Nerve-muscle grafts in amputees for prosthesis control

描述（由申请人提供）：目前，经肱骨截肢者只能使用肌电假体一次操作一个自由度。这是非常不够的，因为需要控制多个功能。我们相信，在经股动脉截肢者的残余臂丛神经可以移植到二头肌，三头肌和肱二头肌的单独区域，这些神经肌肉移植物可以提供额外的肌电控制信号，生理相关的功能，他们将在假体控制。这将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，以提高控制的经肱骨肌电假肢。 一系列的实验表明，该概念是可行的，成功的概率很高。由于肌肉将被供体神经“超神经支配”，因此预期肌肉恢复良好。广泛的EMG建模研究表明，来自不同神经肌肉移植物的表面EMG信号将能够提供离散和独立的控制信号，允许终端设备、肘和腕旋转器的同时操作。 我们提出一个小的，精心策划的临床试验的神经肌肉移植技术在最近的经肱骨截肢者。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，将进行手术以使二头肌和肱肌的内侧头去神经，然后将正中和远端桡神经移植到这些肌肉上。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移植物来控制肌电手以及二头肌和三头肌的侧头来控制动力肘。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。

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.