The influence of 3D printed prostheses on neural activation patterns of the primary motor cortex in children with unilateral congenital upper-limb reductions

在美国，超过541,000人患有先天性上肢切除或截肢。 全世界对上肢先天减少的估计在4-5/10,000到1/100活产之间。对.的使用 身体动力上肢假体帮助上肢缩小的儿童进行功能性活动 这是正常生长和运动发育的基础。然而，假体的发展 儿童由于其快速和持续的成长而变得复杂。高达58%的上肢截肢儿童 因体重过重、缺乏视觉吸引力、功能有限和复杂而拒绝或放弃假体 对控制权的控制。3D打印假体为开发轻量化、定制化的假肢提供了一个经济高效的解决方案 和视觉上吸引儿童的假肢，潜在地鼓励使用。理论上讲，假肢的使用 可能导致位于与运动有关的皮质区域的初级神经元网络扩大 控制受影响的肢体。最终，这可能会导致一个更大的运动战略和整合曲目 假体进入儿童的运动控制，有利于假体的接受。然而，几乎没有或 没有证据支持这一假设。儿童运动能力的神经基础 假体的研究一直严重不足，导致经验证据很少。这在很大程度上是由于i) 在儿科人群中观察到的高假体排斥率和遗弃使其难以适当地 监测使用假体前后的行为或神经变化，以及ii)技术限制 传统的神经成像技术，如功能磁共振成像(FMRI)和 脑电(EEG)在评估儿童人群脑功能中的作用。功能性近乎- 红外光谱(Fnirs)是一种对噪声不太敏感的实用神经成像技术。 和运动伪影，而不是脑电和功能磁共振，使儿童更容易耐受测试。近红外光谱分析在我国的应用 与定制的、视觉上有吸引力的3D打印假体相结合，将提供独特的机会 定量评价上肢假体对老年人神经活动模式的影响 儿童运动皮质与运动能力的关系。我们的试点工作已经显示出皮质激活的减少， 在长期使用3D打印上肢后，运动反应更有效，协调性更强 假肢。这项研究将确定使用假体对老年人神经激活模式的影响。 单侧先天性手部分切除儿童的初级运动皮质。中心假设是 长时间使用假体将导致初级皮质激活减少，这表明佩戴假体 可以帮助初级运动皮质产生更精细、专门和有效的运动皮质反应 改善运动性能和假体的功能使用。

In the United States, more than 541,000 individuals live with congenital upper-limb reductions or amputations. Worldwide estimates for upper-limb congenital reductions range from 4-5/10,000 to 1/100 live births. The use of body-powered upper-limb prostheses helps children with upper-limb reductions to engage in functional activities that are fundamental to normal growth and motor development. However, the development of prostheses for children is complex due to their rapid and continuous growth. Up to 58% of children with upper-limb reductions reject or abandon their prosthesis due to excessive weight, lack of visual appeal, limited function and complexity of control. 3D printed prostheses provide a cost-effective solution to the development of light-weight, customized and visually appealing prostheses for children, potentially encouraging use. Theoretically, the use of a prosthesis may lead to an enlargement of the primary neuronal networks located in the cortical area involved with motor control of the affected limb. Ultimately, this might lead to a larger repertoire of motor strategies and integration of the prosthesis into the motor control of the child facilitating prosthesis acceptance. However, there is little or no evidence supporting this hypothesis. The neural basis underlying motor performance in children using a prosthesis has been severely understudied resulting in minimal empirical evidence. This is largely due to i) the high prosthesis rejection rate and abandonment observed in this pediatric population making it difficult to properly monitor behavioral or neural changes before and after using a prosthesis, and ii) technological constraints of traditional neuroimaging techniques, such as functional magnetic resonance imaging (fMRI) and electroencephalography (EEG), in the assessment of brain function of pediatric populations. Functional near- infrared spectroscopy (fNIRS) has emerged as a practical neuroimaging technique that is less sensitive to noise and movement artifacts than EEG and fMRI, making it easier for children to tolerate testing. The use of fNIRS in conjunction with customized and visually appealing 3D printed prostheses would provide the unique opportunity to quantitatively assess the influence of upper-limb prostheses in the neural activation patterns of the primary motor cortex and motor performance of children. Our pilot work has shown a reduction of cortical activation, a more efficient motor response, and increased coordination after prolonged use of a 3D printed upper-limb prosthesis. This study will determine the influence of using a prosthesis on the neural activation patterns of the primary motor cortex in children with unilateral congenital partial hand reductions. The central hypothesis is that prolonged prosthesis use will result in a reduced primary cortex activation indicating that wearing a prosthesis may assist the primary motor cortex to produce a more refined, specialized, and efficient motor cortex response improving motor performance and the functional use of the prosthesis.