TARGETED HYPER-REINNERVATION TO IMPROVE MYOELECTRIC PROSTHESIS CONTROL

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。肩关节脱臼和经肱骨截肢患者的假体控制明显比远端截肢患者的假体控制困难。截肢者在协调义肢肩部、肘部、腕部和手部组件的独立功能方面存在很大困难。用户必须在随后移动另一个关节之前将一个关节锁定在空间的特定位置。对于截肢者来说，这些设备的使用很少是直观的。尽管在上肢截肢后失去了功能，但周围神经仍然携带来自大脑的信息。我们的策略是使用标准的外周神经手术和肌肉瓣手术技术将截肢的手臂神经残端与胸部和上臂没有功能的残余肌肉连接起来。接受这些新神经转移的肌肉段随后充当周围神经系统电信号的生物放大器。在病人自愿控制下引起的肌肉收缩可以通过表面肌电电极检测到，并可用于肌电假体的信号。这个手术创造了一个有用的脑机接口，它平滑，直观，并且第一次允许同时控制多个假体关节。

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. The control of prostheses for patients with shoulder disarticulations and transhumeral amputations is significantly more difficult than that of prostheses for more distal amputations. Amputees have significant difficulties coordinating the separate functions of prosthetic shoulder, elbow, wrist, and hand components. The user must lock one joint at a particular position in space before subsequently moving a different joint. Use of the devices seldom becomes intuitive for the amputee. Peripheral nerves still carry information from the brain, despite having no function after the amputation of the upper extremity. Our strategy is to surgically link the amputated nerve stumps of the arm to otherwise functionless residual muscles of the chest and upper arm using standard techniques of peripheral nerve surgery and muscle flap surgery. Muscle segments which receive these novel nerve transfers then act as bio-amplifiers of the electric signals of the peripheral nervous system. The muscle contractions elicited under voluntary control of the patient are detectable by surface EMG electrodes, and can be used to signal a myoelectric prosthesis. This surgery creates a useful brain-machine interface which is smooth, intuitive, and for the first time allows the simultaneous control of multiple prosthesis joints.