Bionic Upper Limb Reconstruction: A Valuable Alternative in Global Brachial Plexus Avulsion Injuries—A Case Series

Hruby, Laura A.; Gstoettner, Clemens; Sturma, Agnes; Salminger, Stefan; Mayer, Johannes A.

doi:10.3390/jcm9010023

Cited by 15 publications

(13 citation statements)

References 38 publications

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“…While the evaluation of (prosthetic) hand function in these patients as reported elsewhere (Aszmann et al, 2015;Hruby et al, 2017Hruby et al, , 2019a was not an aim of this study, FIGURE 3 | Prosthetic embodiment after bionic reconstruction: the level of agreement from 0 (no agreement/never) to 10 (full agreement/always) is displayed per question and study participant.…”

Section: Discussionmentioning

confidence: 99%

“…The amputation level was determined by the presence of EMG signals in the forearm and sufficient elbow function. In patients where no elbow flexion against resistance could be achieved by surgical means or training, and where no EMG signals could be generated in the forearm, an amputation level above the elbow was chosen to allow prosthetic function (Hruby et al, 2019a).…”

Section: Participantsmentioning

confidence: 99%

“…Prior to amputation, surgical augmentation of the residual limb may be necessary, in order to improve the position of the arm and provide sufficient EMG signals for myoelectric control (Aszmann et al, 2015). While improvements in patients' hand function, quality of life, and perceived disability have been observed (Aszmann et al, 2015;Hruby et al, 2017Hruby et al, , 2019a, the long-term impact on body image is still unknown. Furthermore, outcomes in terms of prosthetic embodiment in this unique patient group have not been investigated.…”

Section: Introductionmentioning

confidence: 99%

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Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury

et al. 2021

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Brachial plexus injuries with multiple-root involvement lead to severe and long-lasting impairments in the functionality and appearance of the affected upper extremity. In cases, where biologic reconstruction of hand and arm function is not possible, bionic reconstruction may be considered as a viable clinical option. Bionic reconstruction, through a careful combination of surgical augmentation, amputation, and prosthetic substitution of the functionless hand, has been shown to achieve substantial improvements in function and quality of life. However, it is known that long-term distortions in the body image are present in patients with severe nerve injury as well as in prosthetic users regardless of the level of function. To date, the body image of patients who voluntarily opted for elective amputation and prosthetic reconstruction has not been investigated. Moreover, the degree of embodiment of the prosthesis in these patients is unknown. We have conducted a longitudinal study evaluating changes of body image using the patient-reported Body Image Questionnaire 20 (BIQ-20) and a structured questionnaire about prosthetic embodiment. Six patients have been included. At follow up 2.5–5 years after intervention, a majority of patients reported better BIQ-20 scores including a less negative body evaluation (5 out of 6 patients) and higher vital body dynamics (4 out of 6 patients). Moreover, patients described a strong to moderate prosthesis embodiment. Interestingly, whether patients reported performing bimanual tasks together with the prosthetic hand or not, did not influence their perception of the prosthesis as a body part. In general, this group of patients undergoing prosthetic substitution after brachial plexus injury shows noticeable inter-individual differences. This indicates that the replacement of human anatomy with technology is not a straight-forward process perceived in the same way by everyone opting for it.

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Section: Discussionmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury

et al. 2021

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“…After a dedicated rehabilitation program to improve the control of these muscles, an elective amputation of hand has been performed and a replacement with a mechatronic prosthesis was conducted. Although the results are restricted to a limited cohort of patients and this technique is indicated in BPIs without other treatment options, a significant functional improvement has been proved [ 97 , 98 ].…”

Section: Therapeutic Optionsmentioning

confidence: 99%

Brachial Plexus Injuries in Sport Medicine: Clinical Evaluation, Diagnostic Approaches, Treatment Options, and Rehabilitative Interventions

Belviso

Palermi

Sacco

et al. 2020

JFMK

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The brachial plexus represents a complex anatomical structure in the upper limb. This “network” of peripheral nerves permits the rearrangement of motor efferent fibers, coming from different spinal nerves, in several terminal branches directed to upper limb muscles. Moreover, afferent information coming from different cutaneous regions in upper limb are sorted in different spinal nerves through the brachial plexus. Severe brachial plexus injuries are a rare clinical condition in the general population and in sport medicine, but with dramatic consequences on the motor and sensory functions of the upper limb. In some sports, like martial arts, milder injuries of the brachial plexus can occur, with transient symptoms and with a full recovery. Clinical evaluation represents the cornerstone in the assessment of the athletes with brachial plexus injuries. Electrodiagnostic studies and imaging techniques, like magnetic resonance and high-frequency ultrasound, could be useful to localize the lesion and to define an appropriate treatment and a functional prognosis. Several conservative and surgical techniques could be applied, and multidisciplinary rehabilitative programs could be performed to guide the athlete toward the recovery of the highest functional level, according to the type of injury.

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“…The procedure includes elective amputation of the hand, derotation osteotomy of the humerus for better positioning of the forearm, followed by prosthetic fitting. The feasibility of bionic reconstructions in patients suffering from brachial plexus injuries in adulthood is well-documented (9)(10)(11). However, studies investigating this treatment after OBPI are not found in literature.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury

Boesendorfer

Sturma

Gstoettner

et al. 2022

Front. Rehabilit. Sci.

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Introduction: Many adults who had a severe Narakas IV obstetric brachial plexus injury (OBPI) suffer from extensive impairments in daily living due to limited hand-arm function. The dramatic loss of axonal support at this very early age of development often render the entire extremity a biologic wasteland and reconstructive methods and therapies often fail to recover any functional hand use. In this scenario bionic reconstruction, including an elective amputation and a subsequent prosthetic fitting, may enable functional improvement in adults suffering from the consequences of such severe brachial plexus injuries. We here describe our experience in treating such patients and lay out the surgical rational and rehabilitation protocol exemplified in one patient.Case Presentation/Methods: A 27-year-old adult with a unilateral OBPI contacted our center. He presented with globally diminished function of the affected upper extremity with minimal hand activity, resulting in an inability to perform various tasks of daily living. No biological reconstructive efforts were available to restore meaningful hand function. An interdisciplinary evaluation, including a psychosocial assessment, was used to assess eligibility for bionic reconstruction. Before the amputation and after the prosthetic fitting functional assessments and self-reported questionnaires were performed.Results: One month after the amputation and de-rotation osteotomy of the humerus the patient was fitted with a myoelectric prosthesis. At the 1.5 year-follow-up assessment, the patient presented with a distinct improvement of function: the ARAT improved from 12 to 20 points, SHAP score improved from 8 to 29, and the DASH value improved from 50 to 11.7. The average wearing times of the prosthesis were 5 to 6 h per day (on 4–5 days a week).Discussion: The options for adults suffering from the consequences of severe OBPIs to improve function are limited. In selected patients in whom the neurological deficit is so severe that biologic hand function is unsatisfactory, an elective amputation and subsequent restoration of the hand with mechatronic means may be an option. The follow-up results indicate that this concept can indeed lead to solid hand function and independence in daily activities after amputation, subsequent prosthetic fitting, and rehabilitation.

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Bionic Upper Limb Reconstruction: A Valuable Alternative in Global Brachial Plexus Avulsion Injuries—A Case Series

Cited by 15 publications

References 38 publications

Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury

Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury

Brachial Plexus Injuries in Sport Medicine: Clinical Evaluation, Diagnostic Approaches, Treatment Options, and Rehabilitative Interventions

Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury

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