Bionic reconstruction has restored hand function to three patients with brachial plexus injuries including lower root avulsions, according to study results published in The Lancet.
Oskar C. Aszmann, MD, PhD, and colleagues report bionic reconstruction – a combined technique of selective nerve and muscle transfers, elective amputation and prosthetic rehabilitation – was performed on three patients between May 2011 and April 2014. Treatment occurred in two stages: first, the identification and creation of useful electromyographic signals for prosthetic control and second, the amputation of the hand and replacement of a mechatronic prosthesis. Patients underwent a customized pre-amputation rehabilitation program to enhance electromyographic signals and cognitive control of the prosthesis, and fitting of the prosthesis was applied as early as 6 weeks post-amputation.
Indication for inclusion in the study and to proceed to bionic reconstruction was failure of all previous attempted biological reconstruction procedures, resulting in a stiff, insensate, intrinsic minus hand, as well as useful shoulder and elbow function and at least two cognitively separate electromyographic signals in the forearm.
Global arm function was assessed before and after intervention with the Action Research Arm Test (ARAT), Southampton Hand Assessment Procedure (SHAP) and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Pain scores were evaluated with visual analogue scales and QoL scores were determined by the SF-36 Health Survey.
All functional outcomes improved post-intervention and all patients were able to perform bimanual tasks after adjusting to the new prosthetic hands. Results after 3 months showed an increase in the mean ARAT score from 5.3 to 30.7. The mean SHAP score increased after prosthetic hand fitting from 9.3 to 65.3; and the mean DASH score decreased (improved) after prosthetic hand fitting from 46.5 to 11.7. SF-36 outcomes showed substantial improvement in physical functioning and mental health. One patient reported increased pain post-intervention due to prosthetic socket pressure, which was resolved by a socket redesign.
Aszmann O, et al. The Lancet 2015; doi:10.1016/S0140-6736(14)61776-1.
Disclosure: Aszmann reports no relevant financial disclosures.