Demofonti Andrea, Germanotta Marco, Zingaro Andrea, Bailo Gaia, Insalaco Sabina, Cordella Francesca, Aprile Irene Giovanna, Zollo Loredana
Research Unit of Advanced Robotics and Human-Centred Technologies (CREO Lab), Università Campus Bio-Medico di Roma, 00121 Rome, Italy.
IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy.
Cyborg Bionic Syst. 2025 Apr 29;6:0243. doi: 10.34133/cbsystems.0243. eCollection 2025.
Patients with lower limb amputation experience ambulation disorders since they rely exclusively on visual information in addition to the tactile information they receive from stump-socket interface. The lack of sensory feedback in commercial lower limb prostheses is essential in their abandonment by patients with transtibial amputation (TTA) or transfemoral amputation (TFA). Recent studies have obtained promising results using invasive interfaces with peripheral nervous system presenting drawbacks related to surgery. This paper aims to (a) investigate the potential of transcutaneous electrical nerve stimulation (TENS) as noninvasive means for restoring somatotopic sensory feedback in lower limb amputees and (b) evaluate the effect of the system over a 4-week experimental protocol. The first phase of the study involved 13 participants (6 with TTA and 7 with TFA), and the second one evaluated the long-term effect of TENS on ambulation performance of 2 participants (S1 with TTA and S7 with TFA). The proposed system enhanced participant's ambulation significantly increasing the body weight distribution between legs (S1: from 134% to 143%, < 0.0055; S7: from 66% to 72%, < 0.0055) and gait symmetry (S1: step length symmetry index from 11% to 5%, < 0.0055; S7: stance phase symmetry index from -4% to -2%, < 0.0055). It led to a postamputation neuropathic pain reduction in S1 (neuropathic pain symptom inventory score diminished from 6 to 0). This demonstrates how TENS enhanced prosthesis embodiment, enabling greater load bearing and more physiological gait patterns. This study highlights TENS as noninvasive solution for restoring somatotopic sensory feedback, addressing the current limitations and paving the way for further research.
下肢截肢患者会经历行走障碍,因为他们除了从残肢与假肢接受腔的界面获得触觉信息外,完全依赖视觉信息。商用下肢假肢缺乏感觉反馈,这是导致经胫截肢(TTA)或经股截肢(TFA)患者放弃使用假肢的关键因素。最近的研究使用与周围神经系统的侵入性接口取得了有前景的结果,但存在与手术相关的缺点。本文旨在(a)研究经皮电神经刺激(TENS)作为恢复下肢截肢者躯体感觉反馈的非侵入性手段的潜力,以及(b)在为期4周的实验方案中评估该系统的效果。研究的第一阶段涉及13名参与者(6名TTA患者和7名TFA患者),第二阶段评估了TENS对2名参与者(TTA患者S1和TFA患者S7)行走性能的长期影响。所提出的系统显著增强了参与者的行走能力,增加了双腿之间的体重分布(S1:从134%增至143%,<0.0055;S7:从66%增至72%,<0.0055)以及步态对称性(S1:步长对称指数从11%降至5%,<0.0055;S7:站立相对称指数从 -4%降至 -2%,<0.0055)。它还使S1的截肢后神经性疼痛减轻(神经性疼痛症状量表评分从6降至0)。这证明了TENS如何增强了假肢的融入感,实现了更大的承重和更符合生理的步态模式。这项研究突出了TENS作为恢复躯体感觉反馈的非侵入性解决方案,解决了当前的局限性,并为进一步研究铺平了道路。