Using posterior part of the deltoid muscle as receptor and quality control with intra-operative electrophysiological examination in targeted muscle reinnervation for high-level upper extremity amputees.
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ABSTRACT:
SUBMITTER: Yin HW
PROVIDER: S-EPMC8115993 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Myoelectric devices are controlled by electromyographic signals generated by contraction of residual muscles, which thus serve as biological amplifiers of neural control signals. Although nerves severed by amputation continue to carry motor control information intended for the missing limb, loss of muscle effectors due to amputation prevents access to this important control information. Targeted Muscle Reinnervation (TMR) was developed as a novel strategy to improve control of myoelectric upper limb prostheses. Severed motor nerves are surgically transferred to the motor points of denervated target muscles, which, after reinnervation, contract in response to neural control signals for the missing limb. TMR creates additional control sites, eliminating the need to switch the prosthesis between different control modes. In addition, contraction of target muscles, and operation of the prosthesis, occurs in reponse to attempts to move the missing limb, making control easier and more intuitive. TMR has been performed extensively in individuals with high-level upper limb amputations and has been shown to improve functional prosthesis control. The benefits of TMR are being studied in individuals with transradial amputations and lower limb amputations. TMR is also being investigated in an ongoing clinical trial as a method to prevent or treat painful amputation neuromas.
| S-EPMC5448419 | biostudies-literature
Project description:BackgroundWe describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation.MethodsOur 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.ResultsThirty-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.ConclusionsMultidisciplinary 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.
| S-EPMC7701996 | biostudies-literature
Project description:Recently commercialized powered prosthetic arm systems hold great potential in restoring function for people with upper-limb loss. However, effective use of such devices remains limited by conventional (direct) control methods, which rely on electromyographic signals produced from a limited set of muscles. Targeted Muscle Reinnervation (TMR) is a nerve transfer procedure that creates additional recording sites for myoelectric prosthesis control. The effects of TMR may be enhanced when paired with pattern recognition technology. We sought to compare pattern recognition and direct control in eight transhumeral amputees who had TMR in a balanced randomized cross-over study. Subjects performed a 6-8 week home trial using direct and pattern recognition control with a custom prostheses made from commercially available parts. Subjects showed statistically better performance in the Southampton Hand Assessment Procedure (p?=?0.04) and the Clothespin relocation task (p?=?0.02). Notably, these tests required movements along 3 degrees of freedom. Seven of 8 subjects preferred pattern recognition control over direct control. This study was the first home trial large enough to establish clinical and statistical significance in comparing pattern recognition with direct control. Results demonstrate that pattern recognition is a viable option and has functional advantages over direct control.
| S-EPMC5653840 | biostudies-literature
Project description:Targeted muscle reinnervation (TMR) outcome studies reveal the benefit amputees experience and the potential functional improvement by optimizing neurocutaneous signaling for myoelectric prosthesis control. However, there are still many settings where these techniques are not offered to patients requiring lower extremity amputations or neuroma reconstruction. With growing consistency in the literature, it is helpful to systematize the nerve transfers described for lower extremity TMR and to simplify its integration into reconstructive care.MethodsA systematic literature review was performed and contained the following inclusion criteria: original cases of primary or secondary lower extremity amputation defects or nerve-related pain that underwent TMR with clearly described target muscles for each nerve transfer. Studies were excluded if the cases had been previously described or contained incomplete data. The primary outcomes were nerves transferred and muscles targeted. Target muscle options were presented in tables specific to anatomic region, and cross-sectional schematics were created for intraoperative assistance.ResultsSeventeen studies presenting original cases with clearly described nerve transfers and target muscles in the lower extremity were included in the review. Target muscle selection for all nerve transfers at the transfemoral and transtibial levels were presented in separate tables.ConclusionsReports of early experience at multiple institutions identify trends in the selection of certain target muscles for nerve transfers in transfemoral and transtibial TMR. Familiarity with these common target muscles and nerve transfers can simplify intraoperative decision-making and enhance integration of lower extremity TMR in amputation care and in the treatment of nerve-related pain.
| S-EPMC10010850 | biostudies-literature
Project description:Targeted muscle reinnervation (TMR) has been shown to improve phantom and neuropathic pain in both the acute and chronic amputee population. Through rerouting of major peripheral nerves into a newly denervated muscle, TMR harnesses the plasticity of the brain, helping to revert the sensory cortex back toward the preinsult state, effectively reducing pain. We highlight a unique case of an above-elbow amputee for sarcoma who was initially treated with successful transhumeral TMR. Following inadvertent nerve biopsy of a TMR coaptation site, his pain returned, and he was unable to don his prosthetic. Revision of his TMR to a more proximal level was performed, providing improved pain and function of the amputated arm. This is the first report to highlight the concept of secondary neuroplasticity and successful proximal TMR revision in the setting of multiple insults to the same extremity.
| S-EPMC8647333 | biostudies-literature
Project description:Existing prosthetic limbs do not provide amputees with cutaneous feedback. Tactile feedback is essential to intuitive control of a prosthetic limb and it is now clear that the sense of body self-identification is also linked to cutaneous touch. Here we have created an artificial sense of touch for a prosthetic limb by coupling a pressure sensor on the hand through a robotic stimulator to surgically redirected cutaneous sensory nerves (targeted reinnervation) that once served the lost limb. We hypothesize that providing physiologically relevant cutaneous touch feedback may help an amputee incorporate an artificial limb into his or her self image. To investigate this we used a robotic touch interface coupled with a prosthetic limb and tested it with two targeted reinnervation amputees in a series of experiments fashioned after the Rubber Hand Illusion. Results from both subjective (self-reported) and objective (physiological) measures of embodiment (questionnaires, psychophysical temporal order judgements and residual limb temperature measurements) indicate that returning physiologically appropriate cutaneous feedback from a prosthetic limb drives a perceptual shift towards embodiment of the device for these amputees. Measurements provide evidence that the illusion created is vivid. We suggest that this may help amputees to more effectively incorporate an artificial limb into their self image, providing the possibility that a prosthesis becomes not only a tool, but also an integrated body part.
| S-EPMC3044830 | biostudies-literature
Project description:Three male 8-week-old Wistar rats were used. The peroneal nerve of the animals was transected and sutured to the biceps femoris muscle. Four weeks later, the proximal stump was sutured to the distal stump. The animals survived for 8 weeks. All experiments were performed under Ketanest (ketamine hydrochloride, Essex Pharma GmbH, Munich, Germany; 100 mg/kg) and Rompun (xylazine hydrochloride, Bayer, Leverkusen, Germany; 10 mg/kg) anesthesia. Both substances were injected intraperitoneally. RNA was extracted from the ipsilateral and contralateral tibialis anterior muscles of each animal. The gene array analysis compared the ipsilateral muscle with the contralateral muscle of each animal. Keywords: parallel sample
2005-04-28 | GSE2566 | GEO
Project description:Targeted muscle reinnervation (TMR) is a surgical procedure used to redirect nerves originally controlling muscles of the amputated limb into remaining muscles above the amputation, to treat phantom limb pain and facilitate prosthetic control. While this procedure effectively establishes robust prosthetic control, there is little knowledge on the behavior and characteristics of the reinnervated motor units. In this study we compared the m. pectoralis of five TMR patients to nine able-bodied controls with respect to motor unit action potential (MUAP) characteristics. We recorded and decomposed high-density surface EMG signals into individual spike trains of motor unit action potentials. In the TMR patients the MUAP surface area normalized to the electrode grid surface (0.25 ± 0.17 and 0.81 ± 0.46, p < 0.001) and the MUAP duration (10.92 ± 3.89 ms and 14.03 ± 3.91 ms, p < 0.01) were smaller for the TMR group than for the controls. The mean MUAP amplitude (0.19 ± 0.11 mV and 0.14 ± 0.06 mV, p = 0.07) was not significantly different between the two groups. Finally, we observed that MUAP surface representation in TMR generally overlapped, and the surface occupied by motor units corresponding to only one motor task was on average smaller than 12% of the electrode surface. These results suggest that smaller MUAP surface areas in TMR patients do not necessarily facilitate prosthetic control due to a high degree of overlap between these areas, and a neural information-based control could lead to improved performance. Based on the results we also infer that the size of the motor units after reinnervation is influenced by the size of the innervating motor neuron.
| S-EPMC4764766 | biostudies-literature
Project description:Scapular surgery has usually been performed through the posterior Judet approach. This approach allows access to the entire posterior scapular body, but causes significant soft tissue damage and detaches the deltoid muscle. To date, there has been no clinical study of a deltoid-preserving approach to access the joint for displaced postero-inferior glenoid fractures (Ideberg type II or Ib). We describe an easy and less invasive approach to the postero-inferior glenoid fossa.
| S-EPMC10948851 | biostudies-literature
Project description:BackgroundPercutaneous osseointegrated (OI) docking of prosthetic limbs returns loading directly to the residual bone of individuals with amputations. Lower limb diaphyseal biomechanics have not been studied during the wide range of daily activities performed by individuals with lower extremity amputations; therefore, little is known about the loads experienced at the bone-endoprosthetic interface of a percutaneous OI device.Research questionDoes residual limb length and/or gender influence loading magnitudes in the diaphysis of the femur or tibia during daily activities?MethodsThis observational study used motion capture data from 40 non-amputee volunteers performing nine activities ranging from low to high demand, to virtually simulate residual limbs of amputees. To simulate diaphyseal bone loading in individuals with lower limb amputations, virtual joints were defined during post-processing at 25, 50, and 75 % of residual limb length of both the femur and the tibia, representing six clinically relevant residual limb lengths for OI device placement. Peak axial distractive and compressive forces, torsional moments, and bending moments were calculated for each activity. Comparisons were made between genders and between different levels of the simulated residual limb.ResultsFor simulated above and below knee amputations, short residual limbs showed the highest average bending, torsion, and axial distractive loads, while axial compressive loads were highest for long residual limbs. Absolute maxima for all subjects showed this same trend, except in below knee torsion, where 75 % residual tibia length showed the maximum. The highest demand activities yielding peaks in all directions were cutting with right leg planted, jump, run, and fall.SignificanceOverall, individuals with shorter residual limbs experienced higher diaphyseal forces. This should be taken into consideration during surgical implantation of percutaneous OI devices where residual limb length can potentially be shortened, and during rehabilitation of percutaneous OI patients.
| S-EPMC7417188 | biostudies-literature