Nerve-muscle grafts in amputees for prosthesis control

描述(申请人提供)：目前，肌电假体经胸段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。我们认为，截肢者残存的臂丛神经可以移植到二头肌、三头肌和臂肌的不同部位，这些神经-肌肉移植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。这将允许以更自然的感觉同时控制多个自由度。该技术在改善肌电假体的控制方面具有很大的潜力。 一系列的实验表明，这一概念是可行的，成功的概率很高。由于肌肉将得到供体神经的高度再支配，肌肉有望得到良好的恢复。大量的肌电建模研究表明，来自不同神经肌肉移植物的表面肌电信号将能够提供谨慎和独立的控制信号，从而允许终端设备、肘部和腕部旋转器的同时操作。 我们建议对近期经胸骨截肢者进行神经肌肉移植技术的小型、精心策划的临床试验。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，手术将切断二头肌和臂肌的内侧头神经，然后将正中和远端的放射状神经移植到这些肌肉上。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移植物来控制肌电手，以及二头肌和三头肌的外侧头来控制动力肘部。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。

DESCRIPTION (provided by applicant): Currently transhumeral 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. We believe that the residual brachial plexus nerves in a transhumeral amputee can be grafted onto separate regions of the biceps, triceps and brachialis muscles and that these nerve-muscle grafts could provide additional myoelectric control signals that are physiologically related to the functions they would be controlling in the prosthesis. This would allow simultaneous control of multiple degrees-of-freedom with a more natural feel. The technique has great potential for improving the control of transhumeral myoelectric prostheses. A series of experiments have been performed that indicate the concept is feasible with a high probability of success. Since the muscles will be 'hyper-reinnervated' by the donor nerve, good muscle recovery is expected. Extensive EMG modeling studies indicate that surface EMG signals from the different nerve-muscle grafts will be able to provide discreet and independent control signals allowing simultaneous operation of a terminal device, elbow and wrist rotator. We propose a small, carefully orchestrated clinical trial of the nerve-muscle graft technique in recent transhumeral amputees. Baseline testing will be done with a conventional myoelectric prosthesis to measure operational performance. With IRB approval, surgery will be performed to denervate the medial head of the biceps and brachialis muscles, then graft the median and distal radial nerves on to these muscles. 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 grafts to control a myoelectric hand and the lateral head of the biceps and the triceps to control the powered elbow. Performance testing will be repeated with the experimental myoelectric system for comparison to conventional measures.