Therapy Interventions for Upper Limb Amputees Undergoing Selective Nerve Transfers
Author(s)
Type
Journal Article
Abstract
Targeted Muscle Reinnervation (TMR) improves the biological control interface for myoelectric prostheses after above-elbow amputation. Selective activation of muscle units is made possible by surgically re-routing nerves, yielding a high number of independent myoelectric control signals. However, this intervention requires careful patient selection and specific rehabilitation therapy. Here a rehabilitation protocol is presented for high-level upper limb amputees undergoing TMR, based on an expert Delphi study. Interventions before surgery include detailed patient assessment and general measures for pain control, muscle endurance and strength, balance, and range of motion of the remaining joints. After surgery, additional therapeutic interventions focus on edema control and scar treatment and the selective activation of cortical areas responsible for upper limb control. Following successful reinnervation of target muscles, surface electromyographic (sEMG) biofeedback is used to train the activation of the novel muscular units. Later on, a table-top prosthesis may provide the first experience of prosthetic control. After fitting the actual prosthesis, training includes repetitive drills without objects, object manipulation, and finally, activities of daily living. Ultimately, regular patient appointments and functional assessments allow tracking prosthetic function and enabling early interventions if malfunctioning.
Date Issued
2021-10-29
Date Acceptance
2021-10-01
Citation
Jove-Journal of Visualized Experiments, 2021, (176)
ISSN
1940-087X
Publisher
MyJove Corporation
Journal / Book Title
Jove-Journal of Visualized Experiments
Issue
176
Copyright Statement
© 2021 JoVE Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported
License
License
Sponsor
Commission of the European Communities
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000715054700013&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
810346
Subjects
Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
TARGETED MUSCLE REINNERVATION
MOTOR IMAGERY
REHABILITATION
PAIN
OSSEOINTEGRATION
PROSTHETICS
AMPUTATION
CAPACITY
Publication Status
Published
Article Number
ARTN e62896
Date Publish Online
2021-10-29