Targeted Reinnervation for Improved Prosthetic Function

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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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References (26)

  • A.R. Luff et al.

    Electromyographic activity in the cross-reinnervated soleus muscle of unrestrained cats

    J Physiol

    (1985)
  • J.D. Clemis et al.

    Hypoglossal-facial nerve anastomosis: report on 36 cases with posterior fossa facial paralysis

  • Williams T.W. New control options for upper limb prostheses. Presented at the Tenth World Congress of the International...
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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).

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