Despite significant advancements in neuroprosthetic control strategies,current peripheral nerve interfacing techniques are limited in their ability to facilitate accurate and reliable long-term control.The regenerativ...Despite significant advancements in neuroprosthetic control strategies,current peripheral nerve interfacing techniques are limited in their ability to facilitate accurate and reliable long-term control.The regenerative peripheral nerve interface(RPNI)is a biologically stable bioamplifier of efferent motor action potentials with demonstrated long-term stability.This innovative,straightforward,and reproducible surgical technique has shown enormous potential in improving prosthetic control for individuals with upper limb amputations.The RPNI consists of an autologous free muscle graft secured around the end of a transected peripheral nerve or individual fascicles within a residual limb.This construct facilitates EMG signal transduction from the residual peripheral nerve to a neuroprosthetic device using indwelling bipolar electrodes on the muscle surface.This review article focuses on the development of the RPNI and its use for intuitive and enhanced prosthetic control and sensory feedback.In addition,this article also highlights the use of RPNIs for the prevention and treatment of postamputation pain.展开更多
Complications following amputation can be devastating for patients,including debilitating neuropathic pain,the inability to perform activities of daily living(ADLs)or gain meaningful employment.While prosthesis use al...Complications following amputation can be devastating for patients,including debilitating neuropathic pain,the inability to perform activities of daily living(ADLs)or gain meaningful employment.While prosthesis use allows patients to restore independence and reintegrate into daily activities,patients often abandon these devices.Despite the immense advancements in prosthetic technology,there is still a need for an interface that can provide a natural experience with accurate and reliable long-term control.The Regenerative Peripheral Nerve Interface(RPNI)is a simple surgical technique that offers real-time control of myoelectric prosthetic devices to restore extremity function.This stable,biological nerve interface successfully amplifies efferent motor action potentials,provides sensory feedback,and offers a more functional prosthetic device experience.Based on the principles of RPNI,novel surgical approaches have been developed to expand its applications and improve outcomes.This review article summarizes the utilization of the RPNI and its recent modifications of different neural interfaces in the setting of major limb amputation and musculoskeletal injuries.展开更多
Digital neuromas can be psychologically and functionally debilitating.While typically the result of penetrating traumatic injury,neuromas also stem from blunt trauma,chronic irritation,or prior inadequate repair.Abnor...Digital neuromas can be psychologically and functionally debilitating.While typically the result of penetrating traumatic injury,neuromas also stem from blunt trauma,chronic irritation,or prior inadequate repair.Abnormal axonal regeneration without an appropriate distal target following nerve injury results in the formation of end-neuromas,often leading to significant pain.Conservative management is centered around a combination of pharmacological interventions and therapeutic modalities.In the setting of failed conservative management,surgical intervention is employed with the goals of excising the neuroma and redirecting axonal growth into healthy tissue.This article focuses on painful digital neuromas and options for both nonoperative and operative management.展开更多
Amputation is a historically well-grounded procedure,but such a traumatic operation invites a litany of postoperative complications,such as the formation of agonizing neuromas.Developments in mitigating these complica...Amputation is a historically well-grounded procedure,but such a traumatic operation invites a litany of postoperative complications,such as the formation of agonizing neuromas.Developments in mitigating these complications include the clinically successful targeted muscle reinnervation(TMR)and regenerative peripheral nerve interface(RPNI),which showcased the potential for utilizing peripheral nerves'regenerative capabilities to circumvent neuroma formation and isolate neural activity for control of a sophisticated prosthetic device.Nevertheless,these techniques only record the aforementioned neural activity from the reinnervated muscle,not the nerve itself,which may ultimately limit the degree of functionality they can restore to amputees.Alternatively,regenerative sieve electrodes are non-biological end targets for reinnervation that utilize their porous structure to isolate regenerating axons into discrete transient zones lined with stimulating and recording electrodes.Albeit more invasive,such direct contact with the once-damaged nerve opens the door for highly selective,bi-directional neural interfaces with the capacity to restore higher degrees of sensorimotor functionality to patients for enhanced rehabilitation outcomes.By expanding the definition of innervation to include non-biological targets,clinicians can make room for these advancements in neural interfacing to revolutionize patient care.展开更多
文摘Despite significant advancements in neuroprosthetic control strategies,current peripheral nerve interfacing techniques are limited in their ability to facilitate accurate and reliable long-term control.The regenerative peripheral nerve interface(RPNI)is a biologically stable bioamplifier of efferent motor action potentials with demonstrated long-term stability.This innovative,straightforward,and reproducible surgical technique has shown enormous potential in improving prosthetic control for individuals with upper limb amputations.The RPNI consists of an autologous free muscle graft secured around the end of a transected peripheral nerve or individual fascicles within a residual limb.This construct facilitates EMG signal transduction from the residual peripheral nerve to a neuroprosthetic device using indwelling bipolar electrodes on the muscle surface.This review article focuses on the development of the RPNI and its use for intuitive and enhanced prosthetic control and sensory feedback.In addition,this article also highlights the use of RPNIs for the prevention and treatment of postamputation pain.
基金The Institutional Review Board at the University of Michigan approved this study(HUM00124839).
文摘Complications following amputation can be devastating for patients,including debilitating neuropathic pain,the inability to perform activities of daily living(ADLs)or gain meaningful employment.While prosthesis use allows patients to restore independence and reintegrate into daily activities,patients often abandon these devices.Despite the immense advancements in prosthetic technology,there is still a need for an interface that can provide a natural experience with accurate and reliable long-term control.The Regenerative Peripheral Nerve Interface(RPNI)is a simple surgical technique that offers real-time control of myoelectric prosthetic devices to restore extremity function.This stable,biological nerve interface successfully amplifies efferent motor action potentials,provides sensory feedback,and offers a more functional prosthetic device experience.Based on the principles of RPNI,novel surgical approaches have been developed to expand its applications and improve outcomes.This review article summarizes the utilization of the RPNI and its recent modifications of different neural interfaces in the setting of major limb amputation and musculoskeletal injuries.
文摘Digital neuromas can be psychologically and functionally debilitating.While typically the result of penetrating traumatic injury,neuromas also stem from blunt trauma,chronic irritation,or prior inadequate repair.Abnormal axonal regeneration without an appropriate distal target following nerve injury results in the formation of end-neuromas,often leading to significant pain.Conservative management is centered around a combination of pharmacological interventions and therapeutic modalities.In the setting of failed conservative management,surgical intervention is employed with the goals of excising the neuroma and redirecting axonal growth into healthy tissue.This article focuses on painful digital neuromas and options for both nonoperative and operative management.
文摘Amputation is a historically well-grounded procedure,but such a traumatic operation invites a litany of postoperative complications,such as the formation of agonizing neuromas.Developments in mitigating these complications include the clinically successful targeted muscle reinnervation(TMR)and regenerative peripheral nerve interface(RPNI),which showcased the potential for utilizing peripheral nerves'regenerative capabilities to circumvent neuroma formation and isolate neural activity for control of a sophisticated prosthetic device.Nevertheless,these techniques only record the aforementioned neural activity from the reinnervated muscle,not the nerve itself,which may ultimately limit the degree of functionality they can restore to amputees.Alternatively,regenerative sieve electrodes are non-biological end targets for reinnervation that utilize their porous structure to isolate regenerating axons into discrete transient zones lined with stimulating and recording electrodes.Albeit more invasive,such direct contact with the once-damaged nerve opens the door for highly selective,bi-directional neural interfaces with the capacity to restore higher degrees of sensorimotor functionality to patients for enhanced rehabilitation outcomes.By expanding the definition of innervation to include non-biological targets,clinicians can make room for these advancements in neural interfacing to revolutionize patient care.
