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Arm Amputation

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Gregory A. Dumanian – One of the best experts on this subject based on the ideXlab platform.

  • targeted reinnervation for enhanced prosthetic Arm function in a woman with a proximal Amputation a case study
    The Lancet, 2007
    Co-Authors: Todd A Kuiken, Laura A. Miller, Robert D Lipschutz, Blair A. Lock, Kathy Stubblefield, Paul D. Marasco, Ping Zhou, Gregory A. Dumanian

    Abstract:

    Summary Background The function of current artificial Arms is limited by inadequate control methods. We developed a technique that used nerve transfers to muscle to develop new electromyogram control signals and nerve transfers to skin, to provide a pathway for cutaneous sensory feedback to the missing hand. Methods We did targeted reinnervation surgery on a woman with a left Arm Amputation at the humeral neck. The ulnar, median, musculocutaneous, and distal radial nerves were transferred to separate segments of her pectoral and serratus muscles. Two sensory nerves were cut and the distal ends were anastomosed to the ulnar and median nerves. After full recovery the patient was fit with a new prosthesis using the additional targeted muscle reinnervation sites. Functional testing was done and sensation in the reinnervated skin was quantified. Findings The patient described the control as intuitive; she thought about using her hand or elbow and the prosthesis responded appropriately. Functional testing showed substantial improvement: mean scores in the blocks and box test increased from 4·0 (SD 1·0) with the conventional prosthesis to 15·6 (1·5) with the new prosthesis. Assessment of Motor and Process Skills test scores increased from 0·30 to 1·98 for motor skills and from 0·90 to 1·98 for process skills. The denervated anterior chest skin was reinnervated by both the ulnar and median nerves; the patient felt that her hand was being touched when this chest skin was touched, with near-normal thresholds in all sensory modalities. Interpretation Targeted reinnervation improved prosthetic function and ease of use in this patient. Targeted sensory reinnervation provides a potential pathway for meaningful sensory feedback.

  • Targeted reinnervation for enhanced prosthetic Arm function in a woman with a proximal Amputation: a case study
    Lancet, 2007
    Co-Authors: Todd A Kuiken, Laura A. Miller, Robert D Lipschutz, Blair A. Lock, Kathy Stubblefield, Paul D. Marasco, Ping Zhou, Gregory A. Dumanian

    Abstract:

    Background: The function of current artificial Arms is limited by inadequate control methods. We developed a technique that used nerve transfers to muscle to develop new electromyogram control signals and nerve transfers to skin, to provide a pathway for cutaneous sensory feedback to the missing hand. Methods: We did targeted reinnervation surgery on a woman with a left Arm Amputation at the humeral neck. The ulnar, median, musculocutaneous, and distal radial nerves were transferred to separate segments of her pectoral and serratus muscles. Two sensory nerves were cut and the distal ends were anastomosed to the ulnar and median nerves. After full recovery the patient was fit with a new prosthesis using the additional targeted muscle reinnervation sites. Functional testing was done and sensation in the reinnervated skin was quantified. Findings: The patient described the control as intuitive; she thought about using her hand or elbow and the prosthesis responded appropriately. Functional testing showed substantial improvement: mean scores in the blocks and box test increased from 4·0 (SD 1·0) with the conventional prosthesis to 15·6 (1·5) with the new prosthesis. Assessment of Motor and Process Skills test scores increased from 0·30 to 1·98 for motor skills and from 0·90 to 1·98 for process skills. The denervated anterior chest skin was reinnervated by both the ulnar and median nerves; the patient felt that her hand was being touched when this chest skin was touched, with near-normal thresholds in all sensory modalities. Interpretation: Targeted reinnervation improved prosthetic function and ease of use in this patient. Targeted sensory reinnervation provides a potential pathway for meaningful sensory feedback. © 2007 Elsevier Ltd. All rights reserved.

  • targeted reinnervation for enhanced prosthetic Arm function in a woman with a proximal Amputation a case study commentary
    The Lancet, 2007
    Co-Authors: Leigh R Hochberg, Todd A Kuiken, Laura A. Miller, Robert D Lipschutz, Blair A. Lock, Kathy Stubblefield, Paul D. Marasco, Ping Zhou, Dawn M Taylor, Gregory A. Dumanian

    Abstract:

    Background The function of current artificial Arms is limited by inadequate control methods. We developed a technique that used nerve transfers to muscle to develop new electromyogram control signals and nerve transfers to skin, to provide a pathway for cutaneous sensory feedback to the missing hand. Methods We did targeted reinnervation surgery on a woman with a left Arm Amputation at the humeral neck. The ulnar, median, musculocutaneous, and distal radial nerves were transferred to separate segments of her pectoral and serratus muscles. Two sensory nerves were cut and the distal ends were anastomosed to the ulnar and median nerves. After full recovery the patient was fit with a new prosthesis using the additional targeted muscle reinnervation sites. Functional testing was done and sensation in the reinnervated skin was quantified. Findings The patient described the control as intuitive; she thought about using her hand or elbow and the prosthesis responded appropriately. Functional testing showed substantial improvement: mean scores in the blocks and box test increased from 4·0 (SD 1·0) with the conventional prosthesis to 15 6 (1·5) with the new prosthesis. Assessment of Motor and Process Skills test scores increased from 0·30 to 1·98 for motor skills and from 0·90 to 1·98 for process skills. The denervated anterior chest skin was reinnervated by both the ulnar and median nerves; the patient felt that her hand was being touched when this chest skin was touched, with near-normal thresholds in all sensory modalities. Interpretation Targeted reinnervation improved prosthetic function and ease of use in this patient. Targeted sensory reinnervation provides a potential pathway for meaningful sensory feedback.

Todd A Kuiken – One of the best experts on this subject based on the ideXlab platform.

  • targeted reinnervation for enhanced prosthetic Arm function in a woman with a proximal Amputation a case study
    The Lancet, 2007
    Co-Authors: Todd A Kuiken, Laura A. Miller, Robert D Lipschutz, Blair A. Lock, Kathy Stubblefield, Paul D. Marasco, Ping Zhou, Gregory A. Dumanian

    Abstract:

    Summary Background The function of current artificial Arms is limited by inadequate control methods. We developed a technique that used nerve transfers to muscle to develop new electromyogram control signals and nerve transfers to skin, to provide a pathway for cutaneous sensory feedback to the missing hand. Methods We did targeted reinnervation surgery on a woman with a left Arm Amputation at the humeral neck. The ulnar, median, musculocutaneous, and distal radial nerves were transferred to separate segments of her pectoral and serratus muscles. Two sensory nerves were cut and the distal ends were anastomosed to the ulnar and median nerves. After full recovery the patient was fit with a new prosthesis using the additional targeted muscle reinnervation sites. Functional testing was done and sensation in the reinnervated skin was quantified. Findings The patient described the control as intuitive; she thought about using her hand or elbow and the prosthesis responded appropriately. Functional testing showed substantial improvement: mean scores in the blocks and box test increased from 4·0 (SD 1·0) with the conventional prosthesis to 15·6 (1·5) with the new prosthesis. Assessment of Motor and Process Skills test scores increased from 0·30 to 1·98 for motor skills and from 0·90 to 1·98 for process skills. The denervated anterior chest skin was reinnervated by both the ulnar and median nerves; the patient felt that her hand was being touched when this chest skin was touched, with near-normal thresholds in all sensory modalities. Interpretation Targeted reinnervation improved prosthetic function and ease of use in this patient. Targeted sensory reinnervation provides a potential pathway for meaningful sensory feedback.

  • Targeted reinnervation for enhanced prosthetic Arm function in a woman with a proximal Amputation: a case study
    Lancet, 2007
    Co-Authors: Todd A Kuiken, Laura A. Miller, Robert D Lipschutz, Blair A. Lock, Kathy Stubblefield, Paul D. Marasco, Ping Zhou, Gregory A. Dumanian

    Abstract:

    Background: The function of current artificial Arms is limited by inadequate control methods. We developed a technique that used nerve transfers to muscle to develop new electromyogram control signals and nerve transfers to skin, to provide a pathway for cutaneous sensory feedback to the missing hand. Methods: We did targeted reinnervation surgery on a woman with a left Arm Amputation at the humeral neck. The ulnar, median, musculocutaneous, and distal radial nerves were transferred to separate segments of her pectoral and serratus muscles. Two sensory nerves were cut and the distal ends were anastomosed to the ulnar and median nerves. After full recovery the patient was fit with a new prosthesis using the additional targeted muscle reinnervation sites. Functional testing was done and sensation in the reinnervated skin was quantified. Findings: The patient described the control as intuitive; she thought about using her hand or elbow and the prosthesis responded appropriately. Functional testing showed substantial improvement: mean scores in the blocks and box test increased from 4·0 (SD 1·0) with the conventional prosthesis to 15·6 (1·5) with the new prosthesis. Assessment of Motor and Process Skills test scores increased from 0·30 to 1·98 for motor skills and from 0·90 to 1·98 for process skills. The denervated anterior chest skin was reinnervated by both the ulnar and median nerves; the patient felt that her hand was being touched when this chest skin was touched, with near-normal thresholds in all sensory modalities. Interpretation: Targeted reinnervation improved prosthetic function and ease of use in this patient. Targeted sensory reinnervation provides a potential pathway for meaningful sensory feedback. © 2007 Elsevier Ltd. All rights reserved.

  • targeted reinnervation for enhanced prosthetic Arm function in a woman with a proximal Amputation a case study commentary
    The Lancet, 2007
    Co-Authors: Leigh R Hochberg, Todd A Kuiken, Laura A. Miller, Robert D Lipschutz, Blair A. Lock, Kathy Stubblefield, Paul D. Marasco, Ping Zhou, Dawn M Taylor, Gregory A. Dumanian

    Abstract:

    Background The function of current artificial Arms is limited by inadequate control methods. We developed a technique that used nerve transfers to muscle to develop new electromyogram control signals and nerve transfers to skin, to provide a pathway for cutaneous sensory feedback to the missing hand. Methods We did targeted reinnervation surgery on a woman with a left Arm Amputation at the humeral neck. The ulnar, median, musculocutaneous, and distal radial nerves were transferred to separate segments of her pectoral and serratus muscles. Two sensory nerves were cut and the distal ends were anastomosed to the ulnar and median nerves. After full recovery the patient was fit with a new prosthesis using the additional targeted muscle reinnervation sites. Functional testing was done and sensation in the reinnervated skin was quantified. Findings The patient described the control as intuitive; she thought about using her hand or elbow and the prosthesis responded appropriately. Functional testing showed substantial improvement: mean scores in the blocks and box test increased from 4·0 (SD 1·0) with the conventional prosthesis to 15 6 (1·5) with the new prosthesis. Assessment of Motor and Process Skills test scores increased from 0·30 to 1·98 for motor skills and from 0·90 to 1·98 for process skills. The denervated anterior chest skin was reinnervated by both the ulnar and median nerves; the patient felt that her hand was being touched when this chest skin was touched, with near-normal thresholds in all sensory modalities. Interpretation Targeted reinnervation improved prosthetic function and ease of use in this patient. Targeted sensory reinnervation provides a potential pathway for meaningful sensory feedback.

Tamar R Makin – One of the best experts on this subject based on the ideXlab platform.

  • Brain (re)organisation following Amputation: implications for phantom limb pain.
    NeuroImage, 2020
    Co-Authors: Tamar R Makin, Herta Flor

    Abstract:

    Abstract Following Arm Amputation the region that represented the missing hand in primary somatosensory cortex (S1) becomes deprived of its primary input, resulting in changed boundaries of the S1 body map. This remapping process has been termed ‘reorganisation’ and has been attributed to multiple mechanisms, including increased expression of previously masked inputs. In a maladaptive plasticity model, such reorganisation has been associated with phantom limb pain (PLP). Brain activity associated with phantom hand movements is also correlated with PLP, suggesting that preserved limb functional representation may serve as a complementary process. Here we review some of the most recent evidence for the potential drivers and consequences of brain (re)organisation following Amputation, based on human neuroimaging. We emphasise other perceptual and behavioural factors consequential to Arm Amputation, such as non-painful phantom sensations, perceived limb ownership, intact hand compensatory behaviour or prosthesis use, which have also been related to both cortical changes and PLP. We also discuss new findings based on interventions designed to alter the brain representation of the phantom limb, including augmented/virtual reality applications and brain computer interfaces. These studies point to a close interaction of sensory changes and alterations in brain regions involved in body representation, pain processing and motor control. Finally, we review recent evidence based on methodological advances such as high field neuroimaging and multivariate techniques that provide new opportunities to interrogate somatosensory representations in the missing hand cortical territory. Collectively, this research highlights the need to consider potential contributions of additional brain mechanisms, beyond S1 remapping, and the dynamic interplay of contextual factors with brain changes for understanding and alleviating PLP.

  • Stability of Sensory Topographies in Adult Cortex
    Trends in Cognitive Sciences, 2017
    Co-Authors: Tamar R Makin, Sliman J. Bensmaia

    Abstract:

    Textbooks teach us that the removal of sensory input to sensory cortex, for example, following Arm Amputation, results in massive reorganisation in the adult brain. In this opinion article, we critically examine evidence for functional reorganisation of sensory cortical representations, focusing on the sequelae of Arm Amputation on somatosensory topographies. Based on literature from human and non-human primates, we conclude that the cortical representation of the limb remains remarkably stable despite the loss of its main peripheral input. Furthermore, the purportedly massive reorganisation results primarily from the formation or potentiation of new pathways in subcortical structures and does not produce novel functional sensory representations. We discuss the implications of the stability of sensory representations on the development of upper-limb neuroprostheses.

  • Revealing the neural fingerprints of a missing hand
    eLife, 2016
    Co-Authors: Sanne Kikkert, Irene Tracey, Heidi Johansen-berg, James Kolasinski, Saad Jbabdi, Christian F. Beckmann, Tamar R Makin

    Abstract:

    The hand area of the primary somatosensory cortex contains detailed finger topography, thought to be shaped and maintained by daily life experience. Here we utilise phantom sensations and ultra high-field neuroimaging to uncover preserved, though latent, representation of amputees’ missing hand. We show that representation of the missing hand’s individual fingers persists in the primary somatosensory cortex even decades after Arm Amputation. By demonstrating stable topography despite Amputation, our finding questions the extent to which continued sensory input is necessary to maintain organisation in sensory cortex, thereby reopening the question what happens to a cortical territory once its main input is lost. The discovery of persistent digit topography of amputees’ missing hand could be exploited for the development of intuitive and fine-grained control of neuroprosthetics, requiring neural signals of individual digits.