BRAINmade · Against prostheses abandonment: immersive and low-cost platform for the rehabilitation of upper-limb amputees

Up to 44% is the abandonment rate of upper-limb prostheses. The lack of training and rehabilitation is among the reasons underlying the high rejection rate. When available, traditional treatments lead to ineffective results because they are repetitive, tedious, and discouraging. When considering the EU investments in prosthetic development (173.5 million, period 2019-2022) and the costs granted by the national health system for assistance, this problem gets worse. BRAINmade proposes a paradigm shift to change the current situation. Within the ERC-funded HANDmade project, we exploit the idea that natural hand usage shapes behavior and brain activity. We reinforced the conviction that long-term, continuous, specialized training is prodromal for prosthesis acceptance. By integrating virtual reality (VR) scenarios controlled by electromyographic (EMG) activity in upper-limb amputees, our experimental data on a 4-week long motor training show high motor performance and embodiment even of non-anthropomorphic prosthesis (e.g., tweezers). Beyond being highly specialized as it contains the hand degrees of freedom, we realized that this virtual bionic tool simplifies action intention and execution by exploiting motor properties hardwired in the brain. Thus, the difficult transition toward prosthesis acceptance may imply a progressive acquisition of new motor skills and adopting BRAINmade prosthetic devices built on an individual's expertise (and neural resources). The proposed motor training protocol also integrates fully-customized inkjet-printed and low-cost EMG sensors - designed on the patient's stump and residual muscle activity - and daily monitoring of the motor performance. Those data will serve prosthesis fabrication and feed freely-available databases for developers in the R&D sectors of upper-limb prostheses. With the ultimate project goal of reducing prosthesis abandonment, our idea can significantly impact amputees' lives and transform rehabilitation practice.