Use-Dependent Prosthesis Training Strengthens Contralateral Hemodynamic Brain Responses in a Young Adult With Upper Limb Reduction Deficiency: A Case Report

Abstract

The purpose of the current case study was to determine the influence of an 8-week home intervention training utilizing a partial hand prosthesis on hemodynamic responses of the brain and gross dexterity in a case participant with congenital unilateral upper-limb reduction deficiency (ULD). The case participant (female, 19 years of age) performed a gross manual dexterity task (Box and Block Test) while measuring brain activity (functional near-infrared spectroscopy; fNIRS) before and after an 8-weeks home intervention training. During baseline, there was a broad cortical activation in the ipsilateral sensorimotor cortex and a non-focalized cortical activation in the contralateral hemisphere, which was non-focalized, while performing a gross manual dexterity task using a prosthesis. After the 8-week home intervention training, however, cortical activation shifted to the contralateral motor cortex while cortical activation was diminished in the ipsilateral hemisphere. Specifically, the oxygenated hemodynamics (HbO) responses increased in the medial aspects of the contralateral primary motor and somatosensory cortices. Thus, these results suggest that an 8-week prosthetic home intervention was able to strengthen contralateral connections in this young adult with congenital partial hand reduction. This was supported by the case participant showing after training an increased flexor tone, increased range of motion of the wrist, and decreased times to complete various gross dexterity tasks. Changes in HbO responses due to the home intervention training follow the mechanisms of use-dependent plasticity and further guide the use of prostheses as a rehabilitation strategy for individuals with ULD.

fNIRS-Based Upper Limb Motion Intention Recognition Using an Artificial Neural Network for Transhumeral Amputees

“…The width of transition region between the band pass limits H increases with the width of main lobe W . It decides the steepness of transition amongst frequencies [ 43 ]. This value was by default set to 15 by the nirslab according to signal condition [ 44 ].…”

“…To execute control commands for six arm motions, features for the signal classification were extracted. For fNIRS brain signals, signal means (SM), signal peak (SP), and signal minimum (min) [ 43 , 47 ] were extracted for thresholding purposes. The signal mean was calculated as (3): where N represents the total data points and X i represents the signal amplitude value.…”

“…As per the existing literature [ 38 ], SM and SP offer improved control performance for fNIRS-based systems. However, regarding the stated possibility of an initial fNIRS signal dip, a (min) signal value was added as a feature [ 43 ]. The features were calculated from only selected optodes based on criteria described earlier in this section using a 2 s moving window.…”

Phantom limb therapy improves cortical efficiency of the sensorimotor network in a targeted muscle reinnervation amputee: a case report

“…Functional near-infrared spectroscopy (fNIRS) task data were collected and analyzed using similar techniques from a previous case study ( Borrell et al, 2021 ). The main difference in this study is the inclusion of short separation detectors (~8 mm distance), which were used to filter out physiological noise from the scalp ( Zhang et al, 2021 ).…”

Reimagining Prosthetic Control: A Novel Body-Powered Prosthetic System for Simultaneous Control and Actuation

“…This is particularly promising for UL-deficient children and adolescents, as their prosthetic operating space should not be limited as they grow and develop. Prosthesis use in children has been found to affect the development of their brain, as well as their motor control strategies [72][73][74][75][76]. This could have implications for long-term prosthetic outcomes.…”