Bionics Limb Prostheses: Advances in Clinical and Prosthetic Care

Because the use of a prosthesis is essential to maintain quality of life of individuals suffering from limb absence, providers of prosthetic care are constantly innovating to find better clinical solutions maximizing comfort, stability, and functions.

The growing population of individuals without limb commonly suffers from a range of incapacitating neuromusculoskeletal conditions such as phantom and residuum pain, acute and chronic skin issues, oedema, neuroma, muscle contractures, stress fractures, osteopenia and heterotopic bone growth, that altogether increase risks of sound lower joints osteoarthrosis and hyper-lordosis. Satisfactory fitting of a prosthesis is difficult to sustain and, too often, leads to temporary or even definitive prosthesis abandonment.

In the last decades, we witnessed promising developments of bionic limb solutions that could possibly alleviated some of these issues, separately or combined, through better prosthetic attachment (e.g., direct skeletal attachments) and control (e.g., targeted muscle re-innervation). These emerging bionic bone-anchored prostheses could dramatic alleviated socket-related issues and improve intuitive usage of artificial limbs. 

Reports of scientific advances of a particular solution tend focus primarily on the design of body and hardware interface (e.g., osseointegrated implants, electrodes), screening process (e.g., eligibility criteria), surgical techniques (e.g., number of stages, re-innervation matrices), fitting and design of prosthetic components (e.g., microprocessor-controlled joints, control algorithms) as well as short to long terms outcomes (e.g., physical tasks, heath-related quality of life). 

The rehabilitation procedure (e.g., training exercises) and prosthetic fitting (e.g., setting of components) for new solutions are often areas of development under-reported. Level of understanding and acceptance of pre and post-operative clinical care interventions might vary between lower or upper bionics limbs.

Generally, more information is needed to elucidate the relationships between surgical procedure, clinical care interventions and outcomes (e.g., efficacy and safety) that are critical to establish an evidence-based reasonable, and possibly best, standard of care for bionic solutions. Clearly, there is need for a Research Topic focusing on advances in clinical and prosthetic care of current and emerging bionics limb solutions.

The aim of the current Research Topic is to cover promising, recent and novel research trends in clinical and prosthetic care of current and emerging lower and upper bionics limb solutions.

Areas to be covered in this Research Topic may include, but are not limited to:

1.      Pre-operative interventions that could possibly maximize surgical and medical outcomes of bionics limb solutions (e.g., screening process, strength and re-conditioning, stretching program),  

2.      Post-operative intervention following surgical insertion of osseointegrated implants (e.g., rehabilitation programs, prescription of loading progression, monitoring of loading exercises, design of static and dynamics load bearing exercises, strength and conditioning),

3.      Post-operative intervention after targeted muscle reinnervation (e.g., extraction of physiological signal, development of classifiers, design of fine and/or gross motor control training exercises, training for intuitive control),

4.      Fitting of bionic and/or bone-anchored prosthesis (e.g., choice and alignment of prosthetic components, training with microprocessor-controlled joint units, fall prevention program),

5.      Short and long terms outcome measures of efficacy and safety of bionic and/or bone-anchored prostheses extracted from standardized and non-standardized instruments (e.g., physical tasks, self-reported surveys).