Application of Targeted Reinnervation for People with Transradial Amputation

靶向神经再生在经桡动脉截肢患者中的应用

• 批准号: 8767628
• 负责人: Todd Kuiken
• 金额: $ 59.5万
• 依托单位: REHABILITATION INSTITUTE OF CHICAGO D/B/A SHIRLEY RYAN ABILITYLAB
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-20 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8767628
• 关键词: Accounting; Activities of Daily Living; Algorithms; Amputation; Amputees; Anatomy; Bionics; Cadaver; Chicago; Clinical; Clinical Trials; Complex; Contracts; Cross-Over Studies; Custom; Data; Development; Devices; Forearm; Freedom; Goals; Hand; Home environment; Individual; Institutes; Joints; Licensing; Life Style; Limb structure; Medical center; Medicine; Military Personnel; Movement; Multicenter Studies; Muscle; Myoelectric prosthesis; Nerve; Nerve Transfer; Operative Surgical Procedures; Outcome; Pattern; Pattern Recognition; Pattern Recognition Systems; Performance; Phase; Population; Postoperative Period; Procedures; Production; Prosthesis; Quality of life; Randomized; Recruitment Activity; Rehabilitation therapy; Relative (related person); Research; Rotation; Shoulder; Signal Transduction; Site; Structure of ulnar nerve; Surgical Disarticulation; Surveys; System; Techniques; Technology; Testing; Thumb structure; Trauma; Upper Extremity; Veterans; Wrist; arm; cost; density; disability; experience; falls; grasp; hand grasp; improved; limb amputation; median nerve; motor control; operation; public health relevance; reinnervation; research study

DESCRIPTION (provided by applicant): Transradial amputation is the most common level of major upper limb amputation, accounting for an estimated 40% of upper limb loss in the US civilian population and 50% in the US military veteran population over the last decade. Most individuals experience transradial amputation due to trauma, are young, and need prostheses that allow them to resume an active, productive lifestyle. Current prostheses do not provide adequate function, and newer, multifunction prostheses (that are capable of many different hand grasps) cannot be adequately controlled by current control strategies. Poor function is a major factor in high rates of prosthesis rejection in transradial amputees, which contributes to increased disability for these individuals. We have developed a surgical technique, called targeted muscle reinnervation (TMR) in which severed nerves that used to carry important control information to the missing limb are transferred to new 'target' muscles. After reinnervation, the target muscles contract whenever the individual attempts to move their missing arm, generating electrical EMG signals that can be used to control analogous movements in a prosthesis. TMR thus provides access to valuable but previously unavailable control information. Pattern recognition algorithms, developed by CBM-RIC, can decode this rich EMG information to enable intuitive control of many more functions; the user simply has to attempt to make the desired arm or hand movement. This pattern recognition system technology has been licensed for commercial production and will be available for clinical implementation within the next year. Combining TMR with pattern recognition in higher-level arm amputees has resulted in substantially improved control of more DOFs, and control is easier and more intuitive for the user. The goal of this multicenter study is to develop surgical techniques for transradial TMR and to evaluate the benefits of TMR in transradial amputees by performing clinical trials to compare pattern recognition control, before and after TMR, with a conventional control strategy (before TMR). The median and ulnar nerves, which carry control information for intrinsic hand muscles involved in many hand grasps, will be transferred to forearm muscles. Subjects will use a state-of-the-art multifunction prosthesis-with either pattern recognition or conventional control-in activities of daily living during 8-week home trials, followd by comprehensive functional testing and user surveys. Preliminary cadaver and surgical studies indicate that transradial TMR is simple and feasible; data from higher-level TMR amputees indicate that when combined with pattern recognition, TMR provides improved control of multiple hand grasps. We expect that TMR, with pattern recognition, will allow transradial amputees to control more hand grasps more easily and more intuitively. Development of transradial TMR will enable these individuals to control highly dexterous prosthetic hands. It will also undoubtedly stimulate new research into advanced control systems and enable the development of more advanced mechatronic devices.

描述（由申请人提供）：经桡骨截肢是最常见的主要上肢截肢，在过去十年中，估计占美国平民上肢损失的40%，占美国退伍军人上肢损失的50%。大多数经历过经桡骨截肢的人都是年轻人，他们需要假肢来恢复积极、富有成效的生活方式。目前的假肢不能提供足够的功能，而更新的多功能假肢（能够许多不同的手握）不能被当前的控制策略充分控制。功能不良是经桡骨截肢患者假体排斥率高的一个主要因素，这有助于增加这些个体的残疾。我们已经开发了一种手术技术，称为靶向肌肉神经再生（TMR），在这种技术中，被切断的神经被转移到新的“目标”肌肉上，而这些神经曾经承载着对缺失肢体的重要控制信息。在神经移植后，每当个体试图移动他们失去的手臂时，目标肌肉就会收缩，产生电肌电信号，可用于控制假肢的类似运动。因此，TMR提供了对有价值但以前无法获得的控制信息的访问。CBM-RIC开发的模式识别算法可以解码这些丰富的肌电信息，从而实现对更多功能的直观控制；用户只需要尝试做出想要的手臂或手的运动。这种模式识别系统技术已经获得商业生产许可，并将在明年用于临床实施。将TMR与模式识别相结合，在更高级别的手臂截肢者中，大大改善了对更多自由度的控制，并且对用户来说控制更容易，更直观。本多中心研究的目的是开发经桡骨TMR手术技术，并通过临床试验比较模式识别控制（TMR前后）与传统控制策略（TMR前），评估TMR对经桡骨截肢者的益处。掌内侧神经和尺侧神经携带的控制信息会被转移到前臂肌肉。在为期8周的家庭试验中，受试者将使用最先进的多功能假肢（模式识别或传统控制）进行日常生活活动，随后进行全面的功能测试和用户调查。初步的尸体和手术研究表明，经桡骨TMR是简单可行的；来自高级TMR截肢者的数据表明，当与模式识别相结合时，TMR可以改善对多个手握的控制。我们期望TMR，加上模式识别，将允许经桡骨截肢者更容易、更直观地控制更多的手握。经桡骨TMR的发展将使这些人能够控制高度灵巧的假手。它将