Targeted reinnervation is a surgical technique that has created a revolutionary change in the treatment of upper-limb amputation. In targeted muscle reinnervation (TMR), truncated arm nerves are connected to spare (target) muscles, creating an intuitive control interface for multifunctional prosthetic arms. After TMR, individuals with shoulder-level amputations can intuitively control a prosthetic arm with a powered shoulder, elbow, wrist, and hand. Advanced signal processing techniques have enabled these individuals, as well as individuals with above-elbow amputations, to intuitively select different hand grasps. In targeted sensory reinnervation (TSR), arm sensory nerves reinnervate the skin over the target muscles, providing perceived sensation from the missing limb, which provides the potential to provide sensory feedback from a prosthesis. Since targeted reinnervation was first performed in 2002, it has gained worldwide media attention, become a clinically available treatment for amputation, and been embraced by the international medical community. Within the last five years, targeted reinnervation has been performed on more than 50 patients and has encouraged and enabled development of state-of-the-art artificial limbs and cutting-edge control strategies. TMR is now being considered for below-elbow amputation, as well as for lower-limb amputation. The successful implementation of targeted reinnervation requires the cooperation of a highly diverse and highly skilled team, including at minimum a surgeon, a physiatrist, a prosthetist, and an occupational therapist. In addition to standard training, each team member should be familiar with the underlying science and the goals of the procedure, as well as with factors that could ensure or hinder its successful application. This proposal is to request funding to produce a monograph on targeted reinnervation, both to educate clinical professionals and to provide comprehensive information to the scientific and medical communities. This book will offer an in-depth look at each aspect of successful implementation of the technique, including the basic science, surgical and clinical techniques, associated technologies and challenges, and outcomes to date. The monograph will be authored by current and former faculty and staff of the Center for Bionic Medicine (CBM) at the Rehabilitation Institute of Chicago-the research group that has pioneered and developed this technique over the last 20 years-and in addition to colleagues from the US and Europe. Authors will draw from their experience and expertise, and on past publications by CBM and others. Our goal is to engender excitement about the possibilities of targeted reinnervation so that more individuals with amputation can benefit from this technology.
A published monograph on targeted reinnervation would provide clinical teams worldwide with the background and information essential to successfully perform the procedure. This would increase the number of upper limb amputees benefitting from the intuitive control, increased function, and potential sensory feedback that result from targeted reinnervation.
