Four patients underwent targeted sensory reinnervation (TSR), a surgical technique in which a defined skin area is first selectively denervated and then surgically reinnervated by another sensory nerve. In our case, either the area of the lateral femoral cutaneous nerve or the saphenous nerve was reinnervated by the sural nerve. Patients were then fitted with a special prosthetic device capable of transferring the sense of pressure from the sole of the prosthesis to the newly wired skin area. Pain reduction after TSR was highly significant in all patients. In three patients, permanent pain medication could even be discontinued, in one patient the pain medication has been significantly reduced. Two of the four patients were completely pain-free after the surgical intervention. Surgical rewiring of existing sensory nerves by TSR can provide the brain with new afferent signals seeming to originate from the missing limb. These signals help to reduce phantom limb pain and to restore a more normal body image. In combination with special prosthetic devices, the amputee can be provided with sensory feedback from the prosthesis, thus improving gait and balance.
Focal vibration therapy seeks to restore the physiological function of tissues and the nervous system. Recommendations for vibration settings, e.g., that could improve residual limb health and prosthesis acceptance in people with amputation, are pending. To establish a physiological connection between focal vibration settings, clinical outcomes, and molecular and neuronal mechanisms, we combined the literature on focal vibration therapy, vibrotactile feedback, mechanosensitive Piezo ion channels, touch, proprioception, neuromodulation, and the recovery of blood vessels and nerves. In summary, intermittent focal vibration increases endothelial shear stress when applied superficially to blood vessels and tissues and triggers Piezo1 signaling, supporting the repair and formation of blood vessels and nerves. Conversely, stimulating Piezo1 in peripheral axon growth cones could reduce the growth of painful neuromas. Vibrotactile feedback also creates sensory inputs to the motor cortex, predominantly through Piezo2-related channels, and modulates sensory signals in the dorsal horn and ascending arousal system. Thus, sensory feedback supports physiological recovery from maladaptations and can alleviate phantom pain and promote body awareness and physical activity. We recommend focal vibration of phantom limb maps with frequencies from ~60–120 Hz and amplitudes up to 1 mm to positively affect motor control, locomotion, pain, nerves, and blood vessels while avoiding adverse effects.
Inpatient gait analysis is an essential part of rehabilitation for foot amputees and includes the ground contact time (GCT) difference of both legs as an essential component. Doctors communicate improvement advice to patients regarding their gait pattern based on a few steps taken at the doctor’s visit. A wearable sensor system, called Suralis, consisting of an inertial measurement unit (IMU) and a pressure measuring sock, including algorithms calculating GCT, is presented. Two data acquisitions were conducted to implement and validate initial contact (IC) and toe-off (TO) event detection algorithms as the basis for the GCT difference determination for able-bodied and prosthesis wearers. The results of the algorithms show a median GCT error of −51.7 ms (IMU) and 14.7 ms (sensor sock) compared to the ground truth and thus represent a suitable possibility for wearable gait analysis. The wearable system presented, therefore, enables a continuous feedback system for patients and, above all, a remote diagnosis of spatio-temporal aspects of gait behaviour based on reliable data collected in everyday life.
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