ABSTRACT
Targeted muscle reinnervation (TMR) has rapidly transitioned from an experimental procedure-first performed on a human patient in 2002 (Kuiken et al. 2004)—to accepted clinical practice. It is now performed worldwide on individuals with transhumeral and shoulder disarticulation amputations. When coupled with the rehabilitation strategies described in preceding chapters, TMR provides significant functional improvements and increased quality of life for individuals with high-level upper limb amputations. However, current functional control has many limitations, and the individuals currently
CONTENTS
10.0 Introduction ................................................................................................ 165 10.1 Improvements in Control Algorithms .................................................... 166
10.1.1 Limitations of Current Control Algorithms ............................... 166 10.1.2 Overview of Pattern Recognition Myoelectric Control ............ 167 10.1.3 Performance of Pattern Recognition Systems after TMR......... 168
10.1.3.1 Pattern Recognition in Virtual Environments ............ 169 10.1.3.2 Pattern Recognition with Physical Prostheses ............ 170 10.1.3.3 Extension of Pattern Recognition to Simultaneous
Control .............................................................................. 172 10.2 Extension of TMR to Transradial and Lower Limb Amputations ...... 173
10.2.1 TMR for Transradial Amputation ............................................... 173 10.2.2 TMR for Lower Limb Amputation .............................................. 174
10.3 Advanced Prosthetic Systems .................................................................. 176 10.3.1 Advanced Electromechanical Arm Systems .............................. 176 10.3.2 Advanced Prosthetic Interfaces ................................................... 178
10.3.2.1 Intramuscular EMG Systems and Associated Algorithms ....................................................................... 179
10.4 Conclusion .................................................................................................. 180 References ............................................................................................................. 180
served by TMR represent only a small proportion of the total population living with limb loss. There is a tremendous opportunity to improve the control paradigms used for TMR prostheses and to extend the TMR surgical technique to individuals with below-elbow and lower limb amputations. TMR has also enabled advanced research and development opportunities, including development of advanced electromechanical prostheses, novel training routines, and innovative fitting protocols. In combination, these advances could result in an unprecedented ability to control a prosthesis for the majority of individuals with major amputations.
