Oskar C Aszmann1, Aidan D Roche2, Stefan Salminger2, Tatjana Paternostro-Sluga3, Malvina Herceg3, Agnes Sturma2, Christian Hofer4, Dario Farina5. 1. Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria. Electronic address: oskar.aszmann@meduniwien.ac.at. 2. Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria. 3. Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria. 4. Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria; Clinical Research, Research & Development, Otto Bock Healthcare Products GmbH, Vienna, Austria. 5. Department of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology Göttingen, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.
Abstract
BACKGROUND: Brachial plexus injuries can permanently impair hand function, yet present surgical reconstruction provides only poor results. Here, we present for the first time bionic reconstruction; a combined technique of selective nerve and muscle transfers, elective amputation, and prosthetic rehabilitation to regain hand function. METHODS: Between April 2011, and May 2014, three patients with global brachial plexus injury including lower root avulsions underwent bionic reconstruction. Treatment occurred in two stages; first, to identify and create useful electromyographic signals for prosthetic control, and second, to amputate the hand and replace it with a mechatronic prosthesis. Before amputation, the patients had a specifically tailored rehabilitation programme to enhance electromyographic signals and cognitive control of the prosthesis. Final prosthetic fitting was applied as early as 6 weeks after amputation. FINDINGS: Bionic reconstruction successfully enabled prosthetic hand use in all three patients. After 3 months, mean Action Research Arm Test score increased from 5·3 (SD 4·73) to 30·7 (14·0). Mean Southampton Hand Assessment Procedure score improved from 9·3 (SD 1·5) to 65·3 (SD 19·4). Mean Disabilities of Arm, Shoulder and Hand score improved from 46·5 (SD 18·7) to 11·7 (SD 8·42). INTERPRETATION: For patients with global brachial plexus injury with lower root avulsions, who have no alternative treatment, bionic reconstruction offers a means to restore hand function. FUNDING: Austrian Council for Research and Technology Development, Austrian Federal Ministry of Science, Research & Economy, and European Research Council Advanced Grant DEMOVE.
BACKGROUND: Brachial plexus injuries can permanently impair hand function, yet present surgical reconstruction provides only poor results. Here, we present for the first time bionic reconstruction; a combined technique of selective nerve and muscle transfers, elective amputation, and prosthetic rehabilitation to regain hand function. METHODS: Between April 2011, and May 2014, three patients with global brachial plexus injury including lower root avulsions underwent bionic reconstruction. Treatment occurred in two stages; first, to identify and create useful electromyographic signals for prosthetic control, and second, to amputate the hand and replace it with a mechatronic prosthesis. Before amputation, the patients had a specifically tailored rehabilitation programme to enhance electromyographic signals and cognitive control of the prosthesis. Final prosthetic fitting was applied as early as 6 weeks after amputation. FINDINGS: Bionic reconstruction successfully enabled prosthetic hand use in all three patients. After 3 months, mean Action Research Arm Test score increased from 5·3 (SD 4·73) to 30·7 (14·0). Mean Southampton Hand Assessment Procedure score improved from 9·3 (SD 1·5) to 65·3 (SD 19·4). Mean Disabilities of Arm, Shoulder and Hand score improved from 46·5 (SD 18·7) to 11·7 (SD 8·42). INTERPRETATION: For patients with global brachial plexus injury with lower root avulsions, who have no alternative treatment, bionic reconstruction offers a means to restore hand function. FUNDING: Austrian Council for Research and Technology Development, Austrian Federal Ministry of Science, Research & Economy, and European Research Council Advanced Grant DEMOVE.
Authors: Dario Farina; Ivan Vujaklija; Rickard Brånemark; Anthony M J Bull; Hans Dietl; Bernhard Graimann; Levi J Hargrove; Klaus-Peter Hoffmann; He Helen Huang; Thorvaldur Ingvarsson; Hilmar Bragi Janusson; Kristleifur Kristjánsson; Todd Kuiken; Silvestro Micera; Thomas Stieglitz; Agnes Sturma; Dustin Tyler; Richard F Ff Weir; Oskar C Aszmann Journal: Nat Biomed Eng Date: 2021-05-31 Impact factor: 25.671
Authors: K S Houschyar; A Momeni; M N Pyles; J Y Cha; Z N Maan; D Duscher; O S Jew; F Siemers; J van Schoonhoven Journal: Plast Surg Int Date: 2016-01-20
Authors: Anna Lisa Ciancio; Francesca Cordella; Roberto Barone; Rocco Antonio Romeo; Alberto Dellacasa Bellingegni; Rinaldo Sacchetti; Angelo Davalli; Giovanni Di Pino; Federico Ranieri; Vincenzo Di Lazzaro; Eugenio Guglielmelli; Loredana Zollo Journal: Front Neurosci Date: 2016-04-08 Impact factor: 4.677