The authors wish to thank Mr Hans Oppel and his prosthetic technicians of Otto Bock Healthcare Products GmbH for manufacturing the socket used by the participant in this study. This study was financially supported by the European Research Council (ERC) via the ERC Advanced Grant DEMOVE (No. 267888), the Austrian Council for Research and Technology Development, and the Austrian Federal Ministry of Science, Research &#38; Economy.

This study was carried out in accordance with the Declaration of Helsinki, as approved by the local research ethics committee. The study was explained in full detail to the participant prior to commencement, allowing the participant the time to weigh up the decision to voluntarily take part in the study and confirm his participation by informed, written consent.
Note: One man, aged 27 years, took part in the study. The participant had normal vision, was a left below-elbow amputee, and was an e...

<ol>
	<li>Forssberg, H., Eliasson, A. C., Kinoshita, H., Johansson, R. S., Westling, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+human+precision+grip.+I:+Basic+coordination+of+force.">Development of human precision grip. I: Basic coordination of force.</a> Experimental Brain Research. 85 (2), 451-457 (1991).</li><li>Forssberg, H., Kinoshita, H., Eliasson, A. C., Johansson, R. S., Westling, G., Gordon, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+human+precision+grip.+II.+Anticipatory+control+of+isometric+forces+targeted+for+object&#8217;s+weight.">Development of human precision grip. II. Anticipatory control of isometric forces targeted for object&#8217;s weight.</a> Experimental Brain Research. 90 (2), 393-398 (1992).</li><li>Gordon, A. M., Forssberg, H., Johansson, R. S., Eliasson, A. C., Westling, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+human+precision+grip.+III.+Integration+of+visual+size+cues+during+the+programming+of+isometric+forces.">Development of human precision grip. III. Integration of visual size cues during the programming of isometric forces.</a> Experimental Brain Research. 90 (2), 399-403 (1992).</li><li>Forssberg, H., Eliasson, A. C., Kinoshita, H., Westling, G., Johansson, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+human+precision+grip.+IV.+Tactile+adaptation+of+isometric+finger+forces+to+the+frictional+condition.">Development of human precision grip. IV. Tactile adaptation of isometric finger forces to the frictional condition.</a> Experimental Brain Research. 104 (2), 323-330 (1995).</li><li>Eliasson, A. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+human+precision+grip.+V.+anticipatory+and+triggered+grip+actions+during+sudden+loading.">Development of human precision grip. V. anticipatory and triggered grip actions during sudden loading.</a> Experimental Brain Research. 106 (3), 425-433 (1995).</li><li>Roche, A. D., Rehbaum, H., Farina, D., Aszmann, O. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prosthetic+Myoelectric+Control+Strategies+A+Clinical+Perspective.">Prosthetic Myoelectric Control Strategies A Clinical Perspective.</a> Current Surgery Reports. 2 (44), (2014).</li><li>Buccino, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neural+circuits+underlying+imitation+learning+of+hand+actions:+An+event-related+fMRI+study.">Neural circuits underlying imitation learning of hand actions: An event-related fMRI study.</a> Neuron. 42 (2), 323-334 (2004).</li><li>Saunders, J. A., Knill, D. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Humans+use+continuous+visual+feedback+from+the+hand+to+control+fast+reaching+movements.">Humans use continuous visual feedback from the hand to control fast reaching movements.</a> Experimental Brain Research. 152 (3), 341-352 (2003).</li><li>Rizzolatti, G., Craighero, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+mirror-neuron+system.">The mirror-neuron system.</a> Annual Review of Neuroscience. 27, 169-192 (2004).</li><li>Maruishi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Brain+activation+during+manipulation+of+the+myoelectric+prosthetic+hand:+a+functional+magnetic+resonance+imaging+study.">Brain activation during manipulation of the myoelectric prosthetic hand: a functional magnetic resonance imaging study.</a> NeuroImage. 21 (4), 1604-1611 (2004).</li><li>Cusack, W. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Neural+activation+differences+in+amputees+during+imitation+of+intact+versus+amputee+movements.">A Neural activation differences in amputees during imitation of intact versus amputee movements.</a> Frontiers in Human Neuroscience. 6 (June), 182 (2012).</li><li>Vogt, S., Buccino, G., Wohlschl&#228;ger, A. M., Canessa, N., Shah, J. N., Zilles, K., Eickhoff, S. B., Freund, H. J., Rizzolatti, G., Fink, G. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prefrontal+involvement+in+imitation+learning+of+hand+actions:+Effects+and+expertise.">Prefrontal involvement in imitation learning of hand actions: Effects and expertise.</a> Neuroimage. 37 (4), 1371-1383 (2007).</li><li>Gonzalez-Rosa, J. J., Natali, F., Tettamanti, A., Cursi, M., Velikova, S., Comi, G., Gatti, R., Leocani, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Action+observation+and+motor+imagery+in+performance+of+complex+movements:+Evidence+from+EEG+and+kinematics+analysis.">Action observation and motor imagery in performance of complex movements: Evidence from EEG and kinematics analysis.</a> Behavioural Brain Research. 281, 290-300 (2015).</li><li>Bekkering, H., Wohlschl&#228;ger, A. M., Gattis, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Imitation+of+gestures+in+children+is+goal-directed.">Imitation of gestures in children is goal-directed.</a> The Quarterly Journal of Experimental Psychology. 53 (1), 153-164 (2000).</li><li>Catmur, C., Walsh, V., Heyes, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Associative+sequence+learning:+the+role+of+experience+in+the+development+of+imitation+and+the+mirror+system.">Associative sequence learning: the role of experience in the development of imitation and the mirror system.</a> Philosophical Transactions of the Royal Society B. 364 (1528), 2369-2380 (2009).</li><li>Resnik, L., Etter, K., Klinger, S. L., Kambe, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+virtual+reality+environment+to+facilitate+training+with+advanced+upper-limb+prosthesis.">Using virtual reality environment to facilitate training with advanced upper-limb prosthesis.</a> Journal of Rehabilitation Research and Development. 48 (6), 707-718 (2011).</li><li>Bouwsema, H., van der Sluis, C. K., Bongers, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+order+of+practice+in+learning+to+handle+an+upper-limb+prosthesis.">The role of order of practice in learning to handle an upper-limb prosthesis.</a> Archives of Physical Medicine and Rehabilitation. 89 (9), 1759-1764 (2008).</li><li>Bouwsema, H., vander Sluis, C. K., Bongers, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Learning+to+control+opening+and+closing+a+myoelectric+hand.">Learning to control opening and closing a myoelectric hand.</a> Archives of Physical Medicine and Rehabilitation. 91 (9), 1442-1446 (2010).</li><li>Simon, A. M., Lock, B. A., Stubblefield, K. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient+training+for+functional+use+of+pattern+recognition-controlled+prostheses.">Patient training for functional use of pattern recognition-controlled prostheses.</a> Journal of Prosthetics and Orthotics JPO. 24 (2), 56-64 (2012).</li><li>Stubblefield, K. A., Miller, L. A., Lipschutz, R. D., Kuiken, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Occupational+therapy+protocol+for+amputees+with+targeted+muscle+reinnervation.">Occupational therapy protocol for amputees with targeted muscle reinnervation.</a> The Journal of Rehabilitation Research and Development. 46 (4), 481 (2009).</li><li>Ams&#252;ss, S., Roche, A. D., G&#246;bel, P., Graimann, B., Farina, D., Aszmann, O. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regaining+high+functional,+multiple+degrees+of+freedom+hand+control+following+bionic+reconstruction.">Regaining high functional, multiple degrees of freedom hand control following bionic reconstruction.</a> , (2014).</li><li>Dosen, S., Muller, K. -. R., Farina, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Myoelectric+Control+of+Artificial+Limbs&#8212;Is+There+a+Need+to+Change+Focus+[In+the+Spotlight].">Myoelectric Control of Artificial Limbs&#8212;Is There a Need to Change Focus [In the Spotlight].</a> IEEE Signal Processing Magazine. 29 (5), (2012).</li><li>Amsuess, S., Gobel, P., Graimann, B., Farina, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Multi-Class+Proportional+Myocontrol+Algorithm+for+Upper+Limb+Prosthesis+Control:+Validation+in+Real-Life+Scenarios+on+Amputees.">A Multi-Class Proportional Myocontrol Algorithm for Upper Limb Prosthesis Control: Validation in Real-Life Scenarios on Amputees.</a> IEEE Transactions on Neural Systems and Rehabilitation Engineering : A Publication of the IEEE Engineering in Medicine and Biology Society. 4320(c), 1-11 (2014).</li><li>Light, C. M., Chappell, P. H., Kyberd, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Establishing+a+Standardized+Clinical+Assessment+Tool+of+Pathologic+and+Prosthetic+Hand+Function:+Normative+Data,+Reliability,+and+Validity.">Establishing a Standardized Clinical Assessment Tool of Pathologic and Prosthetic Hand Function: Normative Data, Reliability, and Validity.</a> Archives of Physical Medicine and Rehabilitation. 83 (6), 776-783 (2002).</li><li>Wolpert, D. M., Ghahramani, Z., Jordan, M. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+internal+model+for+sensorimotor+integration.">An internal model for sensorimotor integration.</a> Science (New York, N.Y). 269 (5232), 1880-1882 (1995).</li><li>Shadmehr, R., Mussa-Ivaldi, F. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adaptive+representation+of+dynamics+during+learning+of+a+motor+task.">Adaptive representation of dynamics during learning of a motor task.</a> The Journal of Neuroscience the Official Journal of the Society for Neuroscience. 14 (5 Pt 2), (1994).</li><li>Hogervorst, T., Brand, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanoreceptors+in+joint+function.">Mechanoreceptors in joint function.</a> The Journal of Bone and Joint Surgery. American Volume. 80 (9), 1365-1378 (1998).</li><li>Bosco, G., Poppele, R. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Proprioception+from+a+spinocerebellar+perspective.">Proprioception from a spinocerebellar perspective.</a> Physiological Reviews. 81 (2), 539-568 (2001).</li><li>Iacoboni, M., Molnar-Szakacs, I., Gallese, V., Buccino, G., Mazziotta, J. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Grasping+the+intentions+of+others+with+one&#8217;s+own+mirror+neuron+system.">Grasping the intentions of others with one&#8217;s own mirror neuron system.</a> PLoS Biology. 3 (3), 0529-0535 (2005).</li><li>Williams, J. H. G., Whiten, A., Waiter, G. D., Pechey, S., Perrett, D. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cortical+and+subcortical+mechanisms+at+the+core+of+imitation.">Cortical and subcortical mechanisms at the core of imitation.</a> Social Neuroscience. 2 (1), 66-78 (2007).</li><li>Allison, T., Puce, A., McCarthy, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Social+perception+from+visual+cues:+Role+of+the+STS+region.">Social perception from visual cues: Role of the STS region.</a> Trends in Cognitive Sciences. 4 (7), 267-278 (2000).</li><li>Thompson, J. C., Hardee, J. E., Panayiotou, A., Crewther, D., Puce, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Common+and+distinct+brain+activation+to+viewing+dynamic+sequences+of+face+and+hand+movements.">Common and distinct brain activation to viewing dynamic sequences of face and hand movements.</a> NeuroImage. 37 (3), 966-973 (2007).</li><li>Binkofski, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+fronto-parietal+circuit+for+object+manipulation+in+man:+Evidence+from+an+fMRI-study.">A fronto-parietal circuit for object manipulation in man: Evidence from an fMRI-study.</a> European Journal of Neuroscience. 11 (9), 3276-3286 (1999).</li><li>Iacoboni, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cortical+Mechanisms+of+Human+Imitation.">Cortical Mechanisms of Human Imitation.</a> Science. 286 (5449), 2526-2528 (1999).</li></ol>

Our findings suggest for the participant in this study that structured training helped improve control of a multifunctional prosthetic hand during one single session. The structured program used here was a combination of imitation, repetition and reinforcement of hand movements that the participant was not able to complete with his traditional prosthetic hand.
Although the participant scored higher with his traditional prosthesis in the SHAP test, it is worth noting that he typically wore that...

Replacing hand function in amputees is a difficult endeavor. Coordinating highly skilled hand movements is not an innate ability, and takes humans years of learning to develop.1&#8211;5 After the traumatic loss of a hand, replicating this capability by prosthetic means is not a trivial task and may require a period of sustained learning.
Prosthetic design and interfacing methods for their control are subject to rapid technological innovations, with the goal of multifunctional control in a natural manner.6 The complexity of these control systems increases substantially to provide more functions for amputees. To ensure accurate control of these systems, and to reduce abandonment of new technologies, adequate training needs to be established. This is likely to be more successful if it is based on the amputees&#8217; inherent learning strategies.
Vision can play an important role during learning of hand movements. Behavioral studies have shown that by observing the actions of others7 or using visual cues8, able-bodied individuals learn and coordinate new movements. Through a process of observation, understanding and execution of an observed action, individuals are able to imitate the actions of others. Specific cortical networks, which may include a mirror-neuron system (MNS), are believed to underlie this capability, and may have a role in controlling prosthetic limbs.9&#8211;11
The role of imitation might not just be limited to executing actions that have already been seen, but together with the MNS, allow the execution of movements that have not yet been observed but extrapolated from the observer&#8217;s motor repetoire.12 Indeed, imitation may not necessarily be an innate ability, but an accruement of motor skills over time that lead to experienced and sophisticated actions.13 The strength of observing actions, over just simply imagining them, has been shown to improve learning new tasks.14 Thus, imitation may be a pragmatic approach to training amputees, as evidence suggests it a goal directed process15, with the target in the rehabilitation setting of enabling useful prosthetic hand function.
Rehabilitation studies have separately shown that visual cues, such as virtual simulations of a prosthetic hand, encourage amputees during rehabilitation training.16 In addition, the use of repetition when conducted in a blocked paradigm has been shown to enable rapid learning of upper-limb prosthetic control.17 While virtual simulations have been proven to be equally effective as real control of prosthetic hands in enabling abled-body users to control myoelectric devices,18 their effect on amputees using standardized outcome measures is not clear. Finally, where protocols for upper limb amputation training exist, the role of imitation in learning of prosthetic control is not explicitly discussed.19,20
This study aims at understanding if the use of imitation, in combination with repetition and reinforcement, has a positive impact on the learning of multifunctional prosthetic control as part of a structured training program.
Presented herein is a case report of a transradial amputee who was trained to use a multifunctional prosthetic hand. The participant had previously become accustomed to operating traditional myoelectric prostheses. Using visual cues, both in the form of imitation of a healthy demonstrator and as simple computer visual feedback, the amputee quickly improved handling of his new device.

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>Michelangelo Hand</td>
			<td>Otto Bock Healthcare Products GmbH, A</td>
			<td>8E500=L-M</td>
			<td></td>
		</tr>
		<tr>
			<td>AxonRotation</td>
			<td>Otto Bock Healthcare Products GmbH, A</td>
			<td>9S503</td>
			<td></td>
		</tr>
		<tr>
			<td>Wrist Flexor</td>
			<td>Otto Bock Healthcare Products GmbH, A</td>
			<td>&#160;--</td>
			<td>prototype unit</td>
		</tr>
		<tr>
			<td>AxonMaster</td>
			<td>Otto Bock Healthcare Products GmbH, A</td>
			<td>13E500</td>
			<td></td>
		</tr>
		<tr>
			<td>Electrode</td>
			<td>Otto Bock Healthcare Products GmbH, A</td>
			<td>13E200=50AC</td>
			<td></td>
		</tr>
		<tr>
			<td>ScissorFenceElectrodeCarrier</td>
			<td>Otto Bock Healthcare Products GmbH, A</td>
			<td>&#160;--</td>
			<td>prototype unit</td>
		</tr>
		<tr>
			<td>Acquisition Software</td>
			<td>Otto Bock Healthcare Products GmbH, A</td>
			<td>&#160;--</td>
			<td>prototype unit</td>
		</tr>
		<tr>
			<td>Carbon shaft</td>
			<td>Otto Bock Healthcare Products GmbH, A</td>
			<td>&#160;--</td>
			<td>prototype unit</td>
		</tr>
	</tbody>
</table>

a structured rehabilitation protocol for improved multifunctional prosthetic control: a case study

Advances in robotic systems have resulted in prostheses for the upper limb that can produce multifunctional movements. However, these sophisticated systems require upper limb amputees to learn complex control schemes. Humans have the ability to learn new movements through imitation and other learning strategies. This protocol describes a structured rehabilitation method, which includes imitation, repetition, and reinforcement learning, and aims to assess if this method can improve multifunctional prosthetic control. A left below elbow amputee, with 4 years of experience in prosthetic use, took part in this case study. The prosthesis used was a Michelangelo hand with wrist rotation, and the added features of wrist flexion and extension, which allowed more combinations of hand movements. The participant&#8217;s Southampton Hand Assessment Procedure score improved from 58 to 71 following structured training. This suggests that a structured training protocol of imitation, repetition and reinforcement may have a role in learning to control a new prosthetic hand. A larger clinical study is however required to support these findings.

The baseline SHAP performance of the participant with his daily prosthesis was 81 when measured by the clinical staff 8 months prior to testing. A SHAP score of 100 represents able-bodied hand function.24 The participant scored an overall SHAP score of 58 during the na&#239;ve session with the more advanced prosthesis control system. However, 3 months later and with no further interaction with the new system, aside from the structured training, the participant achieved a SHAP score of 71 with the same advanced...

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A Structured Rehabilitation Protocol for Improved Multifunctional Prosthetic Control: A Case Study

As prosthetic development moves towards the goal of natural control, harnessing amputees&#8217; inherent ability to learn new motor skills may enable proficiency. This manuscript describes a structured rehabilitation protocol, which includes imitation, repetition, and reinforcement learning strategies, for improved multifunctional prosthetic control.

Advances in robotic systems have resulted in prostheses for the upper limb that can produce multifunctional movements. However, these sophisticated ...

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9.3K visualizações.  Christian Doppler Laboratory for Restoration of Extremity Function. As prosthetic development moves towards the goal of natural control, harnessing amputees’ inherent ability to learn new motor skills may enable proficiency. This manuscript describes a structured rehabilitation protocol, which includes imitation, repetition, and reinforcement learning strategies, for improved multifunctional prosthetic control.