Physical Medicine and Rehabilitation Clinics of North America
Targeted Reinnervation for Improved Prosthetic Function
Section snippets
Requirements for successful implementation of targeted reinnervation
For targeted reinnervation to be successful in amputees, several requirements exist: (1) multiple nerves need to reinnervate separate regions of muscle and skin consistently; (2) independent signals must be recorded from each target area; and (3) a prosthesis must be available that can handle numerous EMG inputs, control multiple motors, and control sensory feedback systems. Previous studies [13], [14] found that muscle recovery after nerve transection varies. Such variable recovery could prove
Initial clinical application
Target reinnervation has been performed successfully in a patient with bilateral shoulder disarticulation [24]. The patient was a 54-year-old white man working as a high-power lineman, who experienced severe electrical burns in May 2002. He initially was fitted with a body-powered prosthesis on the right side and an externally powered prosthesis on the left. A Boston digital arm was operated using four touch pads mounted in the apex of his socket. The patient received extensive training with
Future research
The case presented here shows the successful use of target reinnervation in a person with shoulder disarticulation amputation. This concept has the potential to benefit individuals with many types of amputation. Currently, the author is conducting a trial of targeted reinnervation in transhumeral amputees. Targeted motor and sensory reinnervation of the median nerve in transradial amputation has the potential to provide thumb control in a multifunction hand and sensory feedback. Targeted
Summary
Target motor reinnervation can produce additional myoelectric control signals for improved powered prosthesis control. This reinnervation allows simultaneous operation of multiple functions in an externally powered prosthesis with physiologically appropriate pathways, and it provides more intuitive control than is possible with conventional myoelectric prostheses. Target sensory reinnervation has the potential to provide the sensory feedback to the amputee that feels like it is in the missing
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This article was supported by a Biomedical Engineering Research Grant from the Whitaker Foundation, the National Institute of Child and Human Development (Grants No. 1K08HD01224-01A1, No. 1R01HD043137-01) and the National Institute of Disability and Rehabilitation Research (Grant No. H133G990074-00).