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Abstract
Targeted muscle reinnervation (TMR) is a surgical procedure, whereby nerves without muscle targets after extremity amputation are transferred to residual stump muscles. Thereby, the control of prosthesis is improved by increasing the number of independent muscle signals. The authors describe indications for TMR to improve prosthetic control and present standard nerve transfer matrices suitable for transhumeral and glenohumeral amputees. In addition, the perioperative procedure is described, including preoperative testing, surgical approach, and postoperative rehabilitation. Based on recent neurophysiological insights and technological advances, they present an outlook into the future of prosthetic control combining TMR and implantable electromyographic technology.
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Affiliation(s)
- Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
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Bergmeister KD, Vujaklija I, Muceli S, Sturma A, Hruby LA, Prahm C, Riedl O, Salminger S, Manzano-Szalai K, Aman M, Russold MF, Hofer C, Principe J, Farina D, Aszmann OC. Broadband Prosthetic Interfaces: Combining Nerve Transfers and Implantable Multichannel EMG Technology to Decode Spinal Motor Neuron Activity. Front Neurosci 2017; 11:421. [PMID: 28769755 PMCID: PMC5515902 DOI: 10.3389/fnins.2017.00421] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 07/05/2017] [Indexed: 01/09/2023] Open
Abstract
Modern robotic hands/upper limbs may replace multiple degrees of freedom of extremity function. However, their intuitive use requires a high number of control signals, which current man-machine interfaces do not provide. Here, we discuss a broadband control interface that combines targeted muscle reinnervation, implantable multichannel electromyographic sensors, and advanced decoding to address the increasing capabilities of modern robotic limbs. With targeted muscle reinnervation, nerves that have lost their targets due to an amputation are surgically transferred to residual stump muscles to increase the number of intuitive prosthetic control signals. This surgery re-establishes a nerve-muscle connection that is used for sensing nerve activity with myoelectric interfaces. Moreover, the nerve transfer determines neurophysiological effects, such as muscular hyper-reinnervation and cortical reafferentation that can be exploited by the myoelectric interface. Modern implantable multichannel EMG sensors provide signals from which it is possible to disentangle the behavior of single motor neurons. Recent studies have shown that the neural drive to muscles can be decoded from these signals and thereby the user's intention can be reliably estimated. By combining these concepts in chronic implants and embedded electronics, we believe that it is in principle possible to establish a broadband man-machine interface, with specific applications in prosthesis control. This perspective illustrates this concept, based on combining advanced surgical techniques with recording hardware and processing algorithms. Here we describe the scientific evidence for this concept, current state of investigations, challenges, and alternative approaches to improve current prosthetic interfaces.
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Affiliation(s)
- Konstantin D. Bergmeister
- CD-Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of ViennaVienna, Austria
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, University of HeidelbergLudwigshafen, Germany
| | - Ivan Vujaklija
- Department of Bioengineering, Centre for Neurotechnology, Imperial College LondonLondon, United Kingdom
| | - Silvia Muceli
- Neurorehabilitation Systems Research Group, Clinic for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center GöttingenGöttingen, Germany
| | - Agnes Sturma
- CD-Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of ViennaVienna, Austria
- Health Assisting Engineering, University of Applied Sciences WienVienna, Austria
| | - Laura A. Hruby
- CD-Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of ViennaVienna, Austria
| | - Cosima Prahm
- CD-Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of ViennaVienna, Austria
| | - Otto Riedl
- CD-Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of ViennaVienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of ViennaVienna, Austria
| | - Stefan Salminger
- CD-Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of ViennaVienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of ViennaVienna, Austria
| | - Krisztina Manzano-Szalai
- CD-Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of ViennaVienna, Austria
| | - Martin Aman
- CD-Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of ViennaVienna, Austria
| | | | - Christian Hofer
- CD-Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of ViennaVienna, Austria
- Otto Bock Healthcare Products GmbHVienna, Austria
| | - Jose Principe
- Department of Electrical and Computer Engineering, University of FloridaGainesville, FL, United States
| | - Dario Farina
- Department of Bioengineering, Centre for Neurotechnology, Imperial College LondonLondon, United Kingdom
| | - Oskar C. Aszmann
- CD-Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of ViennaVienna, Austria
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of ViennaVienna, Austria
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Morel P, Ferrea E, Taghizadeh-Sarshouri B, Audí JMC, Ruff R, Hoffmann KP, Lewis S, Russold M, Dietl H, Abu-Saleh L, Schroeder D, Krautschneider W, Meiners T, Gail A. Long-term decoding of movement force and direction with a wireless myoelectric implant. J Neural Eng 2015; 13:016002. [DOI: 10.1088/1741-2560/13/1/016002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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