Browsing by Subject "Nerve Transfer"
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Item Open Access FITTING AND OUTCOMES OF A BILATERAL SHOULDER DISARTICULATION AMPUTEE FOLLOWING TARGETED HYPER-REINNERVATION NERVE TRANSFER SURGERY(2005) Miller, L.A.; Lipschutz, R.D.; Stubblefield, K.A.; Kuiken, T.A.to be controlled; yet there are fewer control signals remaining to control these multiple degrees-of-freedom. Traditional fitting of a shoulder disarticulation amputee with a myoelectric system uses 2-sites and sequential control. This can be tedious and slow. When an amputation has occurred, the musculature is gone, however, the nerves that controlled the arm remain. The goal of the targeted hyper-reinnervation nerve transfer surgery was to create additional sites using these nerves to allow simultaneous control of multiple movements using more natural control schemes [1,2,3]. Following an experimental nerve transfer procedure, 4 new myoelectric signals were created on the left pectoralis muscle for a single bilateral shoulder disarticulation (BSD) amputee using nerves that previously controlled hand and elbow function. Subsequent prosthetic fitting found that the user was able to operate the elbow and hand in a coordinated fashion and various outcome measurements showed and improvement in prosthetic function.Item Open Access SHOULDER DISARTICULATION FITTING WITH 6 INDEPENDENTLY CONTROLLED MOTORS AFTER TARGETED HYPER-REINNERVATION NERVE TRANSFER SURGERY(2005) Miller, L.A.; Lipschutz, R.D.; Weir, R.W.; Williams, T.W.; Stubblefield, K.A.; Heckathorne, C.W.; Kuiken, T.A.In 2002, targeted hyper-reinnervation nerve transfer surgery was performed unilaterally on a bilateral shoulder disarticulation amputee. The goal of this surgery was to create additional sites using the remaining unused brachial plexus nerves to allow simultaneous control of multiple movements using more natural control schemes [1,2,3]. As a result of the nerve transfer procedure, 4 new myoelectric control sites were created on the left pectoralis muscle. Subsequent prosthetic fitting found that the user was able to operate the elbow and hand in a coordinated fashion using three electrodes. Various outcome measurements showed an improvement in prosthetic function. However, with the increase in the number of input signals, a goal was set to build a prosthesis with the maximum number of controlled motors available. Six motorized components were identified: three were commercially available in the USA, one was commercially available in other countries and two were a research prototype.Item Open Access The evolution of facial reanimation techniques.(American journal of otolaryngology, 2023-05) Pan, Debbie R; Clark, Nicholas W; Chiang, Harry; Kahmke, Russel R; Phillips, Brett T; Barrett, Dane MThis review article provides an updated discussion on evidence-based practices related to the evaluation and management of facial paralysis. Ultimately, the goals of facial reanimation include obtaining facial symmetry at rest, providing corneal protection, restoring smile symmetry and facial movement for functional and aesthetic purposes. The treatment of facial nerve injury is highly individualized, especially given the wide heterogeneity regarding the degree of initial neuronal insult and eventual functional outcome. Recent advancements in facial reanimation techniques have better equipped clinicians to approach challenging patient scenarios with reliable, effective strategies. We discuss how technology such as machine learning software has revolutionized pre- and post-intervention assessments and provide an overview of current controversies including timing of intervention, choice of donor nerve, and management of nonflaccid facial palsy with synkinesis. We highlight novel considerations to mainstay conservative management strategies and examine innovations in modern surgical techniques with a focus on gracilis free muscle transfer. Innervation sources, procedural staging, coaptation patterns, and multi-vector and multi-muscle paddle design are modifications that have significantly evolved over the past decade.Item 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.