The use of targeted muscle reinnervation for improved myoelectric prosthesis control in a bilateral shoulder disarticulation amputee
Abstract
A novel method for the control of a myoelectric upper limb prosthesis was achieved in a patient with bilateral amputations at the shoulder disarticulation level. Four independently controlled nerve-muscle units were created by surgically anastomosing residual brachial plexus nerves to dissected and divided aspects of the pectoralis major and minor muscles. The musculocutaneous nerve was anastomosed to the upper pectoralis major; the median nerve was transferred to the middle pectoralis major region; the radial nerve was anastomosed to the lower pectoralis major region; and the ulnar nerve was transferred to the pectoralis minor muscle which was moved out to the lateral chest wall. After five months, three nerve-muscle units were successful (the musculocutaneous, median and radial nerves) in that a contraction could be seen, felt and a surface electromyogram (EMG) could be recorded. Sensory reinnervation also occurred on the chest in an area where the subcutaneous fat was removed. The patient was fitted with a new myoelectric prosthesis using the targeted muscle reinnervation. The patient could simultaneously control two degrees-of-freedom with the experimental prosthesis, the elbow and either the terminal device or wrist. Objective testing showed a doubling of blocks moved with a box and blocks test and a 26% increase in speed with a clothes pin moving test. Subjectively the patient clearly preferred the new prosthesis. He reported that it was easier and faster to use, and felt more natural.
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In a patient with upper arm amputation, residual brachial plexus nerves anastomosed to pectoralis muscles formed few motor units that allowed simultaneous control of two degrees of freedom with a myoelectric prosthesis.
“The few reformed motor units allowed for the simultaneous control of two degrees of freedom with a myoelectric prosthesis (Kuiken et al., 2004)”
From A critical review of interfaces with the peripheral nervous system for the control of neuroprostheses and hybrid bionic systems (2005) · cites this paper as Kuiken et al., 2004
Targeted muscle reinnervation redirects severed nerves to reinnervate new muscle targets.
“An alternative approach is TMR, which redirects residual nerves to reinnervate new muscle targets.”
From Interfaces with the peripheral nervous system for the control of a neuroprosthetic limb: a review (2020) · cites this paper as [35]
Lost functions were restored to patients with central nervous system damages by electrically activating the intact tissues distal to neural lesions.
“Lost functions were restored to the patients with central nervous system damages by electrically activating the intact tissues distal to neural lesions.”
From Selectivity and Longevity of Peripheral-Nerve and Machine Interfaces: A Review. (2017) · cites this paper as Kuiken et al., 2004
TR increases the size of the sites that can be used to control the prosthetic hand.
“TR does not only help in providing sensory feedback but also increases the size of the sites that can be used to control the prosthetic hand (Kuiken et al., 2004).”
From Selectivity and Longevity of Peripheral-Nerve and Machine Interfaces: A Review. (2017) · cites this paper as Kuiken et al., 2004
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- Authors
- Kuiken, T. A., Dumanian, G. A., Lipschutz, R. D., Miller, L. A., & Stubblefield, K. A.
- Affiliations
- Northwestern University (US)
- Venue
- Prosthetics & Orthotics International
- Published
- 2004-12
- Volume
- 28
- Issue
- 3
- Pages
- 245-253
- ISSN
- 0309-3646 (ISSN-L)
- OpenAlex
- W2135648815
- Cited by
- 583
- References
- 18
- Citations by year
- 2026: 22 · 2025: 34 · 2024: 45 · 2023: 40 · 2022: 27 · 2021: 41 · 2020: 37 · 2019: 34 · 2018: 38 · 2017: 30 · 2016: 26 · 2015: 17 · 2014: 38 · 2013: 23 · 2012: 18
- FWCI
- 8.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Prosthetics and Orthotics International (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5k08hd001224-02)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (1K08HD01224-01A1)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Muscle activation and electromyography studies
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neural Engineering
- Physical Sciences › Engineering › Biomedical Engineering › Prosthetics and Rehabilitation Robotics
- Keywords
- targeted muscle reinnervation, myoelectric prosthesis control, pectoralis major, pectoralis minor, musculocutaneous nerve, median nerve, radial nerve, ulnar nerve, sensory reinnervation, upper limb prosthesis
- MeSH terms
- Anastomosis, Surgical, Arm, Artificial Limbs, Brachial Plexus, Burns, Electric, Electromyography, Humans, Male, Middle Aged, Prosthesis Design, Sensation, Shoulder, Nerve Transfer, Treatment Outcome, Muscle, Skeletal, Prosthesis Implantation
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