Reduced interhemispheric connectivity in traumatic brachial plexopathies after bionic reconstruction.

Traumatic brachial plexus lesions (TBPL) can lead to permanent impairment of hand function despite timely brachial plexus surgical treatment. In selected cases with no recovery of hand function, the affected forearm can be amputated and replaced by a bionic hand to regain prehensile function. This cross-sectional study aimed to assess (sub)cortical motor activity and functional connectivity changes after TBPL and bionic reconstruction.

Free functional gracilis transfer for reconstruction of isolated anterior deltoid atrophy following surgical proximal humerus fixation.

Background: Palsy of the clavicular head of the deltoid is a complication after surgical fixation of proximal humerus fractures. Flexion of the shoulder joint may be impaired as a result. Additionally, patients may complain of joint instability, visible atrophy, and pain.

Long-term functional and clinical outcome of combined targeted muscle reinnervation and osseointegration for functional bionic reconstruction in transhumeral amputees: a case series.

Objective: To describe and evaluate the combination of osseointegration and nerve transfers in 3 transhumeral amputees.

Design: Case series.

Patients: Three male patients with a unilateral traumatic transhumeral amputation.

Nerve transfer reversal to treat co-contraction after anatomic brachial plexus reconstruction and Oberlin transfer: A case report.

Distal nerve transfers to restore elbow flexion have become standard of care in brachial plexus reconstruction. The purpose of this report is to draw attention to intractable co-contraction as a rare but significant adverse event of distal nerve transfers. Here we report of treatment of a disabling co-contraction of the brachialis muscle and wrist/finger flexors after median to brachialis fascicular transfer in a 61-year-old male patient.

Nerve Transfers for Brachial Plexus Reconstruction in Patients over 60 Years.

Negative expectations regarding nerve reconstruction in the elderly prevail in the literature, but little is known about the effectiveness of nerve transfers in patients with brachial plexus injuries aged over 60 years. We present a series of five patients (1 female, 4 male) aged between 60 and 81 years (median 62.0 years) who underwent nerve reconstruction using multiple nerve transfers in brachial plexopathies.

[Perioperative Diagnostics of Peripheral Nerve Lesions and Compression Syndromes: Position Paper of the German-Speaking Group for Microsurgery of Peripheral Nerves and Vessels].

The treatment of peripheral nerve pathologies requires a rapid and precise diagnosis. However, the correct identification of nerve pathologies is often difficult and valuable time is lost in the process. In this position paper of the German-Speaking Group for Microsurgery of Peripheral Nerves and Vessels (DAM), we describe the current evidence for various perioperative diagnostics for the detection of traumatic peripheral nerve lesions or compression syndromes.

Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury.

Many adults who had a severe Narakas IV obstetric brachial plexus injury (OBPI) suffer from extensive impairments in daily living due to limited hand-arm function. The dramatic loss of axonal support at this very early age of development often render the entire extremity a biologic wasteland and reconstructive methods and therapies often fail to recover any functional hand use. In this scenario bionic reconstruction, including an elective amputation and a subsequent prosthetic fitting, may enable functional improvement in adults suffering from the consequences of such severe brachial plexus injuries.

Biomechanical Analysis of Body Movements of Myoelectric Prosthesis Users During Standardized Clinical Tests.

Objective: The objective clinical evaluation of user's capabilities to handle their prosthesis is done using various tests which primarily focus on the task completion speed and do not explicitly account for the potential presence of compensatory motions. Given that the excessive body compensation is a common indicator of inadequate prosthesis control, tests which include subjective observations on the quality of performed motions have been introduced. However, these metrics are then influenced by the examiner's opinions, skills, and training making them harder to standardize across patient pools and compare across different prosthetic technologies.

Simultaneous and Proportional Real-Time Myocontrol of Up to Three Degrees of Freedom of the Wrist and Hand.

Unlabelled: Achieving robust, intuitive, simultaneous and proportional control over multiple degrees of freedom (DOFs) is an outstanding challenge in the development of myoelectric prosthetic systems. Since the priority in myoelectric prosthesis solutions is robustness and stability, their number of functions is usually limited.

Objective: Here, we introduce a system for intuitive concurrent hand and wrist control, based on a robust feature-extraction protocol and machine-learning.

Actual prosthetic usage in relation to functional outcomes and wearing time in individuals with below-elbow amputation.

Background: Wearing time of a prosthesis is regarded as an indicator for success of prosthetic rehabilitation. However, prostheses are frequently worn for esthetic purposes only. Although different supervised measurements to assess prosthetic dexterity are used, it is not clear how performance in such tests translates into actual use in everyday life.

Feasibility of a Wireless Implantable Multi-electrode System for High-bandwidth Prosthetic Interfacing: Animal and Cadaver Study.

Background: Currently used prosthetic solutions in upper extremity amputation have limited functionality, owing to low information transfer rates of neuromuscular interfacing. Although surgical innovations have expanded the functional potential of the residual limb, available interfaces are inefficacious in translating this potential into improved prosthetic control. There is currently no implantable solution for functional interfacing in extremity amputation which offers long-term stability, high information transfer rates, and is applicable for all levels of limb loss.

Therapy Interventions for Upper Limb Amputees Undergoing Selective Nerve Transfers.

Targeted Muscle Reinnervation (TMR) improves the biological control interface for myoelectric prostheses after above-elbow amputation. Selective activation of muscle units is made possible by surgically re-routing nerves, yielding a high number of independent myoelectric control signals. However, this intervention requires careful patient selection and specific rehabilitation therapy.

Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury.

Brachial plexus injuries with multiple-root involvement lead to severe and long-lasting impairments in the functionality and appearance of the affected upper extremity. In cases, where biologic reconstruction of hand and arm function is not possible, bionic reconstruction may be considered as a viable clinical option. Bionic reconstruction, through a careful combination of surgical augmentation, amputation, and prosthetic substitution of the functionless hand, has been shown to achieve substantial improvements in function and quality of life.

Successful salvage via re-osseointegration of a loosened implant in a patient with transtibial amputation.

Case Description: Osseointegration is a relatively new technique for prosthetic limb attachment that offers various improvements for patients with amputation and facilitates joint preservation. We present a case of implant loosening during rehabilitation in a patient with transtibial amputation that was successfully managed through a combination of measures, aiming to promote re-osseointegration of the implant.

Objectives: Not much is known about structured management of adverse events after osseointegration.

Current rates of prosthetic usage in upper-limb amputees - have innovations had an impact on device acceptance?

Purpose: There is a large body of evidence demonstrating high rates of prosthesis abandonment in the upper extremity. However, these surveys were conducted years ago, thus the influence of recent refinements in prosthetic technology on acceptance is unknown. This study aims to gather current data on prosthetic usage, to assess the effects of these advancements.

Rehabilitation of high upper limb amputees after Targeted Muscle Reinnervation.

Study Design: This is a Delphi study based on a scoping literature review.

Introduction: Targeted muscle reinnervation (TMR) enables patients with high upper limb amputations to intuitively control a prosthetic arm with up to six independent control signals. Although there is a broad agreement regarding the importance of structured motor learning and prosthetic training after such nerve transfers, to date, no evidence-based protocol for rehabilitation after TMR exists.

Neuralgic amyotrophy: a paradigm shift in diagnosis and treatment.

Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is characterised by sudden pain attacks, followed by patchy muscle paresis in the upper extremity. Recent reports have shown that incidence is much higher than previously assumed and that the majority of patients never achieve full recovery. Traditionally, the diagnosis was mainly based on clinical observations and treatment options were confined to application of corticosteroids and symptomatic management, without proven positive effects on long-term outcomes.

Bionic Upper Limb Reconstruction: A Valuable Alternative in Global Brachial Plexus Avulsion Injuries-A Case Series.

Global brachial plexopathies including multiple nerve root avulsions may result in complete upper limb paralysis despite surgical treatment. Bionic reconstruction, which includes the elective amputation of the functionless hand and its replacement with a mechatronic device, has been described for the transradial level. Here, we present for the first time that patients with global brachial plexus avulsion injuries and lack of biological shoulder and elbow function benefit from above-elbow amputation and prosthetic rehabilitation.

Outcomes, Challenges, and Pitfalls after Targeted Muscle Reinnervation in High-Level Amputees: Is It Worth the Effort?

Background: Although the distal targets have been lost in proximal upper limb amputees, the neural signals for intuitive hand and arm function are still available and thus can be incorporated into more useful prosthetic function using targeted muscle reinnervation technique. In this article, the authors present their outcomes and range of indications in addition to experiences and pitfalls after 30 targeted muscle reinnervation cases at above-elbow and shoulder disarticulation level of amputation.

Methods: Thirty patients with above-elbow or shoulder disarticulation amputations were enrolled between 2012 and 2017.

Surface Electromyographic Biofeedback as a Rehabilitation Tool for Patients with Global Brachial Plexus Injury Receiving Bionic Reconstruction.

In patients with global brachial plexus injury and lack of biological treatment alternatives, bionic reconstruction, including the elective amputation of the functionless hand and its replacement with a prosthesis, has recently been described. Optimal prosthetic function depends on a structured rehabilitation protocol, as residual muscle activity in a patient's arm is later translated into prosthetic function. Surface electromyographic (sEMG) biofeedback has been used during rehabilitation after stroke, but has so far not been used in patients with complex peripheral nerve injuries.

Structured Motor Rehabilitation After Selective Nerve Transfers.

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on the successful re-innervation of the targets in the periphery and on the motor re-learning process entailing cortical plasticity. While there is an increasing number of methods to improve rehabilitation, their routine implementation in a clinical setting remains a challenge due to their complexity and long duration.

Long-term implant of intramuscular sensors and nerve transfers for wireless control of robotic arms in above-elbow amputees.

Targeted muscle reinnervation (TMR) amplifies the electrical activity of nerves at the stump of amputees by redirecting them in remnant muscles above the amputation. The electrical activity of the reinnervated muscles can be used to extract natural control signals. Nonetheless, current control systems, mainly based on noninvasive muscle recordings, fail to provide accurate and reliable control over time.

The long-term effects of an implantable drop foot stimulator on gait in hemiparetic patients.

Drop foot is a frequent abnormality in gait after central nervous system lesions. Different treatment strategies are available to functionally restore dorsal extension during swing phase in gait. Orthoses as well as surface and implantable devices for electrical stimulation of the peroneal nerve may be used in patients who do not regain good dorsal extension.

[Smart Rehab: App-based rehabilitation training for upper extremity amputees - Case Report].

Background: Control of a myoelectric prostheses entails rehabilitative training, based on repetitive exercises with a physiotherapist. However, many patients lack the motivation to continue the exercises in their home environment. Mobile games on the smartphone can provide patients with long-term motivation to continue the repetitive exercises that prepare the muscles for controlling a prosthesis at home.