Todd  Kuiken, MD, PhD Author of Evaluating Organization Development
FEATURED AUTHOR

Todd Kuiken, MD, PhD

Director Emeritus, Center for Bionic Medicine
Shirley Ryan AbilityLab

An internationally respected leader in the care of people with limb loss, Dr. Todd A. Kuiken is best known for his research in developing a surgical technique called Targeted Muscle Reinnervation (TMR), which allows for more intuitive prosthesis control. Currently, he is Director Emeritus of the Center for Bionic Medicine at the Shirley Ryan AbilityLab (previously named the Rehabilitation Institute of Chicago) and a Professor of PM&R, Surgery, and BME at Northwestern University.

Biography

Dr. Todd A. Kuiken is Director Emeritus of the Center for Bionic Medicine at the Shirley Ryan AbilityLab.  As a physician and biomedical engineer who has spent his entire career working to improve the function of artificial limbs, he is considered an internationally respected leader in the care of people with limb loss.

He received a B.S. degree in biomedical engineering from Duke University (1983), a Ph.D. in biomedical engineering from Northwestern University in Evanston, Illinois (1989) and his M.D. from Northwestern University Medical School (1990).
  
At the Center for Bionic Medicine (CBM), Dr. Kuiken leads a multidisciplinary team of physicians, prosthetists, therapists, neuroscientists, engineers, software developers, graduate students, and post-doctoral researchers. The goal of CBM is to improve function and quality of life for people who have suffered limb loss.  This combination of clinical and research expertise provides a unique environment to translate research data into clinical applications.  

In addition to his work at CBM, Dr. Kuiken is a Professor in the Department of Physical Medicine & Rehabilitation at the Feinberg School of Medicine, Northwestern University. He also has appointments in the Departments of Biomedical Engineering and Surgery.

The primary focus of Dr. Kuiken’s research has been to develop a neural-machine interface to improve the function of artificial limbs.  He is best known for his research in developing a surgical technique called Targeted Muscle Reinnervation (TMR), which is now a standard procedure and has been performed on more than 100 individuals in hospitals worldwide.

With TMR, the residual nerves in an amputated limb are transferred to spare muscle and skin in or near the limb. The nerves grow into this muscle, and then the surface EMG over this muscle can be used as an additional control signal.  For example, if the median nerve reinnervates a small region of surface muscle, then when the patient thinks “close hand,” this muscle will contract and the myoelectric signal can be used to close the powered hand. Since physiologically appropriate neural pathways are used, prosthesis control is more intuitive, easier, and faster.
  
Similarly, sensory nerves can be transferred to the residual nerves so that skin of the chest or arm is reinnervated.  When patients are touched on this reinnervated skin, it feels as if they are being touched in their missing arm or hand.  Transfer sensation can provide a pathway for true sensory feedback of light touch, graded pressure, sharp/dull, and thermal feedback.  Sensors can be placed in the prosthetic hand and the resulting data can be used to control a device that delivers the appropriate sensation to the reinnervated skin.  In this way, prosthetic users can feel what they touch with their prosthesis as if they were touching it with their missing hand.

TMR has led to exciting collaborations and additional research to extract more information out of the reinnervated muscle EMG signals. Pattern Recognition computer algorithms have been added to greatly increase the degrees of freedom that can be intuitively operated.  By decoding these rich EMG signals, Dr. Kuiken’s team has demonstrated the intuitive control of powered shoulders, the elbow, wrist flexion/extension, wrist rotation and even a variety of hand grasp patterns.  Prostheses using pattern recognition are now commercially available.  Most recently, CBM has started to use similar techniques to develop a neural interface for powered prosthetic legs.

More information about the Center for Bionic Medicine (CBM) can be found here:

https://www.sralab.org/cbm

Additionally, further reading about Targeted Muscle Reinnervation (TMR) can be found here:

https://www.sralab.org/cbm/tmr

Areas of Research / Professional Expertise

    Limb loss, biomedical engineering, design of wheelchairs, evaluation of surgical techniques for persons with limb loss, prosthesis design and control

Websites

Books

Featured Title
 Featured Title - Targeted Muscle Reinnervation - 1st Edition book cover

Articles

PRS Global Open

Innovative Use of Thighplasty to Improve Prosthesis Fit and Function in a Transfemoral Amputee


Published: Jan 05, 2018 by PRS Global Open
Authors: Kuiken TA, Fey NP, Reissman T, Finucane SB, Dumanian GA
Subjects: Healthcare

This study demonstrates the potential of using a routine plastic surgery procedure to modify the intrinsic properties of the limb and to improve functional outcomes in overweight or obese transfemoral amputees. This technique is a potentially attractive option compared with multiple reiterations of sockets, which can be time-consuming and costly.

Scientific Reports

Myoelectric Pattern Recognition Outperforms Direct Control for Transhumeral Amputees with Targeted Muscle Reinnervation: A Randomized Clinical Trial


Published: Oct 23, 2017 by Scientific Reports
Authors: Hargrove LJ, Miller LA, Turner K, Kuiken TA
Subjects: Biomedical Science

This study was the first home trial large enough to establish clinical and statistical significance in comparing pattern recognition with direct control. Results demonstrate that pattern recognition is a viable option and has functional advantages over direct control.

Techniques in Orthopaedics

Targeted Muscle Reinnervation for the Upper and Lower Extremity


Published: Jun 01, 2017 by Techniques in Orthopaedics
Authors: Kuiken TA, Barlow AK, Hargrove LJ, Dumanian GA
Subjects: Biomedical Science, Healthcare

The benefits of TMR are being studied in individuals with transradial amputations and lower limb amputations. TMR is also being investigated in an ongoing clinical trial as a method to prevent or treat painful amputation neuromas.

IEEE Journal of Translational Engineering in Health and Medicine

A Comparison of Pattern Recognition Control and Direct Control of a Multiple Degree-of-Freedom Transradial Prosthesis


Published: Nov 22, 2016 by IEEE Journal of Translational Engineering in Health and Medicine
Authors: Kuiken TA, Miller LA, Turner K, Hargrove LJ
Subjects: Biomedical Science

In this paper, three individuals with a transradial amputation completed a home trial to compare direct control and pattern recognition control of a multiple degree-of-freedom prosthesis. Outcome measures before and after the home trial, together with subject questionnaires, were used to evaluate functional control. Although small, this trial has implications for the implementation of pattern recognition in commercial control systems and for future research studies.

Videos

A prosthetic arm that "feels"

Published: Nov 30, 2013

TED Talk describing Dr. Kuiken's research on improving the control of prosthetic limbs.