TARGETED MUSCLE REINNERVATION FOR IMPROVED CONTROL OF MYOELECTRIC UPPER LIMB PROSTHESES

Abstract

Targeted muscle reinnervation (TMR) is a novel surgical technique developed to improve the controlof myoelectric upper limb prostheses. Nerves transected by the amputation, which retain their originalmotor pathways even after being severed, are redirected to residual denervated muscles that serve astarget for consequent reinnervation. Once the process is complete, reinnervated muscles will contractupon voluntary activation of transferred nerves while attempting to move missing regions of theamputated limb, generating EMG signals that can be recorded and used to control a prosthetic device.This allows creating new control sites that can overcome major drawbacks of conventional myoelectricprostheses by offering a more natural and intuitive control of prosthetic arms. TMR has been widelyperformed in individuals who underwent shoulder disarticulation amputation and transhumeralamputation since proximal amputations do not leave enough functional muscles exploitable to controlindependent degree of freedoms of multi-articulated prostheses. TMR application is currently underinvestigation in patients suffering further distal amputations, as well as for treating and preventingpainful post-amputation neuromas. The purpose of this paper is to describe the physiologic basis and thesurgical technique of TMR, reporting current knowledge on the clinical results.