Intuitive control of additional prosthetic joints via electro-neuromuscular constructs improves functional and disability outcomes during home use-a case study.

Objective. The advent of surgical reconstruction techniques has enabled the recreation of myoelectric controls sites that were previously lost due to amputation. This advancement is particularly beneficial for individuals with higher-level arm amputations, who were previously constrained to using a single degree of freedom (DoF) myoelectric prostheses due to the limited number of available muscles from which control signals could be extracted. In this study, we explore the use of surgically created electro-neuromuscular constructs to intuitively control multiple bionic joints during daily life with a participant who was implanted with a neuromusculoskeletal prosthetic interface. Approach. We sequentially increased the number of controlled joints, starting at a single DoF allowing to open and close the hand, subsequently adding control of the wrist (2 DoF) and elbow (3 DoF). Main results. We found that the surgically created electro-neuromuscular constructs allow for intuitive simultaneous and proportional control of up to three degrees of freedom using direct control. Extended home-use and the additional bionic joints resulted in improved prosthesis functionality and disability outcomes. Significance. Our findings indicate that electro-neuromuscular constructs can aid in restoring lost functionality and thereby support a person who lost their arm in daily-life tasks.