Browsing by Author "Phillips, M.E."

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Open Access
OCCUPATIONAL THERAPY OUTCOMES WITH TARGETED HYPER-REINNERVATION NERVE TRANSFER SURGERY : TWO CASE STUDIES
(2005) Stubblefield, K.A.; Miller, L.A.; Lipschutz, R.D.; Heckathorne, C.W.; Phillips, M.E.; Kuiken, T.A.
The control of prostheses, both externally powered and body powered, increases in complexity with higher levels of amputation. The externally powered prosthesis has a limited number of options for controlling multiple joints myo-electrically. Some method is necessary to switch control between functions (ie: elbow and hand). Targeted hyper-reinnervation nerve transfer surgery has the potential to greatly improve control of the electric prosthesis for the above elbow and shoulder disarticulation subjects by increasing the number of control options available. When the limb is lost the Brachial Plexus typically remains intact. The nerve supply to the missing limb is viable and connected to the motor cortex, but the motor end points served are gone. In nerve transfer surgery, the peripheral nerve is relocated to an area of denervated muscle tissue in the residual limb –a muscle that no longer moves the missing limb. Hyper-reinnervation occurs resulting in an area of say the Biceps, being controlled by the Median Nerve (in the intact limb, the Median Nerve supplied finger and wrist flexors). A muscle contraction occurs in the graft area of the Biceps when the subject attempts to close his hand. A myo-control site is added if the subject can isolate the contraction from that of the Biceps muscle served by the Musculocutaneous Nerve distribution.
Open Access
TRANSHUMERAL LEVEL FITTING AND OUTCOMES FOLLOWING TARGETED HYPER-REINNERVATION NERVE TRANSFER SURGERY
(2005) Lipschutz, R.D.; Miller, L.A.; Stubblefield, K.A.; Dumanian, G.; Phillips, M.E.; Kuiken, T.A.
In a typical transhumeral myoelectric system, biceps and triceps control both elbow and hand. Mode selection (frequently co-contraction) is used to switch between these two functions. In addition to requiring that these movements be performed sequentially, use of the biceps and triceps is not physiological for control of the hand. A novel approach for simultaneous control of multiple myoelectric functions was developed. This was made possible by ‘Targeted Reinnervation’; a surgical intervention, which involves the transfer of the peripheral nerves that used to provide signals to the forearm for hand function, to remaining muscles on the transhumeral limb.