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Le ELH, Iorio ML, Greyson MA. Targeted muscle reinnervation in upper extremity amputations. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3717-3725. [PMID: 37814069 DOI: 10.1007/s00590-023-03736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/13/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Targeted muscle reinnervation (TMR) is a relatively recent surgical innovation that involves the coaptation of major peripheral nerves to a recipient motor branch that innervates an expendable muscle target. The original indication for TMR was augmentation and optimization of myoelectric signals in the amputated limb for use of myoelectric prosthetics. Incidentally, surgeons and patients discovered that the technique also could treat and prevent phantom and residual limb pain. TMR is performed at the time of amputation or delayed any time after the amputation, and TMR can also be performed at any level of amputation. In the upper extremity, studies have detailed the various techniques and coaptations possible at each amputation level to create intuitive myoelectric signals and treat neurogenic pain. Treatment of peripheral nerves in the amputee with TMR should be a consideration for all patients with major upper extremity amputations, especially at large institutions able to support multidisciplinary limb salvage teams. This review article summarizes the current literature and authors' techniques and recommendations surrounding TMR in the upper extremity amputee including techniques relevant to each level of upper extremity amputation.
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Affiliation(s)
- Elliot L H Le
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 12631 East 17Th Ave, Room 6111, Aurora, CO, 80045, USA
| | - Matthew L Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 12631 East 17Th Ave, Room 6111, Aurora, CO, 80045, USA
| | - Mark A Greyson
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 12631 East 17Th Ave, Room 6111, Aurora, CO, 80045, USA.
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Gstoettner C, Laengle G, Harnoncourt L, Sassu P, Aszmann OC. Targeted muscle reinnervation in bionic upper limb reconstruction: current status and future directions. J Hand Surg Eur Vol 2024; 49:783-791. [PMID: 38366374 DOI: 10.1177/17531934241227795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Selective nerve transfers are used in the setting of upper limb amputation to improve myoelectric prosthesis control. This surgical concept is referred to as targeted muscle reinnervation (TMR) and describes the rerouting of the major nerves of the arm onto the motor branches of the residual limb musculature. Aside from providing additional myosignals for prosthetic control, TMR can treat and prevent neuroma pain and possibly also phantom limb pain. This article reviews the history and current applications of TMR in upper limb amputation, with a focus on practical considerations. It further explores and identifies technological innovations to improve the man-machine interface in amputation care, particularly regarding implantable interfaces, such as muscle electrodes and osseointegration. Finally, future clinical directions and possible scientific avenues in this field are presented and critically discussed.
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Affiliation(s)
- Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Vienna, Vienna, Austria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Vienna, Vienna, Austria
| | - Leopold Harnoncourt
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Vienna, Vienna, Austria
| | - Paolo Sassu
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Orthoplastic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Vienna, Vienna, Austria
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Sturma A, Boesendorfer A, Gstoettner C, Baumgartner B, Salminger S, Farina D, Brånemark R, Vujaklija I, Hobusch G, Aszmann O. Long-term functional and clinical outcome of combined targeted muscle reinnervation and osseointegration for functional bionic reconstruction in transhumeral amputees: a case series. J Rehabil Med 2024; 56:jrm34141. [PMID: 38770700 PMCID: PMC11135336 DOI: 10.2340/jrm.v56.34141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
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° of abduction and 45° 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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Affiliation(s)
- Agnes Sturma
- Degree Program Physiotherapy, Department of Health Sciences, University of Applied Sciences FH Campus Vienna, Vienna, Austria; Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Anna Boesendorfer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Benedikt Baumgartner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Stefan Salminger
- AUVA Trauma Hospital Lorenz Böhler-European Hand Trauma Center, Vienna, Austria.
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, UK.
| | - Rickard Brånemark
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; K. Lisa Yang Center for Bionics, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, USA.
| | - Ivan Vujaklija
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland.
| | - Gerhard Hobusch
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
| | - Oskar Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
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Harnoncourt L, Gstoettner C, Laengle G, Boesendorfer A, Aszmann O. [Prosthetic Fitting Concepts after Major Amputation in the Upper Limb - an Overview of Current Possibilities]. HANDCHIR MIKROCHIR P 2024; 56:84-92. [PMID: 38417811 PMCID: PMC10954373 DOI: 10.1055/a-2260-9842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/31/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND The upper extremity and particularly the hands are crucial for patients in interacting with their environment, therefore amputations or severe damage with loss of hand function significantly impact their quality of life. In cases where biological reconstruction is not feasible or does not lead to sufficient success, bionic reconstruction plays a key role in patient care. Classical myoelectric prostheses are controlled using two signals derived from surface electrodes in the area of the stump muscles. Prosthesis control, especially in high amputations, is then limited and cumbersome. The surgical technique of Targeted Muscle Reinnervation (TMR) offers an innovative solution: The major arm nerves that have lost their target organs due to amputation are rerouted to muscles in the stump area. This enables the establishment of cognitive control signals that allow significantly improved prosthesis control. PATIENTS/MATERIALS AND METHODS A selective literature review on TMR and bionic reconstruction was conducted, incorporating relevant articles and discussing them considering the clinical experience of our research group. Additionally, a clinical case is presented. RESULTS Bionic reconstruction combined with Targeted Muscle Reinnervation enables intuitive prosthetic control with simultaneous movement of various prosthetic degrees of freedom and the treatment of neuroma and phantom limb pain. Long-term success requires a high level of patient compliance and intensive signal training during the prosthetic rehabilitation phase. Despite technological advances, challenges persist, especially in enhancing signal transmission and integrating natural sensory feedback into bionic prostheses. CONCLUSION TMR surgery represents a significant advancement in the bionic care of amputees. Employing selective nerve transfers for signal multiplication and amplification, opens up possibilities for improving myoelectric prosthesis function and thus enhancing patient care. Advances in the area of external prosthetic components, improvements in the skeletal connection due to osseointegration and more fluid signal transmission using wireless, fully implanted electrode systems will lead to significant progress in bionic reconstruction, both in terms of precision of movement and embodiment.
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Affiliation(s)
- Leopold Harnoncourt
- Klinisches Labor für Bionische Extremitätenrekonstruktion,
Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie,
Medizinische Universität Wien, Wien, Austria
| | - Clemens Gstoettner
- Klinisches Labor für Bionische Extremitätenrekonstruktion,
Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie,
Medizinische Universität Wien, Wien, Austria
- Universitätsklinik für Plastische, Rekonstruktive und Ästhetische
Chirurgie, Medizinische Universität Wien, Wien, Austria
| | - Gregor Laengle
- Klinisches Labor für Bionische Extremitätenrekonstruktion,
Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie,
Medizinische Universität Wien, Wien, Austria
- Universitätsklinik für Plastische, Rekonstruktive und Ästhetische
Chirurgie, Medizinische Universität Wien, Wien, Austria
| | - Anna Boesendorfer
- Klinisches Labor für Bionische Extremitätenrekonstruktion,
Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie,
Medizinische Universität Wien, Wien, Austria
| | - Oskar Aszmann
- Klinisches Labor für Bionische Extremitätenrekonstruktion,
Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie,
Medizinische Universität Wien, Wien, Austria
- Universitätsklinik für Plastische, Rekonstruktive und Ästhetische
Chirurgie, Medizinische Universität Wien, Wien, Austria
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Rehman MU, Shah K, Haq IU, Iqbal S, Ismail MA. A Wearable Force Myography-Based Armband for Recognition of Upper Limb Gestures. SENSORS (BASEL, SWITZERLAND) 2023; 23:9357. [PMID: 38067728 PMCID: PMC10708660 DOI: 10.3390/s23239357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
Force myography (FMG) represents a promising alternative to surface electromyography (EMG) in the context of controlling bio-robotic hands. In this study, we built upon our prior research by introducing a novel wearable armband based on FMG technology, which integrates force-sensitive resistor (FSR) sensors housed in newly designed casings. We evaluated the sensors' characteristics, including their load-voltage relationship and signal stability during the execution of gestures over time. Two sensor arrangements were evaluated: arrangement A, featuring sensors spaced at 4.5 cm intervals, and arrangement B, with sensors distributed evenly along the forearm. The data collection involved six participants, including three individuals with trans-radial amputations, who performed nine upper limb gestures. The prediction performance was assessed using support vector machines (SVMs) and k-nearest neighbor (KNN) algorithms for both sensor arrangments. The results revealed that the developed sensor exhibited non-linear behavior, and its sensitivity varied with the applied force. Notably, arrangement B outperformed arrangement A in classifying the nine gestures, with an average accuracy of 95.4 ± 2.1% compared to arrangement A's 91.3 ± 2.3%. The utilization of the arrangement B armband led to a substantial increase in the average prediction accuracy, demonstrating an improvement of up to 4.5%.
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Affiliation(s)
- Mustafa Ur Rehman
- Department of Mechatronics Engineering, University of Engineering and Technology Peshawar, Peshawar 25000, Pakistan; (M.U.R.)
| | - Kamran Shah
- Department of Mechatronics Engineering, University of Engineering and Technology Peshawar, Peshawar 25000, Pakistan; (M.U.R.)
- Department of Mechanical Engineering, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
| | - Izhar Ul Haq
- Department of Mechatronics Engineering, University of Engineering and Technology Peshawar, Peshawar 25000, Pakistan; (M.U.R.)
| | - Sajid Iqbal
- Department of Information Systems, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
| | - Mohamed A. Ismail
- Department of Mechanical Engineering, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
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Farina D, Vujaklija I, Brånemark R, Bull AMJ, Dietl H, Graimann B, Hargrove LJ, Hoffmann KP, Huang HH, Ingvarsson T, Janusson HB, Kristjánsson K, Kuiken T, Micera S, Stieglitz T, Sturma A, Tyler D, Weir RFF, Aszmann OC. Toward higher-performance bionic limbs for wider clinical use. Nat Biomed Eng 2023; 7:473-485. [PMID: 34059810 DOI: 10.1038/s41551-021-00732-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/01/2021] [Indexed: 12/19/2022]
Abstract
Most prosthetic limbs can autonomously move with dexterity, yet they are not perceived by the user as belonging to their own body. Robotic limbs can convey information about the environment with higher precision than biological limbs, but their actual performance is substantially limited by current technologies for the interfacing of the robotic devices with the body and for transferring motor and sensory information bidirectionally between the prosthesis and the user. In this Perspective, we argue that direct skeletal attachment of bionic devices via osseointegration, the amplification of neural signals by targeted muscle innervation, improved prosthesis control via implanted muscle sensors and advanced algorithms, and the provision of sensory feedback by means of electrodes implanted in peripheral nerves, should all be leveraged towards the creation of a new generation of high-performance bionic limbs. These technologies have been clinically tested in humans, and alongside mechanical redesigns and adequate rehabilitation training should facilitate the wider clinical use of bionic limbs.
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Affiliation(s)
- Dario Farina
- Department of Bioengineering, Imperial College London, London, UK.
| | - Ivan Vujaklija
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Rickard Brånemark
- Center for Extreme Bionics, Biomechatronics Group, MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, UK
| | - Hans Dietl
- Ottobock Products SE & Co. KGaA, Vienna, Austria
| | | | - Levi J Hargrove
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Klaus-Peter Hoffmann
- Department of Medical Engineering & Neuroprosthetics, Fraunhofer-Institut für Biomedizinische Technik, Sulzbach, Germany
| | - He Helen Huang
- NCSU/UNC Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thorvaldur Ingvarsson
- Department of Research and Development, Össur Iceland, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hilmar Bragi Janusson
- School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland
| | | | - Todd Kuiken
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pontedera, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pontedera, Italy
- Bertarelli Foundation Chair in Translational NeuroEngineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, BrainLinks-BrainTools Center and Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Agnes Sturma
- Department of Bioengineering, Imperial College London, London, UK
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Dustin Tyler
- Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Veterans Affairs Medical Centre, Cleveland, OH, USA
| | - Richard F Ff Weir
- Biomechatronics Development Laboratory, Bioengineering Department, University of Colorado Denver and VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
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Simon AM, Turner KL, Miller LA, Dumanian GA, Potter BK, Beachler MD, Hargrove LJ, Kuiken TA. Myoelectric prosthesis hand grasp control following targeted muscle reinnervation in individuals with transradial amputation. PLoS One 2023; 18:e0280210. [PMID: 36701412 PMCID: PMC9879512 DOI: 10.1371/journal.pone.0280210] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/29/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Despite the growing availability of multifunctional prosthetic hands, users' control and overall functional abilities with these hands remain limited. The combination of pattern recognition control and targeted muscle reinnervation (TMR) surgery, an innovative technique where amputated nerves are transferred to reinnervate new muscle targets in the residual limb, has been used to improve prosthesis control of individuals with more proximal upper limb amputations (i.e., shoulder disarticulation and transhumeral amputation). OBJECTIVE The goal of this study was to determine if prosthesis hand grasp control improves following transradial TMR surgery. METHODS Eight participants were trained to use a multi-articulating hand prosthesis under myoelectric pattern recognition control. All participated in home usage trials pre- and post-TMR surgery. Upper limb outcome measures were collected following each home trial. RESULTS Three outcome measures (Southampton Hand Assessment Procedure, Jebsen-Taylor Hand Function Test, and Box and Blocks Test) improved 9-12 months post-TMR surgery compared with pre-surgery measures. The Assessment of Capacity for Myoelectric Control and Activities Measure for Upper Limb Amputees outcome measures had no difference pre- and post-surgery. An offline electromyography analysis showed a decrease in grip classification error post-TMR surgery compared to pre-TMR surgery. Additionally, a majority of subjects noted qualitative improvements in their residual limb and phantom limb sensations post-TMR. CONCLUSIONS The potential for TMR surgery to result in more repeatable muscle contractions, possibly due to the reduction in pain levels and/or changes to phantom limb sensations, may increase functional use of many of the clinically available dexterous prosthetic hands.
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Affiliation(s)
- Ann M. Simon
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States of America
| | - Kristi L. Turner
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, United States of America
| | - Laura A. Miller
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States of America
| | - Gregory A. Dumanian
- Division of Plastic Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, United States of America
| | - Benjamin K. Potter
- Uniformed Services University–Walter Reed National Military Medical Center Department of Surgery, Bethesda, MD, United States of America
| | - Mark D. Beachler
- Orthotic & Prosthetic Service, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - Levi J. Hargrove
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States of America
| | - Todd A. Kuiken
- Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States of America
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Tereshenko V, Dotzauer DC, Luft M, Ortmayr J, Maierhofer U, Schmoll M, Festin C, Carrero Rojas G, Klepetko J, Laengle G, Politikou O, Farina D, Blumer R, Bergmeister KD, Aszmann OC. Autonomic Nerve Fibers Aberrantly Reinnervate Denervated Facial Muscles and Alter Muscle Fiber Population. J Neurosci 2022; 42:8297-8307. [PMID: 36216502 PMCID: PMC9653283 DOI: 10.1523/jneurosci.0670-22.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022] Open
Abstract
The surgical redirection of efferent neural input to a denervated muscle via a nerve transfer can reestablish neuromuscular control after nerve injuries. The role of autonomic nerve fibers during the process of muscular reinnervation remains largely unknown. Here, we investigated the neurobiological mechanisms behind the spontaneous functional recovery of denervated facial muscles in male rodents. Recovered facial muscles demonstrated an abundance of cholinergic axonal endings establishing functional neuromuscular junctions. The parasympathetic source of the neuronal input was confirmed to be in the pterygopalatine ganglion. Furthermore, the autonomically reinnervated facial muscles underwent a muscle fiber change to a purely intermediate muscle fiber population myosin heavy chain type IIa. Finally, electrophysiological tests revealed that the postganglionic parasympathetic fibers travel to the facial muscles via the sensory infraorbital nerve. Our findings demonstrated expanded neuromuscular plasticity of denervated striated muscles enabling functional recovery via alien autonomic fibers. These findings may further explain the underlying mechanisms of sensory protection implemented to prevent atrophy of a denervated muscle.SIGNIFICANCE STATEMENT Nerve injuries represent significant morbidity and disability for patients. Rewiring motor nerve fibers to other target muscles has shown to be a successful approach in the restoration of motor function. This demonstrates the remarkable capacity of the CNS to adapt to the needs of the neuromuscular system. Yet, the capability of skeletal muscles being reinnervated by nonmotor axons remains largely unknown. Here, we show that under deprivation of original efferent input, the neuromuscular system can undergo functional and morphologic remodeling via autonomic nerve fibers. This may explain neurobiological mechanisms of the sensory protection phenomenon, which is because of parasympathetic reinnervation.
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Affiliation(s)
- Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Dominik C Dotzauer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Matthias Luft
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Joachim Ortmayr
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Johanna Klepetko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Olga Politikou
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
| | | | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Karl Landsteiner University of Health Sciences, University Hospital, A-3500 Krems an der Donau, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
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