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Borrell JA, Karumattu Manattu A, Copeland C, Fraser K, D’Ovidio A, Granatowicz Z, Delgado L, Zuniga JM. Prosthetic home intervention induces cortical plasticity in paediatrics with congenital limb reduction. Brain Commun 2024; 6:fcae044. [PMID: 38978721 PMCID: PMC11228431 DOI: 10.1093/braincomms/fcae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/08/2023] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
Paediatrics with congenital upper-limb reduction deficiency often face difficulties with normal development such as motor skills, needing assistance with daily activities such as self-care limitations with certain movements, sports, or activities. The purpose of this non-randomized longitudinal controlled trial was to assess, using intent-to-treat analysis, the effects of an 8-week home intervention of prosthetic use on the sensorimotor cortex in paediatrics with congenital upper-limb reduction deficiency. A paediatric population with congenital upper-limb reduction deficiency (n = 14) who were aged 6-18 years and who had a 20° or greater range of motion in the appropriate joint of the affected arm to move the body-powered prosthesis were enrolled. An age- and sex-matched control group (n = 14) was also enrolled. Participants were non-randomized and fitted with a custom low-cost 3D printed prosthesis and participated in 8 weeks of prosthetic use training at home. Control participants utilized a prosthetic simulator. The home intervention incorporated daily use training and exercises utilizing the prosthesis in direct use and assistive tasks explained by the researchers. After the home intervention, both groups displayed significant improvements in gross manual dexterity. During prosthetic use with the affected limb, significant increases in oxygenated hemodynamic responses were only displayed in the left premotor cortex of the upper-limb reduction deficiency group. The novel findings of this non-randomized longitudinal controlled trial suggest that the intervention may have improved the functional role of the left hemisphere which translated to the improvement of learning direction during adaptation to visuomotor control. The prosthetic home intervention was assumed to provide closed-loop training which could provide a direct benefit to the motor development of paediatrics with upper-limb reduction deficiency.
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Affiliation(s)
- Jordan A Borrell
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Center for Biomedical Rehabilitation and Manufacturing, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Department of Occupational Therapy Education, University of Kansas Medical Center, Kansas City, KS 66103, USA
| | | | - Christopher Copeland
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Kaitlin Fraser
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Andrew D’Ovidio
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Zach Granatowicz
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Liliana Delgado
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Jorge M Zuniga
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Center for Biomedical Rehabilitation and Manufacturing, University of Nebraska at Omaha, Omaha, NE 68182, USA
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Fraser K, Kuhn M, Swanson R, Coulter DW, Copeland C, Zuniga JM. Low Motor Dexterity and Significant Behaviors Following Hospitalized Isolation in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1287. [PMID: 37628286 PMCID: PMC10453062 DOI: 10.3390/children10081287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
The main objective of this study was to describe the cortical patterns of brain activity during a gross dexterity task and develop a behavioral profile of children experiencing isolation. A cross-sectional assessment was conducted during one visit. Sample: Four pediatric patients who had undergone isolation within a hospital comprised the full data collection. During the collection, participants completed the Box and Blocks Test of gross manual dexterity while undergoing imaging of the motor cortex using functional near-infrared spectroscopy. Participants also completed a Behavioral Assessment System for Children, Third Edition (BASC-3) self-report, which was analyzed along with a parent report to quantify their emotional and social behaviors. All participants displayed lower gross dexterity levels than normative data. Furthermore, three out of the four participants displayed ipsilateral dominance of the motor cortex during the dexterity task. Three of the participants displayed behavioral measures reported within clinically significant or at-risk scores. Clinically significant behavioral scores coupled with lower than expected manual dexterity values and ipsilateral hemispheric dominance indicate that neuroplastic changes can occur in populations undergoing hospitalized isolation. While the impacts of the treatments and isolation in this case cannot be separated, further studies should be conducted to understand these impacts of isolation.
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Affiliation(s)
- Kaitlin Fraser
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE 68182, USA (C.C.)
| | - Miriam Kuhn
- Department of Special Education and Communication Disorders, University of Nebraska Omaha, Omaha, NE 68182, USA
| | - Rebecca Swanson
- Pediatric Hematology and Oncology Clinic, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Don W. Coulter
- Division of Pediatric Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Children’s Hospital & Medical Center Specialty Pediatric Center, Omaha, NE 68114, USA
| | - Christopher Copeland
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE 68182, USA (C.C.)
| | - Jorge M. Zuniga
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE 68182, USA (C.C.)
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Borrell JA, Manattu AK, Copeland C, Fraser K, D’Ovidio A, Granatowicz Z, Lesiak AC, Figy SC, Zuniga JM. Phantom limb therapy improves cortical efficiency of the sensorimotor network in a targeted muscle reinnervation amputee: a case report. Front Neurosci 2023; 17:1130050. [PMID: 37234264 PMCID: PMC10205977 DOI: 10.3389/fnins.2023.1130050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Targeted muscle reinnervation (TMR) surgery involves the coaptation of amputated nerves to nearby motor nerve branches with the purpose of reclosing the neuromuscular loop in order to reduce phantom limb pain. The purpose of this case study was to create a phantom limb therapy protocol for an amputee after undergoing TMR surgery, where the four main nerves of his right arm were reinnervated into the chest muscles. The goal of this phantom limb therapy was to further strengthen these newly formed neuromuscular closed loops. The case participant (male, 21- years of age, height = 5'8″ and weight = 134 lbs) presented 1- year after a trans-humeral amputation of the right arm along with TMR surgery and participated in phantom limb therapy for 3 months. Data collections for the subject occurred every 2 weeks for 3 months. During the data collections, the subject performed various movements of the phantom and intact limb specific to each reinnervated nerve and a gross manual dexterity task (Box and Block Test) while measuring brain activity and recording qualitative feedback from the subject. The results demonstrated that phantom limb therapy produced significant changes of cortical activity, reduced fatigue, fluctuation in phantom pain, improved limb synchronization, increased sensory sensation, and decreased correlation strength between intra-hemispheric and inter-hemispheric channels. These results suggest an overall improved cortical efficiency of the sensorimotor network. These results add to the growing knowledge of cortical reorganization after TMR surgery, which is becoming more common to aid in the recovery after amputation. More importantly, the results of this study suggest that the phantom limb therapy may have accelerated the decoupling process, which provides direct clinical benefits to the patient such as reduced fatigue and improved limb synchronization.
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Affiliation(s)
- Jordan A. Borrell
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
- Center for Biomedical Rehabilitation and Manufacturing, University of Nebraska at Omaha, Omaha, NE, United States
| | | | - Christopher Copeland
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
| | - Kaitlin Fraser
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
| | - Andrew D’Ovidio
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
| | - Zach Granatowicz
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
| | - Alex C. Lesiak
- Orthopedic Surgery, OrthoNebraska Hospital, Omaha, NE, United States
| | - Sean C. Figy
- Plastic and Reconstructive Surgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jorge M. Zuniga
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
- Center for Biomedical Rehabilitation and Manufacturing, University of Nebraska at Omaha, Omaha, NE, United States
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Reimagining Prosthetic Control: A Novel Body-Powered Prosthetic System for Simultaneous Control and Actuation. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4030032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Globally, the most popular upper-limb prostheses are powered by the human body. For body-powered (BP) upper-limb prostheses, control is provided by changing the tension of (Bowden) cables to open or close the terminal device. This technology has been around for centuries, and very few BP alternatives have been presented since. This paper introduces a new BP paradigm that can overcome certain limitations of the current cabled systems, such as a restricted operation space and user discomfort caused by the harness to which the cables are attached. A new breathing-powered system is introduced to give the user full control of the hand motion anywhere in space. Users can regulate their breathing, and this controllable airflow is then used to power a small Tesla turbine that can accurately control the prosthetic finger movements. The breathing-powered device provides a novel prosthetic option that can be used without limiting any of the user’s body movements. Here we prove that it is feasible to produce a functional breathing-powered prosthetic hand and show the models behind it along with a preliminary demonstration. This work creates a step-change in the potential BP options available to patients in the future.
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Sattar NY, Kausar Z, Usama SA, Farooq U, Shah MF, Muhammad S, Khan R, Badran M. fNIRS-Based Upper Limb Motion Intention Recognition Using an Artificial Neural Network for Transhumeral Amputees. SENSORS (BASEL, SWITZERLAND) 2022; 22:726. [PMID: 35161473 PMCID: PMC8837999 DOI: 10.3390/s22030726] [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: 11/26/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
Prosthetic arms are designed to assist amputated individuals in the performance of the activities of daily life. Brain machine interfaces are currently employed to enhance the accuracy as well as number of control commands for upper limb prostheses. However, the motion prediction for prosthetic arms and the rehabilitation of amputees suffering from transhumeral amputations is limited. In this paper, functional near-infrared spectroscopy (fNIRS)-based approach for the recognition of human intention for six upper limb motions is proposed. The data were extracted from the study of fifteen healthy subjects and three transhumeral amputees for elbow extension, elbow flexion, wrist pronation, wrist supination, hand open, and hand close. The fNIRS signals were acquired from the motor cortex region of the brain by the commercial NIRSport device. The acquired data samples were filtered using finite impulse response (FIR) filter. Furthermore, signal mean, signal peak and minimum values were computed as feature set. An artificial neural network (ANN) was applied to these data samples. The results show the likelihood of classifying the six arm actions with an accuracy of 78%. The attained results have not yet been reported in any identical study. These achieved fNIRS results for intention detection are promising and suggest that they can be applied for the real-time control of the transhumeral prosthesis.
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Affiliation(s)
- Neelum Yousaf Sattar
- Department of Mechatronics and Biomedical Engineering, Air University, Main Campus, PAF Complex, Islamabad 44000, Pakistan; (Z.K.); (U.F.)
| | - Zareena Kausar
- Department of Mechatronics and Biomedical Engineering, Air University, Main Campus, PAF Complex, Islamabad 44000, Pakistan; (Z.K.); (U.F.)
| | - Syed Ali Usama
- Department of Mechatronics and Biomedical Engineering, Air University, Main Campus, PAF Complex, Islamabad 44000, Pakistan; (Z.K.); (U.F.)
| | - Umer Farooq
- Department of Mechatronics and Biomedical Engineering, Air University, Main Campus, PAF Complex, Islamabad 44000, Pakistan; (Z.K.); (U.F.)
| | - Muhammad Faizan Shah
- Department of Mechanical Engineering, Khwaja Fareed University of Engineering & IT, Rahim Yar Khan 64200, Pakistan;
| | - Shaheer Muhammad
- Department of Computing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong;
| | - Razaullah Khan
- Institute of Manufacturing, Engineering Management, University of Engineering and Applied Sciences, Swat, Mingora 19060, Pakistan;
| | - Mohamed Badran
- Department of Mechanical Engineering, Faculty of Engineering and Technology, Future University in Egypt, New Cairo 11835, Egypt;
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