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- Bergmeister, Konstantin D., et al.
(author)
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Broadband prosthetic interfaces: Combining nerve transfers and implantable multichannel EMG technology to decode spinal motor neuron activity
- 2017
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In: Frontiers in Neuroscience. - : Frontiers Media SA. - 1662-4548 .- 1662-453X. ; 11, s. 1-8
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Journal article (peer-reviewed)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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| 2. |
- Bergmeister, Konstantin D, et al.
(author)
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Peripheral nerve transfers change target muscle structure and function
- 2019
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In: Science advances. - : American Association for the Advancement of Science (AAAS). - 2375-2548. ; 5:1
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Journal article (peer-reviewed)abstract
- Selective nerve transfers surgically rewire motor neurons and are used in extremity reconstruction to restore muscle function or to facilitate intuitive prosthetic control. We investigated the neurophysiological effects of rewiring motor axons originating from spinal motor neuron pools into target muscles with lower innervation ratio in a rat model. Following reinnervation, the target muscle's force regenerated almost completely, with the motor unit population increasing to 116% in functional and 172% in histological assessments with subsequently smaller muscle units. Muscle fiber type populations transformed into the donor nerve's original muscles. We thus demonstrate that axons of alternative spinal origin can hyper-reinnervate target muscles without loss of muscle force regeneration, but with a donor-specific shift in muscle fiber type. These results explain the excellent clinical outcomes following nerve transfers in neuromuscular reconstruction. They indicate that reinnervated muscles can provide an accurate bioscreen to display neural information of lost body parts for high-fidelity prosthetic control.
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| 3. |
- Sturma, Agnes, et al.
(author)
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LONG-TERM FUNCTIONAL AND CLINICAL OUTCOME OF COMBINED TARGETED MUSCLE REINNERVATION AND OSSEOINTEGRATION FOR FUNCTIONAL BIONIC RECONSTRUCTION IN TRANSHUMERAL AMPUTEES: A CASE SERIES
- 2024
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In: JOURNAL OF REHABILITATION MEDICINE. - 1650-1977 .- 1651-2081. ; 56
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Journal article (peer-reviewed)abstract
- 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. Methods: Patients received a combination of osseointegration and targeted muscle reinnervation surgery. Rehabilitation included graded weight training, range of motion exercises, biofeedback, table -top prosthesis training, and controlling the actual device. The impairment in daily life, health -related quality of life, and pain before and after the intervention was evaluated in these patients. Their shoulder range of motion, prosthesis embodiment, and function were documented at a 2- to 5 -year follow-up. Results: All 3 patients attended rehabilitation and used their myoelectric prosthesis on a daily basis. Two patients had full shoulder range of motion with the prosthesis, while the other patient had 55 degrees of abduction and 45 degrees of anteversion. They became more independent in their daily life activities after the intervention and incorporated their prosthesis into their body scheme to a high extent. Conclusion: These results indicate that patients can benefit from the combined procedure. However, the patients' perspective, risks of the surgical procedures, and the relatively long rehabilitation procedure need to be incorporated in the decision -making.
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