Targeted Muscle Reinnervation and Advanced Prosthetic Arms

 

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Abstract

Targeted muscle reinnervation (TMR) is a surgical procedure used to improve the control of upper limb prostheses. Residual nerves from the amputated limb are transferred to reinnervate new muscle targets that have otherwise lost their function. These reinnervated muscles then serve as biological amplifiers of the amputated nerve motor signals, allowing for more intuitive control of advanced prosthetic arms. Here the authors provide a review of surgical techniques for TMR in patients with either transhumeral or shoulder disarticulation amputations. They also discuss how TMR may act synergistically with recent advances in prosthetic arm technologies to improve prosthesis controllability. Discussion of TMR and prosthesis control is presented in the context of a 41-year-old man with a left-side shoulder disarticulation and a right-side transhumeral amputation. This patient underwent bilateral TMR surgery and was fit with advanced pattern-recognition myoelectric prostheses.

• References

• 1 Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008; 89 (3) 422-429
  CrossrefPubMedSearch in Google Scholar
• 2 Fischer H. US Military Casualty Statistics: Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom. Washington, DC: Congressional Research Service; 2010: 1-9
  Search in Google Scholar
• 3 Sears HH. Trends in upper-extremity prosthetics development. In: Bowker JH, Michael JW, , eds. Atlas of Limb Prosthetics. St Louis, MO: Mosby; 1992: 345-356
  Search in Google Scholar
• 4 Souza JM, Cheesborough JE, Ko JH, Cho MS, Kuiken TA, Dumanian GA. Targeted muscle reinnervation: a novel approach to postamputation neuroma pain. Clin Orthop Relat Res 2014; 472 (10) 2984-2990
  CrossrefPubMedSearch in Google Scholar
• 5 Jensen TS, Krebs B, Nielsen J, Rasmussen P. Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation. Pain 1983; 17 (3) 243-256
  CrossrefPubMedSearch in Google Scholar
• 6 Jensen TS, Krebs B, Nielsen J, Rasmussen P. Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain. Pain 1985; 21 (3) 267-278
  CrossrefPubMedSearch in Google Scholar
• 7 Pierce Jr RO, Kernek CB, Ambrose II TA. The plight of the traumatic amputee. Orthopedics 1993; 16 (7) 793-797
  PubMedSearch in Google Scholar
• 8 Wood VE, Mudge MK. Treatment of neuromas about a major amputation stump. J Hand Surg Am 1987; 12 (2) 302-306
  CrossrefPubMedSearch in Google Scholar
• 9 Kim PS, Ko J, O'Shaughnessy KK, Kuiken TA, Dumanian GA. Novel model for end-neuroma formation in the amputated rabbit forelimb. J Brachial Plex Peripher Nerve Inj 2010; 5 (5) 6-6
  Thieme ConnectPubMedSearch in Google Scholar
• 10 Kim PS, Ko JH, O'Shaughnessy KK, Kuiken TA, Pohlmeyer EA, Dumanian GA. The effects of targeted muscle reinnervation on neuromas in a rabbit rectus abdominis flap model. J Hand Surg Am 2012; 37 (8) 1609-1616
  CrossrefPubMedSearch in Google Scholar
• 11 Ko JH, Kim PS, O'Shaughnessy KD, Ding X, Kuiken TA, Dumanian GA. A quantitative evaluation of gross versus histologic neuroma formation in a rabbit forelimb amputation model: potential implications for the operative treatment and study of neuromas. J Brachial Plex Peripher Nerve Inj 2011; 6: 8-8
  Thieme ConnectPubMedSearch in Google Scholar
• 12 Dumanian GA, Souza JM. Surgical techniques for targeted muscle reinnervation. In: Kuiken TA, Schultz Feuser AE, Barlow AK, , eds. Targeted Muscle Reinnervation: A Neural Interface for Artificial Limbs. Boca Raton, FL: CRC Press; 2013: 22-43
  CrossrefSearch in Google Scholar
• 13 O'Shaughnessy KD, Dumanian GA, Lipschutz RD, Miller LA, Stubblefield K, Kuiken TA. Targeted reinnervation to improve prosthesis control in transhumeral amputees. A report of three cases. J Bone Joint Surg Am 2008; 90 (2) 393-400
  PubMedSearch in Google Scholar
• 14 Marquardt E, Neff G. The angulation osteotomy of above-elbow stumps. Clin Orthop Relat Res 1974; (104) 232-238
  PubMedSearch in Google Scholar
• 15 Dumanian GA. Targeted muscle reinnervation and upper limb amputation. In: Thorne CHM, Gurtner GC, Chung K, , et al, eds. Grabb and Smith's, Plastic Surgery. 7th ed. Philadelphia, PA: Wolters Kluwer; 2013: 900-907
  Search in Google Scholar
• 16 Cheesborough JE, Souza JM, Dumanian GA, Bueno Jr RA. Targeted muscle reinnervation in the initial management of traumatic upper extremity amputation injury. Hand (NY) 2014; 9 (2) 253-257
  CrossrefPubMedSearch in Google Scholar
• 17 Lowery MM, Stoykov NS, Taflove A, Kuiken TA. A multiple-layer finite-element model of the surface EMG signal. IEEE Trans Biomed Eng 2002; 49 (5) 446-454
  CrossrefPubMedSearch in Google Scholar
• 18 Urist MR, Nakagawa M, Nakata N, Nogami H. Experimental myositis ossificans: cartilage and bone formation in muscle in response to a diffusible bone matrix-derived morphogen. Arch Pathol Lab Med 1978; 102 (6) 312-316
  PubMedSearch in Google Scholar
• 19 Shehab D, Elgazzar AH, Collier BD. Heterotopic ossification. J Nucl Med 2002; 43 (3) 346-353
  PubMedSearch in Google Scholar
• 20 Garland DE. A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Relat Res 1991; (263) 13-29
  PubMedSearch in Google Scholar
• 21 Williams TW. Control of powered upper extremity prostheses. In: Meier RH, Atkins DJ, , eds. Functional Restoration of Adults and Children with Upper Extremity Amputation. New York, NY: Demos Medical Publishing; 2004: 207-224
  Search in Google Scholar
• 22 Miller LA, Stubblefield KA, Lipschutz RD , et al. Surgical and functional outcomes of targeted muscle reinnervation. In: Kuiken TA, Schultz Feuser AE, Barlow AK, , eds. Targeted Muscle Reinnervation: A Neural Interface for Artificial Limbs. Boca Raton, FL: CRC Press; 2013: 149-164
  CrossrefSearch in Google Scholar
• 23 Miller LA, Stubblefield KA, Lipschutz RD, Lock BA, Kuiken TA. Improved myoelectric prosthesis control using targeted reinnervation surgery: a case series. IEEE Trans Neural Syst Rehabil Eng 2008; 16 (1) 46-50
  CrossrefPubMedSearch in Google Scholar
• 24 Zhou P, Lowery MM, Englehart KB , et al. Decoding a new neural machine interface for control of artificial limbs. J Neurophysiol 2007; 98 (5) 2974-2982
  CrossrefPubMedSearch in Google Scholar
• 25 Coapt. Homepage. Available at: http://coaptengineering.com/ . Accessed September 18, 2014
  PubMed
• 26 Kuiken TA, Li G, Lock BA , et al. Targeted muscle reinnervation for real-time myoelectric control of multifunction artificial arms. JAMA 2009; 301 (6) 619-628
  CrossrefPubMedSearch in Google Scholar
• 27 Scheme E, Englehart K. Electromyogram pattern recognition for control of powered upper-limb prostheses: state of the art and challenges for clinical use. J Rehabil Res Dev 2011; 48 (6) 643-659
  CrossrefPubMedSearch in Google Scholar
• 28 Simon AM, Lock BA, Stubblefield KA. Patient training for functional use of pattern recognition-controlled prostheses. J Prosthet Orthot 2012; 24 (2) 56-64
  CrossrefPubMedSearch in Google Scholar
• 29 Tkach DC, Young AJ, Smith LH, Rouse EJ, Hargrove LJ. Real-time and offline performance of pattern recognition myoelectric control using a generic electrode grid with targeted muscle reinnervation patients. IEEE Trans Neural Syst Rehabil Eng 2014; 22 (4) 727-734
  CrossrefPubMedSearch in Google Scholar
• 30 Hargrove LJ, Englehart K, Hudgins B. A comparison of surface and intramuscular myoelectric signal classification. IEEE Trans Biomed Eng 2007; 54 (5) 847-853
  CrossrefPubMedSearch in Google Scholar
• 31 Hargrove LJ, Lock BA, Simon AM. Pattern recognition control outperforms conventional myoelectric control in upper limb patients with targeted muscle reinnervation. Paper presented at: The 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society; July 3–7, 2013; Osaka, Japan
  PubMed
• 32 Kuiken TA, Turner K, Soltys N, Dumanian GA. First clinical fitting of an individual after bilateral TMR with intuitive pattern recognition control. Paper presented at: Myoelectric Controls Symposium; August 18–24, 2014; Fredericton, New Brunswick, Canada
  PubMed
• 33 Dillingham TR, Pezzin LE, MacKenzie EJ. Limb amputation and limb deficiency: epidemiology and recent trends in the United States. South Med J 2002; 95 (8) 875-883
  PubMedSearch in Google Scholar
• 34 Li G, Schultz AE, Kuiken TA. Quantifying pattern recognition-based myoelectric control of multifunctional transradial prostheses. IEEE Trans Neural Syst Rehabil Eng 2010; 18 (2) 185-192
  CrossrefPubMedSearch in Google Scholar
• 35 Kuiken TA. Application of Targeted Reinnervation for People with Transradial Amputation (NIH R01HD081525). Chicago, IL: Rehabilitation Institute of Chicago; 2014
  Search in Google Scholar
• 36 Young AJ, Smith LH, Rouse EJ, Hargrove LJ. A comparison of the real-time controllability of pattern recognition to conventional myoelectric control for discrete and simultaneous movements. J Neuroeng Rehabil 2014; 11 (1) 5
  CrossrefPubMedSearch in Google Scholar
• 37 Jiang N, Rehbaum H, Vujaklija I, Graimann B, Farina D. Intuitive, online, simultaneous, and proportional myoelectric control over two degrees-of-freedom in upper limb amputees. IEEE Trans Neural Syst Rehabil Eng 2014; 22 (3) 501-510
  CrossrefPubMedSearch in Google Scholar
• 38 Medynski C, Rattray B. Bebionic prosthetic design. Paper presented at: 2011 MyoElectric Controls/Powered Prosthetics Symposium; August 14, 2011; Fredericton, New Brunswick, Canada
  PubMed
• 39 Otr OV, Reinders-Messelink HA, Bongers RM, Bouwsema H, Van Der Sluis CK. The i-LIMB hand and the DMC plus hand compared: a case report. Prosthet Orthot Int 2010; 34 (2) 216-220
  CrossrefPubMedSearch in Google Scholar
• 40 Kyberd PJ, Lemaire ED, Scheme E , et al. Two-degree-of-freedom powered prosthetic wrist. J Rehabil Res Dev 2011; 48 (6) 609-617
  CrossrefPubMedSearch in Google Scholar
• 41 Sensinger J, Lipsey J, Sutton L, Thomas A. Development of a lightweight, low-cost, myoelectric prosthesis. Paper presented at: 39th Annual Meeting and Scientific Symposium of the American Academy of Orthotists & Prosthetists; February 20-23, 2013; Orlando, FL
  PubMed
• 42 Sears HH, Iversen EK, Christenson J, Jacobs T. Integrated system of new electric TD and wrist components - Stage 1 developments. Paper presented at: Myoelectric Controls Symposium; August 18–24, 2014; Fredericton, New Brunswick, Canada
  PubMed
• 43 Brånemark R, Brånemark PI, Rydevik B, Myers RR. Osseointegration in skeletal reconstruction and rehabilitation: a review. J Rehabil Res Dev 2001; 38 (2) 175-181
  PubMedSearch in Google Scholar
• 44 Palmquist A, Jarmar T, Emanuelsson L, Brånemark R, Engqvist H, Thomsen P. Forearm bone-anchored amputation prosthesis: a case study on the osseointegration. Acta Orthop 2008; 79 (1) 78-85
  CrossrefPubMedSearch in Google Scholar
• 45 Weir RF, Troyk PR, DeMichele GA, Kerns DA, Schorsch JF, Maas H. Implantable myoelectric sensors (IMESs) for intramuscular electromyogram recording. IEEE Trans Biomed Eng 2009; 56 (1) 159-171
  CrossrefPubMedSearch in Google Scholar
• 46 Bercich RA, Joseph J, Gall OZ, Maeng J, Kim Y-J, Irazoqui PP. Implantable device for intramuscular myoelectric signal recording. Paper presented at: The 34th Annual International Conference of the IEEE EMBS; August 28–September 1, 2012; San Diego, CA
  PubMed