Design and impact of systems for artificial sensory feedback in lower-limb prostheses

The loss of motor function due to lower limb amputation may be compensated by a prosthetic leg. To improve their functionality, systems for artificial sensory feedback have been proposed, but have yet to reach widespread clinical use. This review aims to provide an overview of the design and impact of such systems.

Based on a systematic literature search in the Pubmed and Embase databases (21 September 2025), we analyzed 63 studies proposing a total of 81 feedback systems. When categorized according to the feedback variable, pre-processing techniques (discretization), stimulation modality, and encoding technique used in each study, a total of 32 unique configurations were obtained. These systems were evaluated with respect to their impact on gait, balance, physiological parameters, or psychological and cognitive functions. The analysis revealed that despite the heterogeneity in system design, most configurations (84%) produced positive outcomes.

We identify important limitations related to the ecological validity and practical usability of the proposed feedback systems. Moreover, the degree to which systematic comparison could be made across studies was limited, preventing the identification of an optimal configuration. Finally, we proposed recommendations for future studies to overcome these limitations.