Improved myoelectric prosthesis control accomplished using multiple nerve transfers.

Abstract:

BACKGROUND:The control of shoulder-level disarticulation prostheses 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/hook components. The user must lock one joint at a particular position in space before subsequently moving a different joint. METHODS:A patient with bilateral humeral disarticulations after an electrical injury underwent a novel nerve transfer procedure designed to improve the control of a myoelectric prosthesis. The median, radial, ulnar, and musculocutaneous nerves were transferred to the nerves of segments of the pectoralis major and minor muscles. Those muscles then act as bioamplifiers of peripheral nerve signals when the normal upper extremity nerves are activated by the patient's brain. Therefore, when the patient thinks "flex elbow," the transferred musculocutaneous nerve fires, and a segment of the pectoralis major contracts. An electromyographic signal is then detected transcutaneously and causes the prosthetic elbow to flex. RESULTS:Three of the four nerve transfers were successful. One of the nerve transfers unexpectedly yielded two separate controllable muscle segments. Standardized testing using a "box-and-blocks" apparatus was performed with the patient's previous myoelectric device and the current device after nerve transfers. The patient's performance improved by 246 percent. CONCLUSIONS:Nerve transfers to small muscle segments are capable of creating a novel neural interface for improved control of a myoelectric prosthesis. This is done using standard techniques of nerve and flap surgery, and without any implantable devices.

journal_name

Plast Reconstr Surg

authors

Hijjawi JB,Kuiken TA,Lipschutz RD,Miller LA,Stubblefield KA,Dumanian GA

doi

10.1097/01.prs.0000242487.62487.fb

subject

Has Abstract

pub_date

2006-12-01 00:00:00

pages

1573-1578

issue

7

eissn

0032-1052

issn

1529-4242

pii

00006534-200612000-00011

journal_volume

118

pub_type

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