chapter  9
- Surgical and Functional Outcomes of Targeted Muscle Reinnervation
ByLaura A. Miller, Kathy A. Stubblefield, Robert D. Lipschutz, Blair A. Lock, Jason M. Souza, Gregory A. Dumanian, and Todd A. Kuiken
Pages 16

Targeted muscle reinnervation (TMR) was initially performed as an experimental procedure designed to improve control of myoelectric prostheses for individuals with amputations at the shoulder disarticulation level and transhumeral level. Beginning in 2002, the first TMR procedures were performed at Northwestern Memorial Hospital (NMH) in Chicago, with prosthetic fitting, training, and extensive testing in a research setting at the Rehabilitation Institute of Chicago (RIC). The use of TMR as an experimental technique was subsequently expanded to include military amputees, through collaboration with San Antonio Military Medical Center (SAMMC) and Walter Reed National Military Medical Center (WRNMMC). TMR is now an established clinical procedure and, to date, has been performed in more than a dozen

CONTENTS

9.0 Introduction ................................................................................................ 149 9.1 Surgical Goals ............................................................................................. 150

9.1.1 Patient Population .......................................................................... 151 9.1.2 Acute Surgical Outcomes ............................................................. 151 9.1.3 Long-Term Surgical Outcomes ..................................................... 152 9.1.4 Postsurgical Pain Outcomes ......................................................... 153

9.2 Assessment of Functional Outcomes at RIC .......................................... 153 9.2.1 Functional Outcomes .................................................................... 156 9.2.2 Patient-Reported Outcomes .......................................................... 161

9.3 Conclusion .................................................................................................. 162 References ............................................................................................................. 163

institutions with more than 60 patients worldwide. Here we review surgical outcomes for initial TMR procedures, performed through February 2012 at NMH and SAMMC, and functional outcomes for the first six patients treated at RIC. All outcomes data were obtained under approved protocols from the Institutional Review Boards of the appropriate institutions.