Dataset Information

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol.

ABSTRACT: BACKGROUND:We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. METHODS:Our TMR cohort was compared to a cross-sectional sample of unselected oncologic amputees not treated at our institution (N?=?58). Patient-Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain. RESULTS:Thirty-one patients underwent amputation with concurrent TMR during the study; 27 patients completed pain surveys; 15 had greater than 1 year follow-up (mean follow-up 14.7 months). Neuroma symptoms occurred significantly less frequently and with less intensity among the TMR cohort. Mean differences for PROMIS pain intensity, behavior, and interference for phantom limb pain (PLP) were 5.855 (95%CI 1.159-10.55; P?=?.015), 5.896 (95%CI 0.492-11.30; P?=?.033), and 7.435 (95%CI 1.797-13.07; P?=?.011) respectively, with lower scores for TMR cohort. For residual limb pain, PROMIS pain intensity, behavior, and interference mean differences were 5.477 (95%CI 0.528-10.42; P?=?.031), 6.195 (95%CI 0.705-11.69; P?=?.028), and 6.816 (95%CI 1.438-12.2; P?=?.014), respectively. Fifty-six percent took opioids before amputation compared to 22% at 1 year postoperatively. CONCLUSIONS:Multidisciplinary care of amputees including concurrent amputation and TMR, multimodal postoperative pain management, amputee-centered rehabilitation, and peer support demonstrates reduced incidence and severity of neuroma and PLP.

SUBMITTER: Alexander JH

PROVIDER: S-EPMC7701996 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol.

Alexander John H JH Jordan Sumanas W SW West Julie M JM Compston Amy A Fugitt Jennifer J Bowen J Byers JB Dumanian Gregory A GA Pollock Raphael R Mayerson Joel L JL Scharschmidt Thomas J TJ Valerio Ian L IL

Journal of surgical oncology 20190613 3

<h4>Background</h4>We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation.<h4>Methods</h4>Our TMR cohort was compared to a cross-sectional sample of unselected oncologic amputees not treated at our institution (N = 58). Patient-Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain.<h4>Results</h4>Thirty-one patients underwent amputation with concurre ...[more]

PMID: 31197851

Similar Datasets

Project description:Improving the function of prosthetic arms remains a challenge, because access to the neural-control information for the arm is lost during amputation. A surgical technique called targeted muscle reinnervation (TMR) transfers residual arm nerves to alternative muscle sites. After reinnervation, these target muscles produce electromyogram (EMG) signals on the surface of the skin that can be measured and used to control prosthetic arms.To assess the performance of patients with upper-limb amputation who had undergone TMR surgery, using a pattern-recognition algorithm to decode EMG signals and control prosthetic-arm motions.Study conducted between January 2007 and January 2008 at the Rehabilitation Institute of Chicago among 5 patients with shoulder-disarticulation or transhumeral amputations who underwent TMR surgery between February 2002 and October 2006 and 5 control participants without amputation. Surface EMG signals were recorded from all participants and decoded using a pattern-recognition algorithm. The decoding program controlled the movement of a virtual prosthetic arm. All participants were instructed to perform various arm movements, and their abilities to control the virtual prosthetic arm were measured. In addition, TMR patients used the same control system to operate advanced arm prosthesis prototypes.Performance metrics measured during virtual arm movements included motion selection time, motion completion time, and motion completion ("success") rate.The TMR patients were able to repeatedly perform 10 different elbow, wrist, and hand motions with the virtual prosthetic arm. For these patients, the mean motion selection and motion completion times for elbow and wrist movements were 0.22 seconds (SD, 0.06) and 1.29 seconds (SD, 0.15), respectively. These times were 0.06 seconds and 0.21 seconds longer than the mean times for control participants. For TMR patients, the mean motion selection and motion completion times for hand-grasp patterns were 0.38 seconds (SD, 0.12) and 1.54 seconds (SD, 0.27), respectively. These patients successfully completed a mean of 96.3% (SD, 3.8) of elbow and wrist movements and 86.9% (SD, 13.9) of hand movements within 5 seconds, compared with 100% (SD, 0) and 96.7% (SD, 4.7) completed by controls. Three of the patients were able to demonstrate the use of this control system in advanced prostheses, including motorized shoulders, elbows, wrists, and hands.These results suggest that reinnervated muscles can produce sufficient EMG information for real-time control of advanced artificial arms.

Dataset Information

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol.

Publications

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets