update on upper extremity prosthetic design - …...- bionics - michael rivlin, md . assistant...
TRANSCRIPT
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UPDATE ON UPPER EXTREMITY PROSTHETIC DESIGN
- BIONICS -
Michael Rivlin, MD Assistant Professor
Rothman Institute,
Thomas Jefferson University
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Reverse engineering
Problem (pathology) Normal
(physiology)
Solution (bionics)
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Take home points:
- Not everything is salvageable… - There are other options - As surgeons of the extremities we
influence the options
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Why prosthetics?
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Prosthetic workshop
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Orthopod: Can we help you?
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Vein grafts for venous reconstruction
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The Dilemma
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Upper extremity prosthetic DESIGN:
Mechanical force Mechanical gross
motor function
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First Mobile Hand Prosthesis Gottfried "Götz" von
Berlichingen (1480 – 23 July 1562) also known as Götz of the Iron Hand designed the first known moving prosthesis capable of multiple functions
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First Mobile Hand Prosthesis Gottfried "Götz" von
Berlichingen (1480 – 23 July 1562) also known as Götz of the Iron Hand designed the first known moving prosthesis capable of multiple functions
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Harness design – first functional prostheses
▪ Body powered ▪ Minimal versatility
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Upper extremity prosthetic DESIGN:
Muscle electrical Mechanical gross
activity motor function
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Myoelectrics - since the 1960’s
▪ uses electromyography signals or potentials from voluntarily contracted muscles
▪ Controls closing and opening of distal attachment
▪ often rejected due to the significant neuromuscular retraining required and, even under the best circumstances, the cumbersome, sequential manipulation of each joint or device
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Targeted muscle reinnervation (TMR)
▪ motor nerves whose primary target muscle groups have been lost are re-implanted into deliberately dennervated proximal muscles
Advantages: • Increased number of independent control sites
• intuitively
• simultaneously, rather than sequentially, manipulate multiple joints or devices
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Hand (N Y). 2014 Jun;9(2):253-7. doi: 10.1007/s11552-014-9602-5. Targeted muscle reinnervation in the initial management of traumatic upper extremity amputation injury. Cheesborough JE1, Souza JM1, Dumanian GA2, Bueno RA Jr3.
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Hand (N Y). 2014 Jun;9(2):253-7. doi: 10.1007/s11552-014-9602-5. Targeted muscle reinnervation in the initial management of traumatic upper extremity amputation injury. Cheesborough JE1, Souza JM1, Dumanian GA2, Bueno RA Jr3.
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ALSO
▪ Following TMR procedures at Northwestern Memorial Hospital, five out of nine shoulder disarticulation patients who reported neuroma pain prior to their TMR procedure reported no neuroma pain after TMR.
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Upper extremity prosthetic DESIGN:
Muscle pattern Mechanical FINE
activity motor function
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Advanced pattern recognition (APR)
▪ computer algorithms to decipher surface electrode data
▪ and subsequently associate speciffic signal patterns with
▪ Requirement: have undergone TMR
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1
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The patient factor … everyone is different Sorry dude…
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THE FUTURE:
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Function
2
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Osteointegration
▪ An emerging surgical technique for direct skeletal attachment of prostheses which may one day render sockets antiquated and obsolete for many patients.
▪ Permanent coupling of metallic
implants to the skeleton. ▪ Works for OMFS, dental
implants… ortho? Branemark , J. Rehabil. Res. 2001 Tillander CORR 2010
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Osseointegrated percutaneous prostheses
Survival rate at two years (92%) enhanced prosthetic use and mobility, fewer problems and improved quality of life
A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation: A prospective study of 51 patients. Brånemark R1, Berlin O, Hagberg K, Bergh P, Gunterberg B, Rydevik B. Bone Joint J. 2014 Apr;96-B(4):562.
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New horizons
iLimb - Touch Bionics: Customization of function via iPhone App
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Upper extremity prosthetic DESIGN:
Neurological Precise fine electrical motor function
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Intuitive control – with CNS
Experimental implant in motor cortex can grant control of extra (third) arm in primates and in early human experiments
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3
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Targeted Sensory Reinervation
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Sensation
▪ Is targeted muscle reinervation the answer?
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Paterned TSR
Sensation is felt as if on the hand in the following areas
▪ 1.First digit ▪ 2.First and second Digit ▪ 3.Third digit ▪ 4.Fourth digit. ▪ 5.Fifth digit
https://sites.google.com/a/gbcpando.com/targeted-muscle-reinnervation/targeted-sensory-reinnervation
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We are not at the finish line yet… ... sometimes its harder than it looks
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Questions
Thank you