Most amputations occur in lower limbs and despite improvements in prosthetic technology, no commercially available prosthetic leg uses electromyography (EMG) information as an input for control. Efforts to integrate EMGsignals as part of the control strategy have increased in the last decade. In this review, we summarize the research in the field of lower limb prosthetic control using EMG. Four different online databases were searched from July-September 2020: Web of Science, Scopus, PubMed, and Science Direct. We included articles that reported systems for controlling a prosthetic leg (with an ankle and/or knee actuator) by decoding gait intent using EMG signals alone or in combination with other sensors. A total of 1,327 papers were initially assessed and 117 were finally included in this review. The literature showed that despite the burgeoning interest in research, controlling a leg prosthesis using EMG signals remains challenging. Specifically, regarding EMG signal quality and stability, electrode placement, prosthetic hardware, and control algorithms, all of which need to be more robust for everyday use. In the studies that were investigated large variations were found across studies between the different control methodologies, type of research participant, recording protocols, assessments, and prosthetic hardware.

In research on lower limb prostheses, safety during testing and training is paramount. Lower limb prosthetic users risk unintentional loss of balance that can result in injury, fear of falling, and overall decreased confidence in their prosthetic leg. Here, we present a protocol for managing the risks during evaluation of active prosthetic legs with modifiable control systems. We propose graded safety levels, each of which must be achieved before advancing to the next one, from laboratory bench testing to independent ambulation in real-world environments. This ensures safety for the research participant and staff.