Current achievements and future directions of hand prostheses controlled via peripheral nervous system

Abstract

The human hand is a powerful tool to feel and act on the environment and a very sophisticated means for physical and social interaction. This is why hand loss can be perceived as a devastating damage that changes people lifestyle. It causes a severe impairment for the amputees and can significantly alter their quality of life, since it affects personal and working fields by reducing the level of autonomy, the capability of performing activities of daily living (ADLs), and the capability to gesture and interact with other people. The upper-limb amputation involves almost 4000 people per year in Italy and about the 20% of amputations in USA. The relevance of the upper-limb loss in the international scenario motivates the flourishing research in the field of upper-limb prosthetics. This chapter intends to provide an overview on hand prostheses driven by non-invasive and invasive interfaces with the peripheral nervous system (PNS), taking into account technical aspects related to hand control, peripheral interfaces, and clinical features about the restoration of sensory feedback. The international scenario of off-the-shelf and on-the-shelf prosthetic hands is explored, and pros and cons of technologies are analyzed. This chapter is especially focused on the recent studies on the restoration of tactile perception in amputees through neural interfaces and first evidence on bidirectional hand control. Current achievements on this thorny topic are in-depth explained in this chapter and future directions are finally roughed out.