The use of targeted muscle reinnervation for improved... : Prosthetics and Orthotics International (original) (raw)

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The use of targeted muscle reinnervation for improved myoelectric prosthesis control in a bilateral shoulder disarticulation amputee

Kuiken, T. A.1,2,; Dumanian, G. A.3; Lipschutz, R. D.1; Miller, L. A.1; Stubblefield, K. A.1

1Rehabilitation Institute of Chicago and the Department of PM&R at Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

2The Electrical and Computer Engineering Department of Northwestern University, Evanston, Illinois, USA

3The Department of Surgery, Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Rehabilitation Institute of Chicago, Room 1124, 345 E. Superior St., Chicago, IL, 60611, USA(+1) 312-238-8072(+1) 312-238-1166 [email protected]

Abstract

A novel method for the control of a myoelectric upper limb prosthesis was achieved in a patient with bilateral amputations at the shoulder disarticulation level. Four independently controlled nerve-muscle units were created by surgically anastomosing residual brachial plexus nerves to dissected and divided aspects of the pectoralis major and minor muscles. The musculocutaneous nerve was anastomosed to the upper pectoralis major; the median nerve was transferred to the middle pectoralis major region; the radial nerve was anastomosed to the lower pectoralis major region; and the ulnar nerve was transferred to the pectoralis minor muscle which was moved out to the lateral chest wall. After five months, three nerve-muscle units were successful (the musculocutaneous, median and radial nerves) in that a contraction could be seen, felt and a surface electromyogram (EMG) could be recorded. Sensory reinnervation also occurred on the chest in an area where the subcutaneous fat was removed. The patient was fitted with a new myoelectric prosthesis using the targeted muscle reinnervation. The patient could simultaneously control two degrees-of-freedom with the experimental prosthesis, the elbow and either the terminal device or wrist. Objective testing showed a doubling of blocks moved with a box and blocks test and a 26% increase in speed with a clothes pin moving test. Subjectively the patient clearly preferred the new prosthesis. He reported that it was easier and faster to use, and felt more natural.