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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gregori V, Cognolato M, Saetta G, Atzori M, Gijsberts A. On the Visuomotor Behavior of Amputees and Able-Bodied People During Grasping. Front Bioeng Biotechnol 2019; 7:316. [PMID: 31799243 PMCID: PMC6874164 DOI: 10.3389/fbioe.2019.00316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/24/2019] [Indexed: 11/15/2022] Open
Abstract
Visual attention is often predictive for future actions in humans. In manipulation tasks, the eyes tend to fixate an object of interest even before the reach-to-grasp is initiated. Some recent studies have proposed to exploit this anticipatory gaze behavior to improve the control of dexterous upper limb prostheses. This requires a detailed understanding of visuomotor coordination to determine in which temporal window gaze may provide helpful information. In this paper, we verify and quantify the gaze and motor behavior of 14 transradial amputees who were asked to grasp and manipulate common household objects with their missing limb. For comparison, we also include data from 30 able-bodied subjects who executed the same protocol with their right arm. The dataset contains gaze, first person video, angular velocities of the head, and electromyography and accelerometry of the forearm. To analyze the large amount of video, we developed a procedure based on recent deep learning methods to automatically detect and segment all objects of interest. This allowed us to accurately determine the pixel distances between the gaze point, the target object, and the limb in each individual frame. Our analysis shows a clear coordination between the eyes and the limb in the reach-to-grasp phase, confirming that both intact and amputated subjects precede the grasp with their eyes by more than 500 ms. Furthermore, we note that the gaze behavior of amputees was remarkably similar to that of the able-bodied control group, despite their inability to physically manipulate the objects.
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Affiliation(s)
- Valentina Gregori
- Department of Computer, Control, and Management Engineering, University of Rome La Sapienza, Rome, Italy.,VANDAL Laboratory, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Matteo Cognolato
- Information Systems Institute, University of Applied Sciences Western Switzerland (HES-SO Valais), Sierre, Switzerland.,Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Gianluca Saetta
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Manfredo Atzori
- Information Systems Institute, University of Applied Sciences Western Switzerland (HES-SO Valais), Sierre, Switzerland
| | | | - Arjan Gijsberts
- VANDAL Laboratory, Istituto Italiano di Tecnologia, Genoa, Italy
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