8/6/2019 Tmr Transhumberal Outcomes
1/36
OUTCOMES ON THREE TRANSHUMERAL LEVEL
FITTINGS FOLLOWING TARGETED
REINNERVATION NERVE TRANSFER SURGERY
Lipschutz,R.D. Miller, L.A., Stubblefield, K.A., Dumanian, G., Phillips, M.E. and
Kuiken, T.A.
Neural Engineering Center for Artificial Limbs, Rehabilitation Institute of ChicagoDept. of PM&R, Feinberg School of Medicine, Northwestern University
Dept. of Plastic Surgery, Northwestern Memorial Hospital
8/6/2019 Tmr Transhumberal Outcomes
2/36
Clinical Presentation
3 Individuals
Traumatic Transhumeral
Amputations
Motor Vehicle Accident
Railroad Accident Machinery Accident
8/6/2019 Tmr Transhumberal Outcomes
3/36
Customary Myoelectric Fitting
Following Transhumeral Amputation
1 - Elbow Extend
Triceps
2 - Hand Open
1 - Elbow Flex
Biceps
2 - Hand Close
Sequentially
8/6/2019 Tmr Transhumberal Outcomes
4/36
CHANGE TO
Myoelectric Fitting
1 - Elbow ExtendTriceps
2 - Hand Open
3 Wrist Pronation
1 - Elbow FlexBiceps
2 - Hand Close
3- Wrist Supination
Mode Selection via
Bump Switch
8/6/2019 Tmr Transhumberal Outcomes
5/36
Why the CHANGE??? Permit Simultaneous Control
Elbow Flexion / Extension - MYOELECTRICALLY
Hand or Wrist LINEAR TRANSDUCER
Prevent Future Confusion
Elbow Flexion (Musculocutaneous Nerve) Flex Elbow ONLY
Elbow Extension (*Prox. Radial Nerve) Extend Elbow ONLY
8/6/2019 Tmr Transhumberal Outcomes
6/36
Review of Surgical Intervention
Brachial Plexus
8/6/2019 Tmr Transhumberal Outcomes
7/36
Peripheral Nerve REVIEW Musculocutaneous Nerve Elbow Flexors
Radial Nerve Elbow Extensors, Wrist Extensors,Finger Extensors
Median Nerve Wrist Flexors, Finger Flexors,Forearm Pronators, Thumb Abductor
Ulnar Nerve Wrist Flexors, Palmar Intrinsics
8/6/2019 Tmr Transhumberal Outcomes
8/36
Surgical Review
Lateral Biceps
Lateral Branch ofMusculocutaneous Nerve
Medial Biceps
Medial Branch ofMusculocutaneous Nerve
8/6/2019 Tmr Transhumberal Outcomes
9/36
Surgical Review
Medial Biceps
Medial Branch ofMusculocutaneous Nerve
Reinnervatedwith
Median Nerve
Brachialis
Musculocutaneous Nerve Divided
8/6/2019 Tmr Transhumberal Outcomes
10/36
8/6/2019 Tmr Transhumberal Outcomes
11/36
Nerve Transfers for
Transhumeral Amputee
8/6/2019 Tmr Transhumberal Outcomes
12/36
Experimental Myoelectric
Fitting Following TranshumeralAmputation
Elbow Extend Triceps
Hand Open Brachialis
Medial Biceps Hand Close
Lateral Biceps Elbow Flex
Simultaneously
Wrist Pronation Wrist Supination
8/6/2019 Tmr Transhumberal Outcomes
13/36
Components for Experimental
Externally Powered Prosthesis(Same as Pre-Op) LTI Linear Transducer
LTI Boston Digital Arm
Otto Bock Electronic
Wrist Rotator
Otto Bock Hand
8/6/2019 Tmr Transhumberal Outcomes
14/36
Location of Electrode Sites Triceps
Superior aspect of the
Postero-Medial Socket
Brachialis
Distal aspect of the
Lateral Socket (slightly
Posterior to Midline)
Posterior View Lateral View
8/6/2019 Tmr Transhumberal Outcomes
15/36
Location of Electrode Sites Lateral Biceps
Anterior Socket
Medial Biceps
Medial aspect of the
Socket (Just Anterior
to Midline)
Medial View
8/6/2019 Tmr Transhumberal Outcomes
16/36
CHALLENGES
8/6/2019 Tmr Transhumberal Outcomes
17/36
Location of Electrode Sites Proximity of Electrodes
Interference
Accuracy during donning
Electrodes
Originally
2-LTI
Packaged 2-Otto Bock (13E125=60)
Currently
4 LTI Remote
8/6/2019 Tmr Transhumberal Outcomes
18/36
As found in PREVIOUS
Four Channel EMG Testing
Co-contraction of
Elbow Extension
with
HandOpen
8/6/2019 Tmr Transhumberal Outcomes
19/36
Multiple Channel Viewing
Liberating Technologies Inc.
8/6/2019 Tmr Transhumberal Outcomes
20/36
ChallengesMovement of Soft Tissue
8/6/2019 Tmr Transhumberal Outcomes
21/36
Aggressive Modifications
andMore Proximal Electrode Placement
8/6/2019 Tmr Transhumberal Outcomes
22/36
Testing
and
Results
8/6/2019 Tmr Transhumberal Outcomes
23/36
Box and Blocks Test
Original Prosthesis Nerve Transfer Prosthesis(Used more than 8 months) (Used about 2 months)
8/6/2019 Tmr Transhumberal Outcomes
24/36
Box and Blocks Test
Original Prosthesis Nerve Transfer Prosthesis
8/6/2019 Tmr Transhumberal Outcomes
25/36
Results of Box and Blocks Test#ofBlocks Conventional
Prosthesis
Experimental
Prosthesis
Subject 1 (AVG) 7.3 22.7
% Difference +311%
Subject 3 (AVG) 5.3 15
% Difference +283%
*AVG = Average of 3 Trials
8/6/2019 Tmr Transhumberal Outcomes
26/36
Clothes Pin Test
Conventional Experimental
(Used more than 8 months) (Used about 2 months)
8/6/2019 Tmr Transhumberal Outcomes
27/36
Clothes Pin Test
Original Prosthesis Nerve Transfer Prosthesis
8/6/2019 Tmr Transhumberal Outcomes
28/36
Results of Clothes Pin TestTime in Seconds Conventional
Prosthesis (sec)
Experimental
Prosthesis (sec)
Subject 1 (AVG) 62.7 34
% Differences -45.7%
Subject 3 (AVG) 92.3 50.3
% Differences -45.5%
*AVG = Average of 3 Trials
8/6/2019 Tmr Transhumberal Outcomes
29/36
AMPS TestingSingle subject validated test of ADL function
8/6/2019 Tmr Transhumberal Outcomes
30/36
Results of AMPS Testing
Subject 1
Motor Score
Conventional = 0.51
Experimental = 1.05
Processing Score
Conventional = 0.35
Experimental = 1.10
Subject 3
Motor Score
Conventional = 0.90
Experimental = 1.56
Processing Score
Conventional = 1.09
Experimental = 1.43
8/6/2019 Tmr Transhumberal Outcomes
31/36
Outcomes from Targeted Reinnervation on
Transhumeral Amputee Subjects 1 & 3
Targeted muscle reinnervation created 2 new myoelectriccontrol sites
Multiple joints were simultaneously controlled withmyoelectric signals
2 with myoelectric control
1 with linear transducer
Control was more physiologically appropriate
Operation feels more natural Prosthesis is easier to use
Additional Tasks were performed
Faster and more accurate during testing
8/6/2019 Tmr Transhumberal Outcomes
32/36
What happened to Subject 2? Still has 2-site Myoelectric Prosthesis
Lack of success likely secondary to
undiagnosed brachial-plexopathy Additional testing continues**
8/6/2019 Tmr Transhumberal Outcomes
33/36
High Density Electrode Array
116 Electrodes
8/6/2019 Tmr Transhumberal Outcomes
34/36
No Detectable
HAND CLOSE
Signal
BUT
PATTERN
RECOGNITION
85-90%
8/6/2019 Tmr Transhumberal Outcomes
35/36
8/6/2019 Tmr Transhumberal Outcomes
36/36
Thank You!
Top Related