TARGETED REINNERVATION TO IMPROVE MYOELECTRIC PROSTHESIS FUNCTION

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 目前，上肢截肢者只能操作一个自由度的时间与肌电假肢。 这是非常不够的，因为需要控制多个功能，特别是高位截肢，如经肱骨（TH）和肩关节离断（SD）。 此外，他们对假肢没有感觉-他们收到的唯一反馈是来自观察手臂的视觉反馈和来自听到马达的听觉反馈。 使用我们开发的一种称为“靶向神经再支配”的技术，我们已经证明截肢者的残余手臂神经可以转移到肌肉的不同区域，并且神经再支配的肌肉可以提供与它们在假肢中控制的功能生理相关的额外肌电控制信号。 这允许以更自然的感觉同时控制多个自由度。 该技术具有很大的潜力，以改善控制的肌电假肢。 此外，通过用手神经重新支配残留区域中的皮肤，存在重要的触觉感觉反馈的潜力。 通过在假手中放置传感器，并在重新神经支配的皮肤上施加压力，截肢者实际上可以感知到他或她用假手挤压的力度，就好像假手在他们失去的手上一样。 我们的第一个系列的四个病人已经非常成功。 1名SD受试者和3名TH截肢者中的2名成功进行了有针对性的运动神经再支配。 这使得他们能够使用生理上合适的神经信号同时控制他们的动力手和肘部。 SD患者还进行了有针对性的神经再支配，使得当触摸他的胸部时，他可以感觉到他的缺失肢体的轻触、分级压力、尖锐/钝感，甚至热和冷。 我们建议在最近的TH和SD截肢者中继续进行精心策划的靶向神经再支配技术的临床试验，以完善该程序。 基线测试将使用传统的肌电假肢来测量操作性能。 经IRB批准后，将进行手术以使残肢内或附近的肌肉或肌肉部分失神经支配，并将残余神经转移到这些肌肉。 支配残肢皮肤的皮神经也将被转移以吻合到残余的手神经，以提供有针对性的感觉反馈。 一旦肌肉被重新神经支配，病人将被安装一个适当修改的肌电假肢，并接受使用训练。 然后，患者将能够使用神经转移肌肉部位来控制肌电手、动力肘和可能的动力腕（所有这些都以自然的方式同时进行）。 将使用实验性肌电系统重复性能测试，以与常规测量进行比较。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Currently, upper limb amputees can only operate a single degree-of-freedom at a time with myoelectric prostheses. This is very inadequate since multiple functions need to be controlled, especially with high-level amputations such as transhumeral (TH) and shoulder disarticulation (SD). Furthermore, they have no feeling with a prosthesis - the only feedback they receive is visual feedback from watching the arm and a bit of auditory feedback from hearing the motors. Using a technique we have developed, called 'Targeted Reinnervation', we have demonstrated that the residual arm nerves in amputees can be transferred onto separate regions of muscle and that the reinnervated muscle can provide additional myoelectric control signals that are physiologically related to the functions they would be controlling in the prosthesis. This allows simultaneous control of multiple degrees-of-freedom with a more natural feel. The technique has great potential for improving the control of myoelectric prostheses. Furthermore, the potential exists for important tactile sensory feedback by reinnervating skin in the residual regions with hand nerves. By placing sensors in the prosthetic hand and giving pressure over the reinnervated skin, the amputee actually perceives how hard he or she is squeezing with the prosthetic hand as if it were in their missing hand. Our first series of four patients has been very successful. One subject with a SD and 2 of 3 TH amputees have had successful targeted motor reinnervation. This has allowed them to simultaneously control their powered hands and elbows using physiologically appropriate nerve signals. The SD patient has also had targeted reinnervation such that he can feel light touch, graded pressure, sharp/dull and even hot and cold in his missing limb when touched on his chest. We propose a continued, carefully orchestrated clinical trial of the targeted reinnervation technique in recent TH and SD amputees to refine the procedure. Baseline testing will be done with a conventional myoelectric prosthesis to measure operational performance. With IRB approval, surgery will be performed to denervate muscles, or parts of muscles, in or near the residual limb and transfer the residual nerves to these muscles. Cutaneous nerves innervating residual limb skin will also be transferred for anastomosis to the residual hand nerves to provide targeted sensory feedback. Once the muscles are reinnervated, the patient will be fit with an appropriately modified myoelectric prosthesis and trained in its use. The patient will then be able to use the nerve transfer muscle sites to control a myoelectric hand, powered elbow and possibly a powered wrist (all simultaneously in a natural fashion). Performance testing will be repeated with the experimental myoelectric system for comparison to conventional measures.