Prothetische Rekonstruktion hoher Amputationen der oberen Extremität

Salminger, Stefan; Sturma, Agnes; Herceg, Malvina; Riedl, O; Bergmeister, Konstantin D.; Aszmann, Oskar C.

doi:10.1007/s00132-015-3113-0

Cited by 30 publications

(47 citation statements)

References 19 publications

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“…In addition, voluntary activation of the 2 electrodes at the same time is often used to switch control between different grip patterns or prosthetic joints. This feature is needed when there are fewer signals available than prosthetic movements [9].…”

Section: Introductionmentioning

confidence: 99%

PlayBionic: Game‐Based Interventions to Encourage Patient Engagement and Performance in Prosthetic Motor Rehabilitation

Prahm

Kayali

Sturma

et al. 2018

PM&R

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Background Prosthetic motor rehabilitation usually relies on the highly repetitive training of movements. Patients might drop out of training because the rehabilitation process is long and often discouraging. Game‐based interventions provide a potentially useful alternative to standard myoelectric (electromyographic [EMG]) training and can increase engagement with training. Objective To assess the short‐term impact of a game‐based rehabilitation protocol on parameters for EMG control, evaluate how game‐based interventions affect patient motivation, performance, and effort, and compare the game‐based intervention with a standard tool in rehabilitation (MyoBoy). Design This randomized controlled trial included 2 patient groups and 1 control group. After establishing a baseline, the 2 patient groups received different interventions that were compared with each other and with the able‐bodied control group. Setting University hospital‐based study. Participants Fourteen patients with traumatic transradial or transhumeral upper extremity amputation and 10 able‐bodied participants. Methods For the game‐based intervention, EMG proficiency was assessed before and after playing the games and 2 days later as follow‐up to measure retention rate. EMG proficiency was measured using maximum voluntary contraction, proportional precision control, signal separation, and muscle endurance. Questionnaires for rating the game‐based intervention and intrinsic motivation were provided after the intervention. Outcomes Outcome measures for EMG proficiency were provisional maximum voluntary muscle contraction, precise proportional control, electrode separation, and muscle endurance. Quantitative outcome measures for participant experience were intrinsic motivation, enjoyment, pressure, exerted effort, and usefulness of the intervention. The qualitative outcome measure was the surveyed attitude toward the game‐based intervention. Results Results showed an overall improvement in EMG control, fine muscle activation, and electrode separation. Patients stated that racing games provided slightly more fun, but rhythm‐based games were considered to provide better challenges for EMG control. Conclusion Game‐based interventions provide a useful addition to standard EMG training and can achieve better results in clinical outcome measures. The racing and music game genres provide solid starting points for interventions. Further studies can look at a wider range of genres and identify more specific game mechanics suitable for training. Level of Evidence I

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Section: Introductionmentioning

confidence: 99%

PlayBionic: Game‐Based Interventions to Encourage Patient Engagement and Performance in Prosthetic Motor Rehabilitation

Prahm

Kayali

Sturma

et al. 2018

PM&R

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“…This approach is simple, reliable, and non-invasive, but the information transfer is limited since only two control signals from an agonist-antagonist muscle pair are available. In this scenario, co-contraction is often used to switch the control signals to different joints of the prosthetic device (hand, wrist, elbow or shoulder) (Salminger et al, 2015; Vujaklija et al, 2016). This classic control method is unintuitive and cumbersome but, due to its reliability, it is still the only widely applied clinical solution (Turker, 1993; Scheme and Englehart, 2011; Farina and Aszmann, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…As a consequence, the innervation of multi-headed or segmentally innervated muscles (e.g., biceps, pectoralis muscle) is separated to increase the number of available myosignals (Dumanian et al, 2009). TMR thus enables simultaneous control of multiple degrees of freedom (DoFs), such as hand opening, wrist rotation and elbow flexion (Kuiken et al, 2007; Salminger et al, 2015). In addition, TMR signals are intuitive to use for the patient, as the nerve's original function is the same function as controlled in the prosthesis after the surgery.…”

Section: Introductionmentioning

confidence: 99%

Broadband Prosthetic Interfaces: Combining Nerve Transfers and Implantable Multichannel EMG Technology to Decode Spinal Motor Neuron Activity

et al. 2017

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Modern robotic hands/upper limbs may replace multiple degrees of freedom of extremity function. However, their intuitive use requires a high number of control signals, which current man-machine interfaces do not provide. Here, we discuss a broadband control interface that combines targeted muscle reinnervation, implantable multichannel electromyographic sensors, and advanced decoding to address the increasing capabilities of modern robotic limbs. With targeted muscle reinnervation, nerves that have lost their targets due to an amputation are surgically transferred to residual stump muscles to increase the number of intuitive prosthetic control signals. This surgery re-establishes a nerve-muscle connection that is used for sensing nerve activity with myoelectric interfaces. Moreover, the nerve transfer determines neurophysiological effects, such as muscular hyper-reinnervation and cortical reafferentation that can be exploited by the myoelectric interface. Modern implantable multichannel EMG sensors provide signals from which it is possible to disentangle the behavior of single motor neurons. Recent studies have shown that the neural drive to muscles can be decoded from these signals and thereby the user's intention can be reliably estimated. By combining these concepts in chronic implants and embedded electronics, we believe that it is in principle possible to establish a broadband man-machine interface, with specific applications in prosthesis control. This perspective illustrates this concept, based on combining advanced surgical techniques with recording hardware and processing algorithms. Here we describe the scientific evidence for this concept, current state of investigations, challenges, and alternative approaches to improve current prosthetic interfaces.

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“…Durch die technische Weiterentwicklung auf dem Gebiet der Prothetik und die dadurch verbesserte Akzeptanz von myoelektrischen Prothesen steigen auch die Anforderungen an den Patienten, den Stumpf und letztendlich die Funktionalität [14]. Die größten Fortschritte der letzten Jahre betrafen allerdings die Steuerungsmöglichkeiten und somit die Schnittstelle Mensch-Maschine [1,13,14].…”

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“…Die größten Fortschritte der letzten Jahre betrafen allerdings die Steuerungsmöglichkeiten und somit die Schnittstelle Mensch-Maschine [1,13,14].…”

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Prothetische Rekonstruktion der oberen Extremität

et al. 2016

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Prothetische Rekonstruktion hoher Amputationen der oberen Extremität

Cited by 30 publications

References 19 publications

PlayBionic: Game‐Based Interventions to Encourage Patient Engagement and Performance in Prosthetic Motor Rehabilitation

PlayBionic: Game‐Based Interventions to Encourage Patient Engagement and Performance in Prosthetic Motor Rehabilitation

Broadband Prosthetic Interfaces: Combining Nerve Transfers and Implantable Multichannel EMG Technology to Decode Spinal Motor Neuron Activity

Prothetische Rekonstruktion der oberen Extremität

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