Objective: Machine learning (ML) models are increasingly used to generate electrical stimulation patterns in neuroprosthetic devices such as visual prostheses. While these models promise precise and personalized control, they also introduce new safety risks when model outputs are delivered directly to neural tissue. We propose a systematic, quantitative approach to detect and characterize unsafe stimulation patterns in ML-driven neurostimulation systems. Approach: We adapt an automated software testing technique known as coverage-guided fuzzing to the domain of neural stimulation. Here, fuzzing performs stress testing by perturbing model inputs and tracking whether resulting stimulation violates biophysical limits on charge density, instantaneous current, or electrode co-activation. The framework treats encoders as black boxes and steers exploration with coverage metrics that quantify how broadly test cases span the space of possible outputs and violation types. Main results: Applied to deep stimulus encoders for the retina and cortex, the method systematically reveals diverse stimulation regimes that exceed established safety limits. Two violation-output coverage metrics identify the highest number and diversity of unsafe outputs, enabling interpretable comparisons across architectures and training strategies. Significance: Violation-focused fuzzing reframes safety assessment as an empirical, reproducible process. By transforming safety from a training heuristic into a measurable property of the deployed model, it establishes a foundation for evidence-based benchmarking, regulatory readiness, and ethical assurance in next-generation neural interfaces.

Current upper limb prostheses aim to enhance user independence in daily activities by incorporating basic motor functions. However, they fall short of replicating the natural movement and interaction capabilities of the human arm. In contrast, human limbs leverage intrinsic compliance and actively modulate joint stiffness, enabling adaptive responses to varying tasks, impact absorption, and efficient energy transfer during dynamic actions. Inspired by this adaptability, we developed a transhumeral prosthesis with Variable Stiffness Actuators (VSAs) to replicate the controllable compliance found in biological joints. The proposed prosthesis features a modular design, allowing customization for different residual limb shapes and accommodating a range of independent control signals derived from users' biological cues. Integrated elastic elements passively support more natural movements, facilitate safe interactions with the environment, and adapt to diverse task requirements. This paper presents a comprehensive overview of the platform and its functionalities, highlighting its potential applications in the field of prosthetics.

However, patient outcomes with current technologies are limited.

When the air ambulance brought Jim Ashworth-Beaumont to King's College hospital in south-east London, nobody thought he had a hope. He had been cycling home when a lorry driver failed to spot him alongside his trailer while turning left after a set of traffic lights. The vehicle's wheels opened his torso like a sardine tin, puncturing his lungs and splitting his liver in two. They also tore off his right arm. Weeks after the accident, in July 2020, Ashworth-Beaumont would see a photo of the severed limb taken by a doctor while it lay beside him in hospital. He had asked to see the picture and says it helped him come to terms with his loss. "My hand didn't look too bad," he says. "It was as if it was waving goodbye to me." Ashworth-Beaumont, a super-fit and sunny former Royal Marine from Edinburgh, would go on to spend six weeks in an induced coma as surgeons raced to repair his crushed body. But as he lay on the road, waiting for the paramedics, his only thoughts were that he was dying.

Current control strategies for powered lower limb prostheses often lack awareness of the environment and the user's intended interactions with it. This limitation becomes particularly apparent in complex terrains. Obstacle negotiation, a critical scenario exemplifying such challenges, requires both real-time perception of obstacle geometry and responsiveness to user intention about when and where to step over or onto, to dynamically adjust swing trajectories. We propose a novel control strategy that fuses environmental awareness and human cooperativeness: an on-board depth camera detects obstacles ahead of swing phase, prompting an elevated early-swing trajectory to ensure clearance, while late-swing control defers to natural biomechanical cues from the user. This approach enables intuitive stepping strategies without requiring unnatural movement patterns. Experiments with three non-amputee participants demonstrated 100 percent success across more than 150 step-overs and 30 step-ons with randomly placed obstacles of varying heights (4-16 cm) and distances (15-70 cm). By effectively addressing obstacle navigation -- a gateway challenge for complex terrain mobility -- our system demonstrates adaptability to both environmental constraints and user intentions, with promising applications across diverse locomotion scenarios.

Human-in-the-loop optimization (HILO) is a promising approach for personalizing visual prostheses by iteratively refining stimulus parameters based on user feedback. Previous work demonstrated HILO's efficacy in simulation, but its performance with human participants remains untested. Here we evaluate HILO using sighted participants viewing simulated prosthetic vision to assess its ability to optimize stimulation strategies under realistic conditions. Participants selected between phosphenes generated by competing encoders to iteratively refine a deep stimulus encoder (DSE). We tested HILO in three conditions: standard optimization, threshold misspecifications, and out-of-distribution parameter sampling. Participants consistently preferred HILO-generated stimuli over both a na\"ive encoder and the DSE alone, with log odds favoring HILO across all conditions. We also observed key differences between human and simulated decision-making, highlighting the importance of validating optimization strategies with human participants. These findings support HILO as a viable approach for adapting visual prostheses to individuals.

Abstract--This paper introduces a new generalized control method designed for multi-degrees-of-freedom devices to help people with limited motion capabilities in their daily activities. The challenge lies in finding the most adapted strategy for the control interface to effectively map user's motions in a lowdimensional space to complex robotic assistive devices, such as prostheses, supernumerary limbs, up to remote robotic avatars. The goal is a system which integrates the human and the robotic parts into a unique system, moving so as to reach the targets decided by the human while autonomously reducing the user's effort and discomfort. We present a framework to control general multi DoFs assistive systems, which translates user-performed compensatory motions into the necessary robot commands for reaching targets while canceling or reducing compensation. The framework extends to prostheses of any number of DoF up to full robotic avatars, regarded here as a sort of "whole-body prosthesis" of the person who sees the robot as an artificial extension of their own body without a physical link but with a sensory-motor integration. We have validated and applied this control strategy through tests encompassing simulated scenarios and real-world trials involving a virtual twin of the robotic parts (prosthesis and robot) and a physical humanoid avatar. SSISTIVE and rehabilitation devices such as powered wheelchairs, assistive robotic arms, and limb prostheses play a crucial role in assisting individuals with severe motor impairments [1], which require daily assistance due to e.g.

Despite decades of research and development, myoelectric prosthetic hands lack functionality and are often rejected by users. This lack in functionality can be partially attributed to the widely accepted anthropomorphic design ideology in the field; attempting to replicate human hand form and function despite severe limitations in control and sensing technology. Instead, prosthetic hands can be tailored to perform specific tasks without increasing complexity by shedding the constraints of anthropomorphism. In this paper, we develop and evaluate four open-source modular non-humanoid devices to perform the motion required to replicate human flicking motion and to twist a screwdriver, and the functionality required to pick and place flat objects and to cut paper. Experimental results from these devices demonstrate that, versus a humanoid prosthesis, non-humanoid prosthesis design dramatically improves task performance, reduces user compensatory movement, and reduces task load. Case studies with two end users demonstrate the translational benefits of this research. We found that special attention should be paid to monitoring end-user task load to ensure positive rehabilitation outcomes.

Intuitively, prostheses with user-controllable stiffness could mimic the intrinsic behavior of the human musculoskeletal system, promoting safe and natural interactions and task adaptability in real-world scenarios. However, prosthetic design often disregards compliance because of the additional complexity, weight, and needed control channels. This paper focuses on designing a Variable Stiffness Actuator (VSA) with weight, size, and performance compatible with prosthetic applications, addressing its implementation for the elbow joint. While a direct biomimetic approach suggests adopting an Agonist-Antagonist (AA) layout to replicate the biceps and triceps brachii with elastic actuation, this solution is not optimal to accommodate the varied morphologies of residual limbs. Instead, we employed the AA layout to craft an elbow prosthesis fully contained in the user's forearm, catering to individuals with distal transhumeral amputations. Additionally, we introduce a variant of this design where the two motors are split in the upper arm and forearm to distribute mass and volume more evenly along the bionic limb, enhancing comfort for patients with more proximal amputation levels. We characterize and validate our approach, demonstrating that both architectures meet the target requirements for an elbow prosthesis. The system attains the desired 120{\deg} range of motion, achieves the target stiffness range of [2, 60] Nm/rad, and can actively lift up to 3 kg. Our novel design reduces weight by up to 50% compared to existing VSAs for elbow prostheses while achieving performance comparable to the state of the art. Case studies suggest that passive and variable compliance could enable robust and safe interactions and task adaptability in the real world.