26 Feb Hand Function Restored By Bionic Reconstruction

MedicalResearch.com Interview with:
Aidan Roche MBBS, PhD, BEng and
Prof Oskar C Aszmann MD
Director of the Christian Doppler Laboratory for Restoration of Extremity Function
Division of Plastic and Reconstructive Surgery
Department of Surgery
Medical University of Vienna, Vienna, Austria

Medical Research: What is the background for this study? What are the main findings?

Response: The study was prompted by lack of techniques to restore hand function in patients with global plexopathies with avulsion of the lower roots. In simple terms, this is a tearing injury to parts of the brachial plexus. The brachial plexus is a complex junction of nerves that leaves the spinal cord and supplies the arm. If this junction of nerves is severely damaged, information cannot reach the hand to control it or to receive sensation from it.  In some of these cases, traditional reconstructive surgical techniques are only able to restore shoulder and elbow function, not the hand itself. In severe cases, this might leave the patient with a useless hand.  In previous clinical studies with existing amputees, advancing research has shown that good prosthetic control can be achieved by selectively transferring nerves. However, our study differs as our patients had intact, but functionless hands. The innovation here was to selectively transfer nerves and muscles to create useable signals for prosthetic control. Together with a comprehensive rehabilitation regime, followed by elective amputation, this formed the bionic reconstruction process. The main finding is that all three patients had excellent hand function restored through bionic reconstruction (as measured by the uniform improvement in all patients in the clinical outcome scores of the Action Research Arm Test, the Disability of Arm, Shoulder and Hand Questionairre, and the Southampton Hand Assessment Procedure and reported in detail in The Lancet).

Medical Research: What should clinicians and patients take away from your report?

Response: While bionic reconstruction currently has only been performed in the Medical University of Vienna,  there is no reason why this procedure could not be conducted at another institution with similar facilities, medical skill (physiatrists, occupational therapists, prosthetists, technicians)  and surgical skill (experienced micro- and nerve surgeons). The technique is not limited by the myoelectric prosthesis, indeed the technique can work with any standardly available myoelectric prosthesis that is widely used in the clinical setting. Importantly however, this procedure is not appropriate for every patient. They must be assessed on a case-by-case basis. In this study we only included patients who had a functionless hand with no sensation following a global plexopathies with avulsion of the lower roots and failure of all previous surgical reconstructions.  Absolute contraindications for inclusion in this study were the presence of useful sensation in the hand, an unstable shoulder, and an inability to lift the forearm against resistance.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: The next step in this research is to apply this technique to patients who have had different injuries that have led to a functionless hand. Examples include severe trauma such as crush injuries or a mangled limb following an industrial accident. We have done this with three different patients, and will report separately soon. We are also looking into ways to decode the muscular signals, using advanced pattern recognition methods, towards achieving more intuitive control of  prosthetic hands.In addition, the addition of sensation would improve prosthetic control.

Citation:

Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients

Prof Oskar C Aszmann, MD Aidan D Roche, PhD Stefan Salminger, MD Tatjana Paternostro-Sluga, MD Malvina Herceg, MD Agnes Sturma, BSc Christian Hofer, PhD Prof Dario Farina, PhD

Lancet Published Online: 24 February 2015

DOI: http://dx.doi.org/10.1016/S0140-6736(14)61776-1

MedicalResearch.com Interview with: Aidan Roche MBBS, PhD, BEng and, &Prof Oskar C Aszmann MD (2015). Hand Function Restored By Bionic Reconstruction 

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Last Updated on February 26, 2015 by Marie Benz MD FAAD