near-normative neuromechanics in standing postural control

Current lower-limb prostheses do not provide active assistance in postural control tasks to maintain the user's balance, particularly in situations of perturbation. In this study, we aimed to address this missing function by enabling neural control of robotic lower-limb prostheses. Specifically, electromyographic (EMG) signals (amplified neural control signals) recorded from antagonistic residual ankle muscles were used to drive a robotic prosthetic ankle directly and continuously. Participants with transtibial amputation were recruited and trained in using the EMG-driven robotic ankle. We studied how using the EMG-controlled ankle affected the participants' anticipatory and compensatory postural control strategies and stability under expected perturbations compared with using their daily passive devices. We investigated the similarity of neuromuscular coordination (by analyzing motor modules) of the participants, using either device in a postural sway task, to that of able-bodied controls. Results showed that, compared with their passive prosthesis, the EMG-controlled prosthesis enabled participants to use near-normative postural control strategies, as evidenced by improved between-limb symmetry in intact-prosthetic center-of-pressure and joint angle excursions. Participants substantially improved postural stability, as evidenced by a reduction in steps or falls using the EMG-controlled prosthetic ankle. Furthermore, after relearning to use residual ankle muscles to drive the robotic ankle in postural control, nearly all participants' motor module structure shifted toward that observed in individuals without limb amputations. Here, we have demonstrated the potential benefit of direct EMG control of robotic lower limb prostheses to restore normative postural control strategies (both neural and biomechanical) toward enhancing standing postural stability in amputee users.