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A Single Incision Anterior Approach for Transhumeral Amputation Targeted Muscle Reinnervation.

ABSTRACT: Targeted muscle reinnervation (TMR) is an evolving technique with promising results for prevention and treatment of neuropathic pain, as well as modulation of control for myoelectric prostheses. The previously described and most commonly used technique for transhumeral TMR combines both an anterior and posterior approach to access the major peripheral nerves of the upper extremity. In this article, we review the literature for transhumeral TMR and describe a more expeditious and efficient anterior-only approach that offers safe access through a single incision.

SUBMITTER: Daly MC

PROVIDER: S-EPMC7209851 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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A Single Incision Anterior Approach for Transhumeral Amputation Targeted Muscle Reinnervation.

Daly Michael C MC He Janice J JJ Ponton Ryan P RP Ko Jason H JH Valerio Ian L IL Eberlin Kyle R KR

Plastic and reconstructive surgery. Global open 20200423 4

Targeted muscle reinnervation (TMR) is an evolving technique with promising results for prevention and treatment of neuropathic pain, as well as modulation of control for myoelectric prostheses. The previously described and most commonly used technique for transhumeral TMR combines both an anterior and posterior approach to access the major peripheral nerves of the upper extremity. In this article, we review the literature for transhumeral TMR and describe a more expeditious and efficient anteri ...[more]

PMID: 32440419

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Project description:BackgroundMyoelectric control of multifunctional prostheses is challenging for individuals with high-level amputations due to insufficient surface electromyography (sEMG) signals. A surgical technique called targeted muscle reinnervation (TMR) has achieved impressive improvements in myoelectric control by providing more sEMG control signals. In this case, some channels of sEMG signals are coupled after TMR, which limits the performance of conventional amplitude-based control for upper-limb prostheses.MethodsIn this paper, two different ways (training and algorithms) were attempted to solve the problem in a transhumeral amputee after TMR. Firstly, effect of rehabilitation training on generating independent sEMG signals was investigated. The results indicated that some sEMG signals recorded were still coupled over the targeted muscles after rehabilitation training for about two months. Secondly, pattern recognition (PR) algorithm was then applied to classify the sEMG signals. In the second way, to further improve the real-time performance of prosthetic control, a post-processing method named as mean absolute value-based (MAV-based) threshold switches was utilized.ResultsUsing the improved algorithms, substantial improvement was shown in a subset of the modified Action Research Arm Test (ARAT). Compared with common PR control without post-processing method, the total scores increased more than 18% with majority vote and more than 58% with MAV-based threshold switches. The amputee was able to finish all the tasks within the allotted time with the standard MAV-based threshold switches. Subjectively the amputee preferred the PR control with MAV-based threshold switches and reported it to be more accurate and much smoother both in experiment and practical use.ConclusionsAlthough the sEMG signals were still coupled after rehabilitation training on the TMR patient, the online performance of the prosthetic operation was improved through application of PR control with combination of the MAV-based threshold switches.Trial registrationRetrospectively registered http://www.chictr.org.cn/showproj.aspx?proj=22058 .

Dataset Information

A Single Incision Anterior Approach for Transhumeral Amputation Targeted Muscle Reinnervation.

Publications

A Single Incision Anterior Approach for Transhumeral Amputation Targeted Muscle Reinnervation.

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