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Sturma A, Hruby LA, Boesendorfer A, Pittermann A, Salminger S, Gstoettner C, Politikou O, Vujaklija I, Farina D, Aszmann OC. Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury. Front Neurorobot 2021; 15:645261. [PMID: 33994986 PMCID: PMC8119996 DOI: 10.3389/fnbot.2021.645261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/01/2021] [Indexed: 01/10/2023] Open
Abstract
Brachial plexus injuries with multiple-root involvement lead to severe and long-lasting impairments in the functionality and appearance of the affected upper extremity. In cases, where biologic reconstruction of hand and arm function is not possible, bionic reconstruction may be considered as a viable clinical option. Bionic reconstruction, through a careful combination of surgical augmentation, amputation, and prosthetic substitution of the functionless hand, has been shown to achieve substantial improvements in function and quality of life. However, it is known that long-term distortions in the body image are present in patients with severe nerve injury as well as in prosthetic users regardless of the level of function. To date, the body image of patients who voluntarily opted for elective amputation and prosthetic reconstruction has not been investigated. Moreover, the degree of embodiment of the prosthesis in these patients is unknown. We have conducted a longitudinal study evaluating changes of body image using the patient-reported Body Image Questionnaire 20 (BIQ-20) and a structured questionnaire about prosthetic embodiment. Six patients have been included. At follow up 2.5–5 years after intervention, a majority of patients reported better BIQ-20 scores including a less negative body evaluation (5 out of 6 patients) and higher vital body dynamics (4 out of 6 patients). Moreover, patients described a strong to moderate prosthesis embodiment. Interestingly, whether patients reported performing bimanual tasks together with the prosthetic hand or not, did not influence their perception of the prosthesis as a body part. In general, this group of patients undergoing prosthetic substitution after brachial plexus injury shows noticeable inter-individual differences. This indicates that the replacement of human anatomy with technology is not a straight-forward process perceived in the same way by everyone opting for it.
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Affiliation(s)
- Agnes Sturma
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Neurorehabilitation Engineering Group, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Laura A Hruby
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Anna Boesendorfer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Anna Pittermann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Clinical Psychology, General Hospital of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Salminger
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Clemens Gstoettner
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Olga Politikou
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Ivan Vujaklija
- Bionic and Rehabilitation Engineering Research Group, Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Dario Farina
- Neurorehabilitation Engineering Group, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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Brito S, White J, Thomacos N, Hill B. The lived experience following free functioning muscle transfer for management of pan-brachial plexus injury: reflections from a long-term follow-up study. Disabil Rehabil 2019; 43:1517-1525. [PMID: 31574227 DOI: 10.1080/09638288.2019.1668970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Traumatic, pan-brachial plexus injuries result in major functional disability. Surgical advancements, such as free-functioning muscle transfers, are restoring physical capacity that was not achieved 3-4 decades ago. Despite reconstructive procedures, brachial plexus injury patients report chronic pain, changes in work circumstances, concerns about their appearance, increased reliance on others, and difficulty completing daily activities. This suggests that recovery needs to be considered to better deliver post-injury health services. OBJECTIVES Investigate the lived-experience of patients following free-functioning muscle transfers for management of traumatic, pan-brachial plexus injuries.Better understand issues during recovery and implications for rehabilitation with this population. METHODS A phenomenological, qualitative design was employed that involved 5 participants who underwent surgery between 2007 and 2015. In-depth, semi-structured interviews were conducted and data were analyzed using interpretative phenomenological analysis. RESULTS Three interrelated themes were generated from the data. The first theme 'Experience of health care systems' captures the participants' reflections of their post-injury experience and health care received. The second 'Psychosocial considerations' consists of emotional responses, relationship disturbance, and coming to terms with the permanence of their changed arm. The last theme, 'Creating a new self-identity', relates to the participants experience of adjustment to their new circumstances. CONCLUSIONS The findings of this study demonstrate that comprehensive medical coverage and access to expert brachial plexus injury health providers support patients following injury. However, recovery also requires the need for the patient to adjust and establish a new self-concept. Health care providers can assist patients by establishing positive therapeutic relationships, as well as, reducing the number of care providers by providing a continuity of care from the same health professionals.IMPLICATIONS FOR REHABILITATIONIndividuals with pan-brachial plexus injuries felt it was beneficial to work with health care providers with extensive brachial plexus injury knowledge.Stable, long-term relationships with health providers during rehabilitation were reported as beneficial to recovery.Greater consideration of the process of adjustment and creating a new self-identity following pan-brachial plexus injury needs to be considered during rehabilitation.
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Affiliation(s)
- Sara Brito
- Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Jennifer White
- Department of Physiotherapy, Monash University, Frankston, Australia
| | - Nikos Thomacos
- Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Bridget Hill
- Epworth Monash Rehabilitation Medicine Unit, Epworth Hospital, Richmond, Australia
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