The Experts below are selected from a list of 1971 Experts worldwide ranked by ideXlab platform
Todd A. Kuiken - One of the best experts on this subject based on the ideXlab platform.
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Novel intramedullary device for lengthening transfemoral residual limbs
Journal of Orthopaedic Surgery and Research, 2017Co-Authors: Todd A. Kuiken, Bennet A. Butler, Tom Sharkey, Daniel Li, Terrance D. PeabodyAbstract:Background Lower limb loss is a highly disabling medical condition that can severely impact a person’s quality of life. Recovery becomes especially challenging if an amputee has a short residual limb, which can complicate proper Prosthetic Fitting, causing discomfort, difficulties in suspension, and reduced mobility. Current limb lengthening techniques such as the Ilizarov apparatus and external fixators are cumbersome, uncomfortable, and have high complication rates. In this study, we investigated the effectiveness of a novel limb-lengthening device that uses intramedullary bone lengthening and requires only one percutaneous rod at the end of the limb during the distraction phase. Only the intramedullary nail remains after the distraction phase, and no external components are required during the consolidation phase. We hypothesize that this system would create a much easier experience for the patient. Methods The system was first tested in a mock surgical implantation using plastic femur bones. The device was then tested in a series of cadaveric experiments using pelvis-to-knee specimens by a group of surgeons. Surgeons evaluated the surgical insertion technique, soft tissue considerations, hardware fixation strategies, and the effectiveness of the distraction mechanism. Revisions and improvements to the device and surgical procedure were made based on the results from the cadaveric experiments. Results A questionnaire was given to two visiting surgeons following the final iteration of the device. The surgeons reported that the system effectively lengthened the limb, was sturdy, and could be installed efficiently. However, there remains a risk of infection and soft tissue imbalances, similar to that introduced by an external fixator device. Suggestions on how to improve the design of the device and mitigate infection through postoperative management and surgical standard of care will be considered for future clinical trials. Conclusions The described intramedullary residual limb-lengthening device has evolved from a prototype to a mature model tested in six cadaveric experiments to date. Further mechanical and functional testing is needed to finalize the device before testing in patients.
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targeted muscle reinnervation a neural interface for artificial limbs
2013Co-Authors: Todd A. Kuiken, Aimee E. Schultz Feuser, Ann K. BarlowAbstract:Introduction to Targeted Reinnervation, Todd A. Kuiken The Scientific Basis of Targeted Muscle Reinnervation, Todd A. Kuiken Principles of Targeted Muscle Reinnervation Optimization of the EMG Signal Surgical Techniques for Targeted Muscle Reinnervation, Gregory A. Dumanian and Jason M. Souza Fundamentals of Targeted Musscle Reinnervation Surgery Targeted Muscle Reinnervation for the Transhumeral Amputee Targeted Muscle Reinnervation for the Shoulder Disarticulation Amputee Targeted Sensory Reinnervation Targeted Muscle Reinnervation as a Strategy for Neuroma Prevention, Jason H. Ko, Peter S. Kim, and Douglas G. Smith Neuroma Pathophysiology Treatment of Neuromas TMR as a Strategy for Neuroma Prevention Rehabilitation of the Targeted Muscle Reinnervation Patient, Todd A. Kuiken Presurgical Evaluation Patient and Team Education Potential Surgical Complications Prosthetic Fitting before and after Targeted Muscle Reinnervation, Laura A. Miller and Robert D. Lipschutz Presurgical Considerations Postsurgical Reinnervation (Interim) Period Post-Reinnervation Fitting Occupational Therapy for the Targeted Muscle Reinnervation Patient, Kathy A. Stubblefield and Todd A. Kuiken Presurgical Program Postsurgical Program Targeted Sensory Reinnervation, Paul D. Marasco Sensory Perception and Feedback in Prostheses Transfer Sensation in Targeted Reinnervation Amputees Application of Transfer Sensation for Sensory Feedback Surgical and Functional Outcomes of Targeted Muscle Reinnervation, Laura A. Miller, Kathy A. Stubblefield, Robert D. Lipschutz, Blair A. Lock, Jason M. Souza, Gregory A. Dumanian, and Todd A. Kuiken Surgical Goals Assessment of Functional Outcomes at RIC Future Research Directions, Levi J. Hargrove and Blair A. Lock Improvements in Control Algorithms Extension of TMR to Transradial and Lower Limb Amputations Advanced Prosthetic Systems Index References appear at the end of each chapter.
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Prosthetic Command Signals Following Targeted Hyper-Reinnervation Nerve Transfer Surgery
2005 IEEE Engineering in Medicine and Biology 27th Annual Conference, 2006Co-Authors: Todd A. Kuiken, Robert D Lipschutz, K A Stubblefield, L.a. Miller, G.a. DumanianAbstract:High-level upper-limb amputations result in prostheses with many degrees-of-freedom to be controlled, with very few control signals. A novel method for the control of myoelectric upper limb prostheses has been developed. By transferring the residual nerves to spare muscles in or near the residual limb, additional myoelectric control signals are created that allow the simultaneous control of multiple degrees-of-freedom in the prostheses. Since the nerve function correlates physiologically to the Prosthetic function, operation is more natural and thus easier than current control paradigms. This surgical procedure and subsequent Prosthetic Fitting have been successfully completed on one shoulder disarticulation and one transhumeral amputee. The shoulder disarticulation amputee has also been fit with a unique 6 motor system, allowing him to control 3 motors (hand, elbow, and humeral rotator) with the use of 6 myoelectric signals; there was marked increase in functional range-of-motion. He was able to control multiple joints simultaneously and could perform tasks that he could not do before, including reaching out to pick up objects
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Fitting and outcomes of a bilateral shoulder disarticulation amputee following targeted hyper reinnervation nerve transfer surgery
2005Co-Authors: Laura A. Miller, Robert D Lipschutz, K A Stubblefield, Todd A. KuikenAbstract:INTRODUCTION With higher levels of amputation, there are more movements and Prosthetic joints that need to be controlled; yet there are fewer control signals remaining to control these multiple degrees-of-freedom. Traditional Fitting of a shoulder disarticulation amputee with a myoelectric system uses 2-sites and sequential control. This can be tedious and slow. When an amputation has occurred, the musculature is gone, however, the nerves that controlled the arm remain. The goal of the targeted hyper-reinnervation nerve transfer surgery was to create additional sites using these nerves to allow simultaneous control of multiple movements using more natural control schemes [1,2,3]. Following an experimental nerve transfer procedure, 4 new myoelectric signals were created on the left pectoralis muscle for a single bilateral shoulder disarticulation (BSD) amputee using nerves that previously controlled hand and elbow function. Subsequent Prosthetic Fitting found that the user was able to operate the elbow and hand in a coordinated fashion and various outcome measurements showed and improvement in Prosthetic function.
Zubaidi Alfan - One of the best experts on this subject based on the ideXlab platform.
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Perbedaan Pengaruh Penggunaan Transtibial Prosthesis Dan Axial Crutch Terhadap Keseimbangan Pasien Post Amputasi Transtibial
'Poltekkes Kemenkes Surakarta', 2017Co-Authors: Rachmat Nur, Zubaidi AlfanAbstract:Abstract: Transtibial Prosthesis, Walking Balance, Axilla Crutch, Post Transtibial Amputation. This study aims to determine the effect of the use of transtibial prosthesis and axial crutch on the balance of transtibial post amputation patient. This research is hoped to be beneficial to the benefit of people who have transtibial amputation in order to obtain the appropriate balance. This research method is Quantitative research, pre experiment, using research design one groups pre and post test design, where in this research there is only one group of subjects that will be measured equilibrium using prosthesis and axial crutch. Research conducted at PT. Kuspito Ortotik Prostetik. In this research, there are two variables, namely (1) dependent variable, balance, (2) independent variables are use of transtibial prosthesis and axial crutch. Data collection is done in two stages, first and second phase. In the first stage, the researcher records the client identity that has been defined as the research subject (sample), including name, gender, age, address, and examination to establish the type of patient who meets the inclusion criteria. Afterwards, measurements were made on patients using transtibial prostheses and recording the results of the treatment group in terms of their equilibrium values. In the second stage of data collection, measurements were taken in patients using axial crutch and recording the results of the treatment group in terms of their equilibrium value. The instruments used are TUG Test equipment (armrest and armrest seats, stopwatch, wall, stationery). Data were analyzed with SPSS for Win13.00 for Windows software. Test the normality of data using Shapiro-Wilk normality test. The results showed that there was a difference of effect of axial crutch with prosthesis on post amputation patient equilibrium (0,017 <0,05), it is also known that average equilibrium in group of axial crutch (18,46) while mean balance in group Prosthesis (20,84). Crutches are walking sticks, usually used in pairs that are created to regulate the balance at the time of going and sustaining the user's body. Axilla crutches are not designed to rest during support of the body. To minimize the inconvenience of using axilla crutches, a prosthesis is created which, when an amputation patient has been determined to use a prosthesis, determines the purpose of Prosthetic Fitting, whether functional, cosmetic or both
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PERBEDAAN PENGARUH PENGGUNAAN TRANSTIBIAL PROSTHESIS DAN AXIAL CRUTCH TERHADAP KESEIMBANGAN PASIEN POST AMPUTASI TRANSTIBIAL
Interest : Jurnal Ilmu Kesehatan, 2017Co-Authors: Rachmat Nur, Zubaidi AlfanAbstract:Abstract: Transtibial Prosthesis, Walking Balance, Axilla Crutch, Post Transtibial Amputation. This study aims to determine the effect of the use of transtibial prosthesis and axial crutch on the balance of transtibial post amputation patient. This research is hoped to be beneficial to the benefit of people who have transtibial amputation in order to obtain the appropriate balance. This research method is Quantitative research, pre experiment, using research design one groups pre and post test design, where in this research there is only one group of subjects that will be measured equilibrium using prosthesis and axial crutch. Research conducted at PT. Kuspito Ortotik Prostetik. In this research, there are two variables, namely (1) dependent variable, balance, (2) independent variables are use of transtibial prosthesis and axial crutch. Data collection is done in two stages, first and second phase. In the first stage, the researcher records the client identity that has been defined as the research subject (sample), including name, gender, age, address, and examination to establish the type of patient who meets the inclusion criteria. Afterwards, measurements were made on patients using transtibial prostheses and recording the results of the treatment group in terms of their equilibrium values. In the second stage of data collection, measurements were taken in patients using axial crutch and recording the results of the treatment group in terms of their equilibrium value. The instruments used are TUG Test equipment (armrest and armrest seats, stopwatch, wall, stationery). Data were analyzed with SPSS for Win13.00 for Windows software. Test the normality of data using Shapiro-Wilk normality test. The results showed that there was a difference of effect of axial crutch with prosthesis on post amputation patient equilibrium (0,017 <0,05), it is also known that average equilibrium in group of axial crutch (18,46) while mean balance in group Prosthesis (20,84). Crutches are walking sticks, usually used in pairs that are created to regulate the balance at the time of going and sustaining the user's body. Axilla crutches are not designed to rest during support of the body. To minimize the inconvenience of using axilla crutches, a prosthesis is created which, when an amputation patient has been determined to use a prosthesis, determines the purpose of Prosthetic Fitting, whether functional, cosmetic or both. Keywords: Transtibial Prosthesis, Walking Balance, Axilla Crutch, Post Transtibial Amputation LINK OJS 3 ARTIKEL "PERBEDAAN PENGARUH PENGGUNAAN TRANSTIBIAL PROSTHESIS DAN AXIAL CRUTCH TERHADAP KESEIMBANGAN PASIEN POST AMPUTASI TRANSTIBIAL
Nicolas E Walsh - One of the best experts on this subject based on the ideXlab platform.
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successful Prosthetic Fitting of a 73 year old hip disarticulation amputee patient with cardiopulmonary disease
Archives of Physical Medicine and Rehabilitation, 1998Co-Authors: Robert D Mcanelly, Manouchehr Refaeian, Dennis G Oconnell, Gregory D Powell, Nicolas E WalshAbstract:Abstract Patients with hip disarticulation (HD) require high energy expenditure for successful Prosthetic ambulation. Thus, older patients are rarely fitted with an HD prosthesis. To our knowledge there are no reports of gait analysis following successful Prosthetic Fitting of an elderly HD amputee patient with systemic cardiopulmonary disease. We report the case of successful Prosthetic ambulation in a 73-year-old man with HD secondary to histiosarcoma and a medical history significant for stable angina, chronic obstructive pulmonary disease, and diabetes mellitus. The patient underwent gait training with an endoskeletal prosthesis and achieved ambulation to 400 feet with bilateral forearm crutches. Vicon kinematic gait analysis revealed a cadence of 44steps/min (112steps/min normal), and double support time of 47% (26% normal). Oxygen rate during ambulation (Vo 2 ) was 11.0mL/kg/min at velocity of .35m/sec, compared with published figures for ambulation in those with HD of 10.73mL/kg/min at velocity of .93m/sec. At 1-year follow-up, the patient continued to walk into church with the prosthesis. We conclude that a trial Fitting of an HD prosthesis should be considered on an individual basis in elderly amputee patients.
Stefan Salminger - One of the best experts on this subject based on the ideXlab platform.
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Rehabilitation of high upper limb amputees after Targeted Muscle Reinnervation.
Journal of hand therapy : official journal of the American Society of Hand Therapists, 2020Co-Authors: Agnes Sturma, Stefan Salminger, Clemens Gstoettner, Birgit Bischof, Tanja A. Stamm, Laura A. Hruby, Cosima Prahm, Anna Pittermann, Robert Wakolbinger, Christian HoferAbstract:Abstract Study Design This is a Delphi study based on a scoping literature review. Introduction Targeted muscle reinnervation (TMR) enables patients with high upper limb amputations to intuitively control a Prosthetic arm with up to six independent control signals. Although there is a broad agreement regarding the importance of structured motor learning and Prosthetic training after such nerve transfers, to date, no evidence-based protocol for rehabilitation after TMR exists. Purpose of the Study We aimed at developing a structured rehabilitation protocol after TMR surgery after major upper limb amputation. The purpose of the protocol is to guide clinicians through the full rehabilitation process, from presurgical patient education to functional Prosthetic training. Methods European clinicians and researchers working in upper limb Prosthetic rehabilitation were invited to contribute to a web-based Delphi study. Within the first round, clinical experts were presented a summary of recent literature and were asked to describe the rehabilitation steps based on their own experience and scientific evidence. The second round was used to refine these steps, while the importance of each step was rated within the third round. Results Experts agreed on a rehabilitation protocol that consists of 16 steps and starts before surgery. It is based on two overarching principles, namely the necessity of multiprofessional teamwork and a careful selection and education of patients within the rehabilitation team. Among the different steps in therapy, experts rated the training with electromyographic biofeedback as the most important one. Discussion Within this study, a first rehabilitation protocol for TMR patients based on a broad experts' consensus and relevant literature could be developed. The detailed steps for rehabilitation start well before surgery and Prosthetic Fitting, and include relatively novel interventions as motor imagery and biofeedback. Future studies need to further investigate the clinical outcomes and thereby improve therapists’ practice. Conclusion Graded rehabilitation offered by a multiprofessional team is needed to enable individuals with upper limb amputations and TMR to fully benefit from Prosthetic reconstruction. Level of Evidence Low.
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functional and psychosocial outcomes of hand transplantation compared with Prosthetic Fitting in below elbow amputees a multicenter cohort study
PLOS ONE, 2016Co-Authors: Stefan Salminger, Agnes Sturma, Laura A. Hruby, Stefan Schneeberger, Marina Ninkovic, Aidan D Roche, Tatjana Paternostrosluga, Martin Kumnig, Gerhard Pierer, M GablAbstract:Background Hand-transplantation and improvements in the field of prostheses opened new frontiers in restoring hand function in below-elbow amputees. Both concepts aim at restoring reliable hand function, however, the indications, advantages and limitations for each treatment must be carefully considered depending on level and extent of amputation. Here we report our findings of a multi-center cohort study comparing hand function and quality-of-life of people with transplanted versus Prosthetic hands. Methods Hand function in amputees with either transplant or prostheses was tested with Action Research Arm Test (ARAT), Southampton Hand Assessment Procedure (SHAP) and the Disabilities of the Arm, Shoulder and Hand measure (DASH). Quality-of-life was compared with the Short-Form 36 (SF-36). Results Transplanted patients (n = 5) achieved a mean ARAT score of 40.86 ± 8.07 and an average SHAP score of 75.00 ± 11.06. Prosthetic patients (n = 7) achieved a mean ARAT score of 39.00 ± 3.61 and an average SHAP score of 75.43 ± 10.81. There was no significant difference between transplanted and Prosthetic hands in ARAT, SHAP or DASH. While quality-of-life metrics were equivocal for four scales of the SF-36, transplanted patients reported significantly higher scores in “role-physical” (p = 0.006), “vitality” (p = 0.008), “role-emotional” (p = 0.035) and “mental-health” (p = 0.003). Conclusions The indications for hand transplantation or Prosthetic Fitting in below-elbow amputees require careful consideration. As functional outcomes were not significantly different between groups, patient’s best interests and the route of least harm should guide treatment. Due to the immunosuppressive side-effects, the indication for allotransplantation must still be restrictive, the best being bilateral amputees.
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Hand Transplantation Versus Hand Prosthetics: Pros and Cons
Current Surgery Reports, 2016Co-Authors: Stefan Salminger, Agnes Sturma, A. D. Roche, J. A. Mayer, O. C. AszmannAbstract:Composite tissue transplantation and new developments in the field of Prosthetics have opened new frontiers in the restoration of function among upper limb amputees. It is now possible to restore hand function in affected patients; however, the indications, advantages, and limitations for either hand transplantation or Prosthetic Fitting must be carefully considered depending on the level and extent of the limb loss. Hand transplantation allows comprehensive hand function to be restored, yet composite tissue transplantation comes with disadvantages, making this method a controversial topic in the hand surgical community. Alternatively, Prosthetic limb replacement represents the standard of care for upper limb amputees, but results in the known limitations of function, sensation, and usage. The indication for hand transplantation or Prosthetic Fitting strongly depends on the level of amputation, as well as on the extent (unilateral/bilateral) of the amputation. In this review, we discuss the advantages and disadvantages of hand transplantation and Prosthetic replacement for upper limb amputees in general, as well as in regard to the different levels of amputation.
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bionic reconstruction to restore hand function after brachial plexus injury a case series of three patients
The Lancet, 2015Co-Authors: O. C. Aszmann, Stefan Salminger, Agnes Sturma, Christian Hofer, Aidan D Roche, Tatjana Paternostrosluga, Malvina Herceg, Dario FarinaAbstract:Summary Background Brachial plexus injuries can permanently impair hand function, yet present surgical reconstruction provides only poor results. Here, we present for the first time bionic reconstruction; a combined technique of selective nerve and muscle transfers, elective amputation, and Prosthetic rehabilitation to regain hand function. Methods Between April 2011, and May 2014, three patients with global brachial plexus injury including lower root avulsions underwent bionic reconstruction. Treatment occurred in two stages; first, to identify and create useful electromyographic signals for Prosthetic control, and second, to amputate the hand and replace it with a mechatronic prosthesis. Before amputation, the patients had a specifically tailored rehabilitation programme to enhance electromyographic signals and cognitive control of the prosthesis. Final Prosthetic Fitting was applied as early as 6 weeks after amputation. Findings Bionic reconstruction successfully enabled Prosthetic hand use in all three patients. After 3 months, mean Action Research Arm Test score increased from 5·3 (SD 4·73) to 30·7 (14·0). Mean Southampton Hand Assessment Procedure score improved from 9·3 (SD 1·5) to 65·3 (SD 19·4). Mean Disabilities of Arm, Shoulder and Hand score improved from 46·5 (SD 18·7) to 11·7 (SD 8·42). Interpretation For patients with global brachial plexus injury with lower root avulsions, who have no alternative treatment, bionic reconstruction offers a means to restore hand function. Funding Austrian Council for Research and Technology Development, Austrian Federal Ministry of Science, Research & Economy, and European Research Council Advanced Grant DEMOVE.
Warren C. Breidenbach - One of the best experts on this subject based on the ideXlab platform.
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major replantation versus revision amputation and Prosthetic Fitting in the upper extremity a late functional outcomes study
Journal of Hand Surgery (European Volume), 1998Co-Authors: Brent Graham, P Adkins, Tsumin Tsai, J Firrell, Warren C. BreidenbachAbstract:The functional outcomes of amputated arms that were either replanted or had a prosthesis were compared. In addition, factors that influenced the functional outcome of replants were evaluated. The Carroll test was used to evaluate functional capacity of 22 successful upper extremity replantations at or proximal to the wrist as well as 22 amputees (at similar levels) fitted with a variety of Prosthetic devices. The outcome was excellent or good in 8 (36%) replanted limbs. This proportion was statistically higher than those grades in the Prosthetic group. When the groups were more closely matched (adults with below elbow injuries), the replantation group had 6 (50%) good or excellent outcomes and the Prosthetic group had none. An analysis of covariance of the replatations demonstrated a statistical association between a better outcome in younger patients with more distal injuries. This study indicates that replantation produces superior functional results compared with amputation and a prosthesis.
