Targeted Muscle Reinnervation
A Neural Interface for Artificial Limbs
Implement TMR with Your Patients and Improve Their Quality of Life
Developed by Dr. Todd A. Kuiken and Dr. Gregory A. Dumanian, targeted muscle reinnervation (TMR) is a new approach to accessing motor control signals from peripheral nerves after amputation and providing sensory feedback to prosthesis users. This practical approach has many advantages over other neural-machine interfaces for the improved control of artificial limbs. Targeted Muscle Reinnervation: A Neural Interface for Artificial Limbs provides a template for the clinical implementation of TMR and a resource for further research in this new area of science.
After describing the basic scientific concepts and key principles underlying TMR, the book presents surgical approaches to transhumeral and shoulder disarticulation amputations. It explores the possible role of TMR in the prevention and treatment of end-neuromas and details the principles of rehabilitation, prosthetic fitting, and occupational therapy for TMR patients. The book also describes transfer sensation and discusses the surgical and functional outcomes of the first several TMR patients. It concludes with emerging research on using TMR to further improve the function and quality of life for people with limb loss.
With contributions from renowned leaders in the field, including Drs. Kuiken and Dumanian, this book is a useful guide to implementing TMR in patients with high-level upper limb amputations. It also supplies the foundation to enable improvements in TMR techniques and advances in prosthetic technology.
Table of Contents
Introduction to Targeted Reinnervation, Todd A. Kuiken
The Scientific Basis of Targeted Muscle Reinnervation, Todd A. Kuiken
Principles of Targeted Muscle Reinnervation
Optimization of the EMG Signal
Surgical Techniques for Targeted Muscle Reinnervation, Gregory A. Dumanian and Jason M. Souza
Fundamentals of Targeted Musscle Reinnervation Surgery
Targeted Muscle Reinnervation for the Transhumeral Amputee
Targeted Muscle Reinnervation for the Shoulder Disarticulation Amputee
Targeted Sensory Reinnervation
Targeted Muscle Reinnervation as a Strategy for Neuroma Prevention, Jason H. Ko, Peter S. Kim, and Douglas G. Smith
Treatment of Neuromas
TMR as a Strategy for Neuroma Prevention
Rehabilitation of the Targeted Muscle Reinnervation Patient, Todd A. Kuiken
Patient and Team Education
Potential Surgical Complications
Prosthetic Fitting before and after Targeted Muscle Reinnervation, Laura A. Miller and Robert D. Lipschutz
Postsurgical Reinnervation (Interim) Period
Occupational Therapy for the Targeted Muscle Reinnervation Patient, Kathy A. Stubblefield and Todd A. Kuiken
Targeted Sensory Reinnervation, Paul D. Marasco
Sensory Perception and Feedback in Prostheses
Transfer Sensation in Targeted Reinnervation Amputees
Application of Transfer Sensation for Sensory Feedback
Surgical and Functional Outcomes of Targeted Muscle Reinnervation, Laura A. Miller, Kathy A. Stubblefield, Robert D. Lipschutz, Blair A. Lock, Jason M. Souza, Gregory A. Dumanian, and Todd A. Kuiken
Assessment of Functional Outcomes at RIC
Future Research Directions, Levi J. Hargrove and Blair A. Lock
Improvements in Control Algorithms
Extension of TMR to Transradial and Lower Limb Amputations
Advanced Prosthetic Systems
References appear at the end of each chapter.
Todd A. Kuiken, MD, PhD, is the director of both the Center for Bionic Medicine and Amputee Services at the Rehabilitation Institute of Chicago, where he and his interdisciplinary team seek to understand and capitalize on the potential of TMR to provide improved prosthetic function. Dr. Kuiken is also a professor in the Departments of Physical Medicine and Rehabilitation, Surgery, and Biomedical Engineering at Northwestern University. An internationally respected clinician and research scientist, he has received many awards for his work on TMR. He earned a PhD in biomedical engineering and an MD from Northwestern University.
Aimee E. Schultz Feuser, MS, is a freelance scientific writer and editor working with the Center for Bionic Medicine. She has authored and coauthored several journal articles on targeted sensory reinnervation and prosthetics. She earned an MS in mechanical engineering from Northwestern University.
Ann K. Barlow, PhD, is a scientific writer at the Center for Bionic Medicine, where she works on manuscript editing and grant development. She earned a PhD in molecular microbiology from the University of Southampton.