Center for Bionics and Pain Research, Mölndal, Sweden.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
J Neuroeng Rehabil. 2024 Nov 23;21(1):204. doi: 10.1186/s12984-024-01508-5.
Following upper limb amputation, surgeries such as arm transplantation or replantation might be an option to restore function. After such surgeries, rehabilitation of the arm is needed. However, conventional rehabilitation is dependent on some volitional movement of the arm. If there is no or minimal movement of the arm, conventional rehabilitation might not be successful. The purpose of this study is to evaluate a novel combination of myoelectric motor execution (MME) and sensory training (ST) to reduce pain and improve upper limb function in a person with a highly impaired replanted arm.
The participant, a 72-year-old male, had his right arm replanted after a traumatic accident. No functional recovery was achieved following conventional rehabilitation and chronic neuropathic pain developed post-surgery. The participant then received 18 sessions of MME in which intended movements were decoded from the replanted arm's myoelectric signals using machine learning and real-time feedback was provided on a screen. Nine sessions included ST using tactile grids where the participant discriminated different sensations.
The participant regained active extension of the thumb (4 degrees) and regained active wrist movement (flex: 6 degrees, extend: 10 degrees), both of which had no active movement prior the MME interventions. He also perceived an increase in sensation in the thumb and fingers. Pain levels fluctuated throughout the study and no consistent change could be concluded.
MME is a novel virtual rehabilitation treatment which provides feedback using virtual limbs and serious games. MME combined with ST is a potential rehabilitation treatment for individuals with highly impaired arms and hands which might ameliorate chronic neuropathic pain.
上肢截肢后，臂移植或再植等手术可能是恢复功能的选择。手术后需要对手臂进行康复。然而，传统的康复依赖于手臂的一些自主运动。如果手臂没有或只有最小的运动，传统的康复可能不会成功。本研究的目的是评估一种新型肌电运动执行（MME）和感觉训练（ST）的组合，以减轻疼痛并改善一名上肢严重受损再植手臂的功能。
参与者是一名 72 岁男性，因意外事故导致右臂截肢。传统康复后没有恢复功能，术后出现慢性神经性疼痛。然后，参与者接受了 18 次 MME 治疗，其中使用机器学习从再植手臂的肌电信号解码预期运动，并在屏幕上提供实时反馈。九次治疗包括使用触觉网格的 ST，参与者在其中辨别不同的感觉。
参与者恢复了拇指的主动伸展（4 度），并恢复了主动腕部运动（弯曲：6 度，伸展：10 度），这些运动在 MME 干预之前都没有主动运动。他还感觉到拇指和手指的感觉增加。疼痛水平在整个研究中波动，没有得出一致的变化结论。
MME 是一种新型的虚拟康复治疗方法，它使用虚拟肢体和严肃游戏提供反馈。MME 与 ST 结合是一种治疗上肢和手部严重受损的潜在康复治疗方法，可能减轻慢性神经性疼痛。
