One of the main reasons why amputees report poor satisfaction with prostheses is their excessive weight perceived,1 despite the fact that they typically weigh less than half of the natural limb.2 Weight perception can be a subjective percept that is influenced by cognitive processes.3-5 Even though recent developments in prosthetics have shown that sensory feedback restoration positively influences cognitive aspects (as embodiment of the device and cognitive load),6,7 the potential benefits on prosthesis heaviness perception have never been investigated. In this study, we explored this matter using intraneural sensory feedback in a transfemoral (above-knee) amputee. We hypothesized that providing neural feedback would affect the integration of the prosthesis in the amputee's body schema, hence influencing the prosthesis weight perception. The results indicate that, after performing an over-ground walking task, the sensory feedback allowed a 23% decrease in prosthesis heaviness perception compared to the no feedback condition. Our hypothesis was confirmed by a significant increase in the embodiment of the prosthesis (by 60.5%) and confidence (by 36%) while walking with the sensory feedback. A subsequent dual task (i.e., walking while spelling backward) showed that the sensory feedback abolished the reduction of walking speed and accuracy observed during the no-feedback condition and normally seen with increased mental workload, suggesting a cognitive integration of the system. These results show the importance of providing close-to-natural sensations from the missing limb to allow a good integration of the prostheses and increase the satisfaction of their users. VIDEO ABSTRACT.
Trial registration: ClinicalTrials.gov NCT03350061.
Keywords: amputees; cognitive integration; embodiment; intraneural; neuromodulation; prosthesis; sensory feedback; weight perception.
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