Brain-Machine Interfaces
Brain-machine interfaces (BMI) are being developed to restore upper limb function for persons with spinal cord injury or other motor degenerative conditions. BMI and implantable sensors for myoelectric prostheses directly extract information from the central or peripheral nervous system to provide users with high fidelity control of their prosthetic device. Control algorithms have been highly transferable between the 2 technologies but also face common issues. In this review of the current state of the art in each field, the authors point out similarities and differences between the 2 technologies that may guide the implem...
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Alex K. Vaskov, Cynthia A. Chestek Source Type: research
Fascicle-Specific Targeting of Longitudinal Intrafascicular Electrodes for Motor and Sensory Restoration in Upper-Limb Amputees
Multichannel longitudinal intrafascicular electrode (LIFE) interfaces provide optimized balance of invasiveness and stability for chronic sensory stimulation and motor recording/decoding of peripheral nerve signals. Using a fascicle-specific targeting (FAST)-LIFE approach, where electrodes are individually placed within discrete sensory- and motor-related fascicular subdivisions of the residual ulnar and/or median nerves in an amputated upper limb, FAST-LIFE interfacing can provide discernment of motor intent for individual digit control of a robotic hand, and restoration of touch- and movement-related sensory feedback. Th...
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Jonathan Cheng, Zhi Yang, Cynthia K. Overstreet, Edward Keefer Source Type: research
Regenerative Peripheral Nerve Interfaces for Advanced Control of Upper Extremity Prosthetic Devices
This article describes the development of RPNIs and summarizes its successful use in the control of advanced prosthetic devices in patients with upper extremity amputations. (Source: Hand Clinics)
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Nishant Ganesh Kumar, Theodore A. Kung, Paul S. Cederna Source Type: research
The Agonist-Antagonist Myoneural Interface
The agonist-antagonist myoneural interface is a novel surgical construct and neural interfacing approach designed to augment volitional control of adapted prostheses, preserve proprioception, and prevent limb atrophy in the setting of limb amputation. (Source: Hand Clinics)
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Matthew J. Carty, Hugh M. Herr Source Type: research
Starfish Procedure
For those patients with partial hand level amputation who would benefit from myoelectric prosthetic digits for enhanced prehensile function, the Starfish Procedure provides muscle transfers, which allow for the generation of intuitively controlled electromyographic signals for individual digital control with minimal myoelectric cross-talk. Thoughtful preoperative planning allows for creation of multiple sources of high-quality myoelectric signal in a single operation, which does not require microsurgery, providing for wide applicability to hand surgeons of all backgrounds. (Source: Hand Clinics)
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Andrew Jordan Grier, Bryan J. Loeffler, Raymond Glenn Gaston Source Type: research
Neuroma, Neural Interface, and Prosthetics
There are over 37 million people worldwide living with limb loss. In the United States alone, there are over 1.7 million people, with 185,000 new amputations each year. This is an incredible number of people who have sustained devastating loss of a limb, which can lead to chronic pain, inability to be gainfully employed, and even an inability to perform the simplest activities of daily living. For centuries, engineers, scientists, and physicians have attempted to improve quality of life and restore function following limb loss with a variety of static and dynamic prosthetic devices, novel interfaces, and creative surgical ...
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Paul S. Cederna, Theodore A. Kung Tags: Preface Source Type: research
Targeted Muscle Reinnervation for the Treatment of Neuroma
This article reviews the indications for TMR, preoperative evaluation, and various surgical techniques. (Source: Hand Clinics)
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Lindsay E. Janes, Megan E. Fracol, Gregory A. Dumanian, Jason H. Ko Source Type: research
Regenerative Peripheral Nerve Interfaces for the Treatment and Prevention of Neuromas and Neuroma Pain
A neuroma occurs when a regenerating transected peripheral nerve has no distal target to reinnervate. This situation can result in a hypersensitive free nerve ending that causes debilitating pain to affected patients. No techniques to treat symptomatic neuromas have shown consistent results. One novel physiologic solution is the regenerative peripheral nerve interface (RPNI). RPNI consists of a transected peripheral nerve that is implanted into an autologous free skeletal muscle graft. Early clinical studies have shown promising results in the use of RPNIs to treat and prevent symptomatic neuromas. This review article desc...
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Nishant Ganesh Kumar, Theodore A. Kung Source Type: research
Nerve Interface Strategies for Neuroma Management and Prevention
In this article, the authors propose a strategy to manage and prevent symptomatic neuromas using a combination of nerve interface approaches. By using a reconstructive paradigm, these procedures provide the components integral to organized nerve regeneration, conferring both improvements in pain and potential for myoelectric control of prostheses in the future. Given the lack of evidence at this point indicating the advantage of any single nerve interface procedure, the authors propose a management approach that maximizes physiologic restoration while limiting morbidity where possible. (Source: Hand Clinics)
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Benjamin W. Hoyt, Benjamin K. Potter, Jason M. Souza Source Type: research
Dermatosensory Peripheral Nerve Interfaces: Prevention of Pain Recurrence Following Sensory Neurectomy
Chronic pain is a significant health care problem. Many patients' pain can be linked to a neuropathic origin, diagnosed with a thorough history and physical examination, and confirmed with a diagnostic nerve block. There are new procedures designed to address neuropathic pain from symptomatic neuromas by providing physiologic targets for regenerating axons following neurectomy. Dermal wrapping of the end of a sensory nerve following transection, a technique called dermatosensory peripheral nerve interface, may provide an optimal environment to prevent neuroma pain and reduce chronic neuropathic pain. (Source: Hand Clinics)
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Sarah E. Hart, David L. Brown Source Type: research
Targeted Muscle Reinnervation for Prosthetic Control
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 t...
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Konstantin D. Bergmeister, Stefan Salminger, Oskar C. Aszmann Source Type: research
Recommendations for the Successful Implementation of Upper Limb Prosthetic Technology
Despite the numerous prosthetic hand designs that are commercially available, people with upper limb loss still frequently report dissatisfaction and abandonment. Over the past decade there have been numerous advances in prosthetic design, control, sensation, and device attachment. Each offers the potential to enhance function and satisfaction, but most come at high costs and involve surgical risks. Here, we discuss potential barriers and solutions to promote the widespread use of novel prosthetic technology. With appropriate reimbursement, multidisciplinary care teams, device-specific rehabilitation, and patient and clini...
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Deanna H. Gates, Susannah M. Engdahl, Alicia Davis Source Type: research
Neuroma, Neural Interface, and Prosthetics
HAND CLINICS (Source: Hand Clinics)
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Authors: Paul S. Cederna, Theodore A. Kung Source Type: research
Copyright
ELSEVIER (Source: Hand Clinics)
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Source Type: research
Contributors
KEVIN C. CHUNG, MD, MS (Source: Hand Clinics)
Source: Hand Clinics - July 10, 2021 Category: Orthopaedics Source Type: research
