Dataset Information

Revision Targeted Muscle Reinnervation Improves Secondary Pain Insult in an Upper Extremity Amputee: A Case Report.

ABSTRACT: 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.

SUBMITTER: Rivedal DD

PROVIDER: S-EPMC8647333 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

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Publications

Revision Targeted Muscle Reinnervation Improves Secondary Pain Insult in an Upper Extremity Amputee: A Case Report.

Rivedal David D DD Guo Meng M Sanger James J Morgan Aaron A

Hand (New York, N.Y.) 20210217 6

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 inadver ...[more]

PMID: 33593099

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Project description:BACKGROUND:Myoelectric 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. METHODS:In 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. RESULTS:Using 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. CONCLUSIONS:Although 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 REGISTRATION:Retrospectively registered http://www.chictr.org.cn/showproj.aspx?proj=22058 .

Dataset Information

Revision Targeted Muscle Reinnervation Improves Secondary Pain Insult in an Upper Extremity Amputee: A Case Report.

Publications

Revision Targeted Muscle Reinnervation Improves Secondary Pain Insult in an Upper Extremity Amputee: A Case Report.

Similar Datasets

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