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[PMID]:29414988
[Au] Autor:Morgan SJ; McDonald CL; Halsne EG; Cheever SM; Salem R; Kramer PA; Hafner BJ
[Ad] Endereço:Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States of America.
[Ti] Título:Laboratory- and community-based health outcomes in people with transtibial amputation using crossover and energy-storing prosthetic feet: A randomized crossover trial.
[So] Source:PLoS One;13(2):e0189652, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Contemporary prosthetic feet are generally optimized for either daily or high-level activities. Prosthesis users, therefore, often require multiple prostheses to participate in activities that span a range of mobility. Crossover feet (XF) are designed to increase the range of activities that can be performed with a single prosthesis. However, little evidence exists to guide clinical prescription of XF relative to traditional energy storing feet (ESF). The objective of this study was to assess the effects of XF and ESF on health outcomes in people with transtibial amputation. A randomized crossover study was conducted to assess changes in laboratory-based (endurance, perceived exertion, walking performance) and community-based (step activity and self-reported mobility, fatigue, balance confidence, activity restrictions, and satisfaction) outcomes. Twenty-seven participants were fit with XF and ESF prostheses with standardized sockets, interfaces, and suspensions. Participants were not blinded to the intervention, and wore each prosthesis for one month while their steps were counted with an activity monitor. After each accommodation period, participants returned for data collection. Endurance and perceived exertion were measured with the Six-Minute Walk Test and Borg-CR100, respectively. Walking performance was measured using an electronic walkway. Self-reported mobility, fatigue, balance confidence, activity restrictions, and satisfaction were measured with survey instruments. Participants also reported foot preferences upon conclusion of the study. Differences between feet were assessed with a crossover analysis. While using XF, users experienced improvements in most community-based outcomes, including mobility (p = .001), fatigue (p = .001), balance confidence (p = .005), activity restrictions (p = .002), and functional satisfaction (p < .001). Participants also exhibited longer sound side steps in XF compared to ESF (p < .001). Most participants (89%) reported an overall preference for XF; others (11%) reported no preference. Results indicate that XF may be a promising alternative to ESF for people with transtibial amputation who engage in a range of mobility activities. TRIAL REGISTRATION: ClinicalTrials.gov NCT02440711.
[Mh] Termos MeSH primário: Amputação
Membros Artificiais

Próteses e Implantes
Tíbia/cirurgia
[Mh] Termos MeSH secundário: Estudos Cross-Over
Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180208
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189652


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[PMID]:28470463
[Au] Autor:Hoffmeister T; Schwarze F; Aschoff HH
[Ad] Endereço:Sana Kliniken Lübeck GmbH, Kronsforder Allee 71/73, 23560, Lübeck, Deutschland.
[Ti] Título:[The endo-exo prosthesis treatment concept : Improvement in quality of life after limb amputation].
[Ti] Título:Das Endo-Exo-Prothesen-Versorgungskonzept : Verbesserung der Lebensqualität nach Extremitätenamputation..
[So] Source:Unfallchirurg;120(5):371-377, 2017 May.
[Is] ISSN:1433-044X
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Osseointegrated, percutaneous implants as the force bearer for exoprosthetics after limb amputation have been used in individual cases for clinical rehabilitation of amputees during the past years. Most experience in this field in Germany has been accumulated at the Sana Klinik in Lübeck with the so-called endo-exo prosthesis (EEP) system. The two-step implantation procedure can now be considered as reliable. Following a well-documented learning curve initial soft tissue problems concerning the cutaneous stoma can now be regarded as exceptions. The retrospective examination of the results concerning by now more than 100 patients provided with an endo-exo femoral prosthesis (EEFP) showed a very satisfying outcome concerning objective as well as subjective values, such as duration of daily use and wearing comfort of the exoprosthesis. Regaining the ability of osseoperception due to the intraosseous fixation is described by the patients as a great advantage. The step from a socket prosthesis to an EEP is felt to be a big increase in quality of life by nearly all patients included into the follow-up. Nearly all of the patients questioned would choose an endo-exo prosthesis again. Meanwhile, the success of the EEP resulted in the broadening of indications from above-knee amputations to transtibial as well as transhumeral amputations. The results are likewise encouraging. The use of EEP for the upper limbs leads to substantial improvement in the range of motion of the shoulder joint with the intramedullary anchored percutaneous implant. Furthermore, new pathbreaking possibilities in the fixation of myoelectrically controlled arm prostheses may arise from the EEP technique.
[Mh] Termos MeSH primário: Cotos de Amputação/cirurgia
Amputação/reabilitação
Artroplastia de Quadril/instrumentação
Exoesqueleto Energizado
Prótese de Quadril
Perna (Membro)/cirurgia
Qualidade de Vida/psicologia
[Mh] Termos MeSH secundário: Amputação/psicologia
Artroplastia de Quadril/métodos
Artroplastia de Quadril/psicologia
Membros Artificiais
Terapia Combinada/instrumentação
Terapia Combinada/métodos
Terapia Combinada/psicologia
Seres Humanos
Osseointegração
Desenho de Prótese
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1007/s00113-017-0350-1


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[PMID]:28470462
[Au] Autor:Grundei H; Timmermann A
[Ad] Endereço:Fa. Eska Orthopaedic Handels GmbH, Osterweide 2c, 23562, Lübeck, Deutschland. info@eskaorthopaedic.de.
[Ti] Título:[Connecting adapter for coupling exoprostheses to endoshafts : Demands on orthopedic technicians with respect to planning and application].
[Ti] Título:Anschlussadapter zur Ankopplung der Exoprothese an den Endostiel : Anforderungen an den Orthopädietechniker hinsichtlich Planung und Anwendung..
[So] Source:Unfallchirurg;120(5):378-384, 2017 May.
[Is] ISSN:1433-044X
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:INTRODUCTION: Transcutaneous, bone anchored prostheses have proved to be an alternative for amputees. In addition to the safe osseointegration of the implant, the correct prosthetic alignment is also important. Therefore, the interaction between prosthesis components and the prosthesis wearer is significant and the role of the certified prosthetist should not be underestimated. AIM: The aim of treatment is the best possible compensation of disability after limb loss with increase of physical abilities and comfort of the prosthesis wearer by means of bone anchored prosthesis. METHOD: Endoprosthesis inserted by the surgeon carrying out both surgery with the implant and a double-cone and 6 weeks later the exoprosthesis is fitted by the certified prosthetist orthotist (CPO). Mounting the external adaptors, assembly of the prosthesis. RESULTS: The long-term results with cementless implants and more than 35 years experience are presented. Clinical experience with the endo-exo prosthesis since 1999. A total of 135 patients treated after transfemoral amputation, 8 of them bilateral, 8 out of 135 were transtibial amputees and 1 of them bilateral. A total of 85% were amputated as a consequence of trauma and 12 out of 135 had a full range of motion at the beginning of the prosthetic work following osseointegration. In other cases, a hip flexion contracture between 3 and 12 ° had to be considered by corresponding posterior displacement adaptors. CONCLUSION: Bone anchored prostheses influence the skeleton and joints in a more direct way. This fact requires specific prosthetic measures concerning the connection between the endo-implant and the exoprosthesis. Therefore, specially matched adaptors and the prosthetic alignment are the focus of interest. Prostheses connected to an osseointegrated implant have many biomechanical advantages compared to socket-guided prostheses. Because the quality of rehabilitation is clearly affected by the prosthetic alignment, it has to be carried out extremely carefully and precisely if the prosthesis is connected to an osseointegrated implant. According to the survey, none of the prosthesis wearers wanted to return to a socket-guided prosthesis.
[Mh] Termos MeSH primário: Cotos de Amputação/cirurgia
Amputação/reabilitação
Artroplastia de Substituição/instrumentação
Membros Artificiais
Exoesqueleto Energizado
Prótese Articular
Perna (Membro)/cirurgia
[Mh] Termos MeSH secundário: Artroplastia de Substituição/métodos
Terapia Combinada/instrumentação
Terapia Combinada/métodos
Seres Humanos
Osseointegração
Desenho de Prótese
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1007/s00113-017-0351-0


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[PMID]:29329344
[Au] Autor:Russell Esposito E; Miller RH
[Ad] Endereço:Center for the Intrepid, Brooke Army Medical Center, Department of Rehabilitation Medicine, JBSA, Ft. Sam Houston, Texas, United States of America.
[Ti] Título:Maintenance of muscle strength retains a normal metabolic cost in simulated walking after transtibial limb loss.
[So] Source:PLoS One;13(1):e0191310, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Recent studies on relatively young and fit individuals with limb loss suggest that maintaining muscle strength after limb loss may mitigate the high metabolic cost of walking typically seen in the larger general limb loss population. However, these data are cross-sectional and the muscle strength prior to limb loss is unknown, and it is therefore difficult to draw causal inferences on changes in strength and gait energetics. Here we used musculoskeletal modeling and optimal control simulations to perform a longitudinal study (25 virtual "subjects") of the metabolic cost of walking pre- and post-limb loss (unilateral transtibial). Simulations of walking were first performed pre-limb loss on a model with two intact biological legs, then post-limb loss on a model with a unilateral transtibial prosthesis, with a cost function that minimized the weighted sum of gait deviations plus metabolic cost. Metabolic costs were compared pre- vs. post-limb loss, with systematic modifications to the muscle strength and prosthesis type (passive, powered) in the post-limb loss model. The metabolic cost prior to limb loss was 3.44±0.13 J/m/kg. After limb loss, with a passive prosthesis the metabolic cost did not increase above the pre-limb loss cost if pre-limb loss muscle strength was maintained (mean -0.6%, p = 0.17, d = 0.17). With 10% strength loss the metabolic cost with the passive prosthesis increased (mean +5.9%, p < 0.001, d = 1.61). With a powered prosthesis, the metabolic cost was at or below the pre-limb loss cost for all subjects with strength losses of 10% and 20%, but increased for all subjects with strength loss of 30% (mean +5.9%, p < 0.001, d = 1.59). The results suggest that maintaining muscle strength may prevent an increase in the metabolic cost of walking following unilateral transtibial limb loss, and that a gait with minimal deviations can be achieved when muscle strength is sufficiently high, even when using a passive prosthesis.
[Mh] Termos MeSH primário: Amputados
Membros Artificiais
Força Muscular
Tíbia
Caminhada/fisiologia
[Mh] Termos MeSH secundário: Seres Humanos
Modelos Biológicos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180113
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191310


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[PMID]:28322115
[Au] Autor:Li Y; Simpson KJ; Nolan L; Miller M; Johnson B
[Ad] Endereço:a Department of Kinesiology , California State University , Chico , CA , USA.
[Ti] Título:Lower extremity kinematics of curve sprinting displayed by runners using a transtibial prosthesis.
[So] Source:J Sports Sci;36(3):293-302, 2018 Feb.
[Is] ISSN:1466-447X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The purpose of the study was to determine if the kinematics exhibited by skilled runners wearing a unilateral, transtibial prosthesis during the curve section of a 200-m sprint race were influenced by interaction of limb-type (prosthetic limb (PROS-L) vs. nonprosthetic limb (NONPROS-L)) and curve-side (inside and outside limb relative to the centre of the curve). Step kinematics, toe clearance and knee and hip flexion/extension, hip ab/adduction for one stride of each limb were generated from video of 13 males running the curve during an international 200 m transtibial-classified competition. Using planned comparisons (P < 0.05), limb-type and curve-side interactions showed shortest support time and lowest hip abduction displacement by outside-NONPROS-L; shortest step length and longest time to peak knee flexion by the inside-PROS-L. For limb-type, greater maximum knee flexion angle and lower hip extension angles and displacement during support and toe clearance of PROS-Ls occurred. For curve-side, higher hip abduction angles during non-support were displayed by inside-limbs. Therefore, practitioners should consider that, for curve running, these kinematics are affected mostly by PROS-L limitations, with no clear advantage of having the PROS-L on either side of the curve.
[Mh] Termos MeSH primário: Amputados/reabilitação
Membros Artificiais
Extremidade Inferior/fisiologia
Corrida/fisiologia
[Mh] Termos MeSH secundário: Fenômenos Biomecânicos
Quadril/fisiologia
Seres Humanos
Joelho/fisiologia
Masculino
Desenho de Prótese
Estudos de Tempo e Movimento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170322
[St] Status:MEDLINE
[do] DOI:10.1080/02640414.2017.1303186


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[PMID]:29384921
[Au] Autor:Xu G; Gao L; Tao K; Wan S; Lin Y; Xiong A; Kang B; Zeng H
[Ad] Endereço:Department of Orthopaedics, Zhaoqing First People's Hospital, Guangdong, China.
[Ti] Título:Three-dimensional-printed upper limb prosthesis for a child with traumatic amputation of right wrist: A case report.
[So] Source:Medicine (Baltimore);96(52):e9426, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: For traumatic upper limb amputees, the prohibitive cost of a custom-made prosthesis brings an insufferable financial burden for their families in developing countries. Three-dimensional (3D) printing allows for creating affordable, lightweight, customized, and well-fitting prosthesis, especially for the growing children. PATIENT CONCERNS: We presented a case of an 8-year-old boy, who suffered a traumatic right wrist amputation as result of a mincing machine accident. The patient was immediately sent to the emergency orthopedics department after the accident. DIAGNOSES: He was diagnosed as severed mangled limb crash injury at the level of the right wrist with a Mangled Extremity Severity Score of 8. INTERVENTIONS: A wrist disarticulation was performed and a 3D-printed prosthetic hand was designed and manufactured for this child. A personalized prosthetic rehabilitation training was applied after the prosthesis installation at 6 months postoperatively. The function of the prosthesis was evaluated at 1-month and 3-month follow-up using the Children Amputee Prosthetics Projects (CAPP) score and the University Of New Brunswick Test Of Prosthetic Function for Unilateral Amputees (UNB test). OUTCOMES: The materials cost <20 dollars. The printing took <8 hours and the component assembling was completed within 20 minutes. During the 3-month follow-up, the child's parents were satisfied with the prosthesis and the UNB test showed the significantly improved function of the prosthesis. LESSONS: This novel 3D-printed upper limb prosthesis in a child with the traumatic wrist amputation might serve as a practical and affordable alternative for children in developing countries and those lacking access to health care providers. A personalized prosthetic rehabilitation needs to be undertaken and more clinical studies are warranted to validate the potential superiority of similar 3D-printed prostheses.
[Mh] Termos MeSH primário: Amputação Traumática/terapia
Membros Artificiais
Impressão Tridimensional
Desenho de Prótese
[Mh] Termos MeSH secundário: Criança
Mãos
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009426


  7 / 5333 MEDLINE  
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[PMID]:28463204
[Au] Autor:Lee JD; Mooney LM; Rouse EJ
[Ti] Título:Design and Characterization of a Quasi-Passive Pneumatic Foot-Ankle Prosthesis.
[So] Source:IEEE Trans Neural Syst Rehabil Eng;25(7):823-831, 2017 07.
[Is] ISSN:1558-0210
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The majority of commercially available passive prosthetic feet are not capable of providing joint mechanics that match that of the intact human ankle. Due to their cantilever design, their stiffness characteristics contrast with what has been observed in the biological ankle, namely, an increase in stiffness during the stance phase of walking. In this paper, we introduce the design and control of a pneumatic foot-ankle prosthesis that attempts to provide biomimetic mechanics. The prosthesis is comprised of a pneumatic cylinder in series with a fiberglass leaf spring, and a solenoid valve to control the flow of air between the two sides of the cylinder. The solenoid valve acts as a mechanical clutch, enabling resetting of the ankle's equilibrium position. By adjusting the pressure inside the cylinder, the prosthesis can be customized to provide a range of ankle mechanics. A mechanical testing machine is used to compare the torque-angle curve of the pneumatic prosthesis with a low-profile passive prosthetic foot. Finally, data are presented of one transtibial amputee walking with the prosthesis at 1.2 m/s. The testing shows that the pneumatic prosthesis is capable of providing an appropriate range of motion as well a maximum torque of 94 Nm, while returning approximately 11.5 J of energy.
[Mh] Termos MeSH primário: Amputados/reabilitação
Articulação do Tornozelo/fisiopatologia
Membros Artificiais
Biomimética/instrumentação
Exoesqueleto Energizado
Prótese Articular
Robótica/métodos
[Mh] Termos MeSH secundário: Pressão do Ar
Projeto Auxiliado por Computador
Desenho de Equipamento
Análise de Falha de Equipamento
Seres Humanos
Meia-Idade
Reprodutibilidade dos Testes
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1109/TNSRE.2017.2699867


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[PMID]:29190727
[Au] Autor:Romkema S; Bongers RM; van der Sluis CK
[Ad] Endereço:University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands.
[Ti] Título:Influence of the type of training task on intermanual transfer effects in upper-limb prosthesis training: A randomized pre-posttest study.
[So] Source:PLoS One;12(11):e0188362, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Intermanual transfer, the transfer of motor skills from the trained hand to the untrained hand, can be used to train upper limb prosthesis skills. The aim of this study was to determine the relation between the magnitude of the intermanual transfer effect and the type of training task. The used tasks were based on different aspects of prosthetic handling: reaching, grasping, grip-force production and functional tasks. A single-blinded clinical trial, with a pre-posttest design was executed. Seventy-one able-bodied, right-handed participants were randomly assigned to four training and two control groups. The training groups performed a training program with an upper-limb prosthesis simulator. One control group performed a sham training (a dummy training without the prosthesis simulator) and another control group received no training at all. The training groups and sham group trained on five consecutive days. To determine the improvement in skills, a test was administered before, immediately after, and one week after the training. Training was performed with the 'unaffected' arm; tests were performed with the 'affected' arm, with the latter resembling the amputated limb. In this study half of the participants trained with the dominant hand, while the other half trained with the non-dominant hand. Participants executed four tests that corresponded to the different training tasks. The tests measured the reaching (movement time and symmetry ratio), grasping (opening time, duration of maximum hand opening, and closing time), grip-force production (deviation of asked grip-force) and functional (movement time) performance. Half of the participants were tested with their dominant arm and half of the participants with their non-dominant arm. Intermanual transfer effects were not found for reaching, grasping or functional tasks. However, we did find intermanual transfer effects for grip-force production tasks. Possibly, the study design contributed to the negative results due to the duration of the training sessions and test sessions. The positive results of the grip-force production might be an effect of the specificity of the training, that was totally focused on training grip-force production. When using intermanual transfer training in novice amputees, specific training should be devoted to grip-force.
[Mh] Termos MeSH primário: Membros Artificiais
Extremidade Superior/fisiopatologia
[Mh] Termos MeSH secundário: Fenômenos Biomecânicos
Seres Humanos
Destreza Motora
Modalidades de Fisioterapia
Método Simples-Cego
Análise e Desempenho de Tarefas
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188362


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[PMID]:27777640
[Au] Autor:Osborn L; Kaliki R; Soares A; Thakor N
[Ad] Endereço:PhD student in Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205 USA.
[Ti] Título:Neuromimetic Event-Based Detection for Closed-Loop Tactile Feedback Control of Upper Limb Prostheses.
[So] Source:IEEE Trans Haptics;9(2):196-206, 2016 Apr-Jun.
[Is] ISSN:2329-4051
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Upper limb amputees lack the valuable tactile sensing that helps provide context about the surrounding environment. Here we utilize tactile information to provide active touch feedback to a prosthetic hand. First, we developed fingertip tactile sensors for producing biomimetic spiking responses for monitoring contact, release, and slip of an object grasped by a prosthetic hand. We convert the sensor output into pulses, mimicking the rapid and slowly adapting spiking responses of receptor afferents found in the human body. Second, we designed and implemented two neuromimetic event-based algorithms, and , on a prosthesis to create a local closed-loop tactile feedback control system (i.e. tactile information is sent to the prosthesis). Grasping experiments were designed to assess the benefit of this biologically inspired neuromimetic tactile feedback to a prosthesis. Results from able-bodied and amputee subjects show the average number of objects that broke or slipped during grasping decreased by over 50% and the average time to complete a grasping task decreased by at least 10% for most trials when comparing neuromimetic tactile feedback with no feedback on a prosthesis. Our neuromimetic method of closed-loop tactile sensing is a novel approach to improving the function of upper limb prostheses.
[Mh] Termos MeSH primário: Membros Artificiais/provisão & distribuição
Biomimética/métodos
Retroalimentação Sensorial/fisiologia
Tato/fisiologia
Extremidade Superior/inervação
[Mh] Termos MeSH secundário: Força da Mão/fisiologia
Seres Humanos
Extremidade Superior/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171127
[Lr] Data última revisão:
171127
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:29088353
[Au] Autor:Serino A; Akselrod M; Salomon R; Martuzzi R; Blefari ML; Canzoneri E; Rognini G; van der Zwaag W; Iakova M; Luthi F; Amoresano A; Kuiken T; Blanke O
[Ad] Endereço:Center for Neuroprosthetics, Swiss Federal Institute of Technology of Lausanne (EPFL), chemin des mines 9, 1202 Geneva, Switzerland.
[Ti] Título:Upper limb cortical maps in amputees with targeted muscle and sensory reinnervation.
[So] Source:Brain;140(11):2993-3011, 2017 Nov 01.
[Is] ISSN:1460-2156
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Neuroprosthetics research in amputee patients aims at developing new prostheses that move and feel like real limbs. Targeted muscle and sensory reinnervation (TMSR) is such an approach and consists of rerouting motor and sensory nerves from the residual limb towards intact muscles and skin regions. Movement of the myoelectric prosthesis is enabled via decoded electromyography activity from reinnervated muscles and touch sensation on the missing limb is enabled by stimulation of the reinnervated skin areas. Here we ask whether and how motor control and redirected somatosensory stimulation provided via TMSR affected the maps of the upper limb in primary motor (M1) and primary somatosensory (S1) cortex, as well as their functional connections. To this aim, we tested three TMSR patients and investigated the extent, strength, and topographical organization of the missing limb and several control body regions in M1 and S1 at ultra high-field (7 T) functional magnetic resonance imaging. Additionally, we analysed the functional connectivity between M1 and S1 and of both these regions with fronto-parietal regions, known to be important for multisensory upper limb processing. These data were compared with those of control amputee patients (n = 6) and healthy controls (n = 12). We found that M1 maps of the amputated limb in TMSR patients were similar in terms of extent, strength, and topography to healthy controls and different from non-TMSR patients. S1 maps of TMSR patients were also more similar to normal conditions in terms of topographical organization and extent, as compared to non-targeted muscle and sensory reinnervation patients, but weaker in activation strength compared to healthy controls. Functional connectivity in TMSR patients between upper limb maps in M1 and S1 was comparable with healthy controls, while being reduced in non-TMSR patients. However, connectivity was reduced between S1 and fronto-parietal regions, in both the TMSR and non-TMSR patients with respect to healthy controls. This was associated with the absence of a well-established multisensory effect (visual enhancement of touch) in TMSR patients. Collectively, these results show how M1 and S1 process signals related to movement and touch are enabled by targeted muscle and sensory reinnervation. Moreover, they suggest that TMSR may counteract maladaptive cortical plasticity typically found after limb loss, in M1, partially in S1, and in their mutual connectivity. The lack of multisensory interaction in the present data suggests that further engineering advances are necessary (e.g. the integration of somatosensory feedback into current prostheses) to enable prostheses that move and feel as real limbs.
[Mh] Termos MeSH primário: Amputação
Córtex Motor/diagnóstico por imagem
Movimento/fisiologia
Músculo Esquelético/inervação
Pele/inervação
Córtex Somatossensorial/diagnóstico por imagem
Tato/fisiologia
Extremidade Superior
[Mh] Termos MeSH secundário: Adulto
Idoso
Membros Artificiais
Mapeamento Encefálico
Eletromiografia
Feminino
Neuroimagem Funcional
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Córtex Motor/fisiologia
Plasticidade Neuronal
Córtex Somatossensorial/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171101
[St] Status:MEDLINE
[do] DOI:10.1093/brain/awx242



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