TARGETED REINNERVATION TO IMPROVE MYOELECTRIC PROSTHESIS FUNCTION

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 目前，使用肌电假体的上肢截肢者一次只能操作一个自由度。这是非常不够的，因为需要控制多种功能，特别是对于高位截肢，如经尺骨(TH)和肩关节脱位(SD)。此外，他们对假肢没有感觉--他们得到的唯一反馈是观察手臂时的视觉反馈，以及听到马达时的一点听觉反馈。使用我们开发的一种名为“靶向再支配”的技术，我们已经证明截肢者的残馀手臂神经可以转移到肌肉的不同区域，并且再神经支配的肌肉可以提供额外的肌电控制信号，这些信号在生理上与它们在假体中控制的功能有关。这允许同时控制多个自由度，具有更自然的手感。这项技术在改善肌电假体的控制方面具有巨大的潜力。此外，通过用手神经重新支配残留区的皮肤，有可能产生重要的触觉感觉反馈。通过在假手上放置传感器并对重新支配的皮肤施加压力，截肢者实际上感觉到他或她用假手挤压的力度有多大，就好像它在他们失去的手中一样。 我们的第一个系列的四名患者非常成功。一名患有SD的受试者和第二名截肢者已经成功地进行了靶向运动神经再支配.这使得他们能够同时使用生理上合适的神经信号来控制他们有动力的手和肘部。这位SD患者还进行了有针对性的神经再支配，当触摸到他的胸部时，他可以感觉到失去的肢体轻触、分级压力、尖锐/迟钝，甚至冷热。 我们建议在最近的TH和SD截肢者中继续进行一项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。将使用传统的肌电假体进行基线测试，以衡量操作性能。在获得IRB批准的情况下，将进行手术，使残肢内或附近的肌肉或部分肌肉失神经，并将残馀神经转移到这些肌肉。支配残肢皮肤的皮神经也将被转移，以便与残手神经吻合，以提供有针对性的感觉反馈。一旦肌肉重新获得神经，患者将安装适当改装的肌电假体，并接受使用培训。然后，患者将能够使用神经转移肌肉部位来控制肌电手、动力肘部和可能的动力手腕(所有这些都以自然的方式同时进行)。性能测试将与实验肌电系统重复进行，以与传统测量进行比较。

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.