Todd  Kuiken Author of Evaluating Organization Development
FEATURED AUTHOR

Todd Kuiken

Director, Center for Bionic Medicine
Rehabilitation Institute of Chicago

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 a board certified physiatrist at the Rehabilitation Institute of Chicago (RIC), Director of the Center for Bionic Medicine at RIC, and a professor in the Departments of PM&R, BME, and Surgery at Northwestern University.

Biography

Dr. Todd A. Kuiken is a board certified physiatrist at the Rehabilitation Institute of Chicago (RIC) and Director of the Center for Bionic Medicine at RIC.  As a practicing 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.ric.org/research/centers/bionic-medicine/

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

https://www.ric.org/research/centers/bionic-medicine/tmr-book-supplement/

Areas of Research / Professional Expertise

    Amputation/Amputee, Gait disorders, Limb deficiency

Websites

Books

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

Articles

Clinical Orthopaedics and Related Research®

Targeted Muscle Reinnervation: A Novel Approach to Postamputation Neuroma Pain


Published: Feb 01, 2014 by Clinical Orthopaedics and Related Research®
Authors: Jason M. Souza MD, Jennifer E. Cheesborough MD, Jason H. Ko MD, Mickey S. Cho MD, Todd A. Kuiken MD, et al
Subjects: Biomedical Science

Postamputation neuroma pain can prevent comfortable prosthesis wear in patients with limb amputations, and currently available treatments are not consistently effective. Targeted muscle reinnervation (TMR) is a decade-old technique that employs a series of novel nerve transfers to permit intuitive control of upper-limb prostheses. Clinical experience suggests that it may also serve as an effective therapy for postamputation neuroma pain; however, this has not been explicitly studied.

New England Journal of Medicine

Robotic Leg Control with EMG Decoding in an Amputee with Nerve Transfers


Published: Sep 26, 2013 by New England Journal of Medicine
Authors: Levi J. Hargrove, Ph.D., Ann M. Simon, Ph.D., Aaron J. Young, M.S., Robert D. Lipschutz, C.P., et al
Subjects: Biomedical Science

The clinical application of robotic technology to powered prosthetic knees and ankles is limited by the lack of a robust control strategy. We found that the use of electromyographic (EMG) signals from natively innervated and surgically reinnervated residual thigh muscles in a patient who had undergone knee amputation improved control of a robotic leg prosthesis.

Biomedical Engineering, IEEE Transactions

Improving Myoelectric Pattern Recognition Robustness


Published: Mar 01, 2012 by Biomedical Engineering, IEEE Transactions
Authors: Young, A.J.; Hargrove, L.J.; Kuiken, T.A.
Subjects: Biomedical Science

This paper focused on investigating the optimal interelectrode distance, channel configuration, and electromyography feature sets for myoelectric pattern recognition in the presence of electrode shift.

PM&R

Neural Interfaces for Control of Upper Limb Prostheses


Published: Jan 02, 2011 by PM&R
Authors: Aimee E. Schultz, MS; Todd A. Kuiken, MD, PhD
Subjects: Biomedical Science

Current treatment of upper-limb amputation restores some degree of functional ability but falls far below the standard set by the natural arm. Although acceptance rates can be high when patients are highly motivated and receive proper training and care, current prostheses often fail to meet the daily needs of amputees and frequently are abandoned. Recent advancements in science and technology have led to promising methods of accessing neural information for communication or control.

Neural Systems and Rehabilitation Engineering, IEEE Transactions

Quantifying Pattern Recognition—Based Myoelectric Control


Published: Apr 01, 2010 by Neural Systems and Rehabilitation Engineering, IEEE Transactions
Authors: Guanglin Li; Schultz, A.E.; Kuiken, T.A.
Subjects: Biomedical Science

We evaluated real-time myoelectric pattern recognition control of a virtual arm by transradial amputees. Five unilateral patients performed 10 wrist and hand movements using their amputated and intact arms. In order to demonstrate the value of information from intrinsic hand muscles, this data was included in EMG recordings from the intact arm.

The Journal of the American Medical Association

Targeted Muscle Reinnervation for Real-time Myoelectric Control of Multifunction


Published: Feb 11, 2009 by The Journal of the American Medical Association
Authors: Todd A. Kuiken, MD, PhD; Guanglin Li, PhD; Blair A. Lock, MS; Robert D. Lipschutz, CP; Laura A. Miller, CP, PhD, et. al
Subjects: Biomedical Science

Improving the function of prosthetic arms remains a challenge because access to the neural-control information for the arm is lost during amputation. A surgical technique called targeted muscle reinnervation (TMR) transfers residual arm nerves to alternative muscle sites. After reinnervation, these target muscles produce electromyogram (EMG) signals on the surface of the skin that can be measured and used to control prosthetic arms.

Videos

A prosthetic arm that "feels" (TED Talks)

Published: Jun 24, 2014

Physiatrist and engineer Todd Kuiken is building a prosthetic arm that connects with the human nervous system — improving motion, control and even feeling. Onstage, patient Amanda Kitts helps demonstrate this next-gen robotic arm.