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Targeted Reinnervation to Improve Prosthesis Control in Transhumeral AmputeesA Report of Three Cases
Kristina D. O'Shaughnessy, MD1; Gregory A. Dumanian, MD1; Robert D. Lipschutz, CP1; Laura A. Miller, PhD, CP1; Kathy Stubblefield, OTR1; Todd A. Kuiken, MD, PhD1
1 Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, 675 North St. Clair Street, 19th Floor Galter, Suite 250, Chicago, IL 60611. E-mail address for G.A. Dumanian: gdumania@nmh.org
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institutes of Health (National Institute of Child and Human Development grants #R01 HD044798 and #R01 HD043137-01 and National Institute of Disability and Rehabilitation Research grant #R01 HD044798). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, and Rehabilitation Institute of Chicago, Chicago, Illinois

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Feb 01;90(2):393-400. doi: 10.2106/JBJS.G.00268
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Controlling an upper-limb prosthesis is challenging for transhumeral amputees. A central problem is the inability to move multiple prosthetic joints at the same time. With a body-powered prosthesis, an amputee uses shoulder motion to sequentially move the prosthetic elbow and lock it in place before switching to operation of the wrist, hand, or hook. With a myoelectric prosthesis, surface electromyographic signals from the residual biceps and triceps are used to control a motorized arm. Again, sequential control is required, as the biceps and triceps can only operate one joint at a time. The use of these prostheses rarely becomes intuitive. The patient is forced to use chest, shoulder girdle, or upper-arm muscles to move the prosthetic elbow, wrist, and hand in a slow, complex, and burdensome manner. Often, expensive prostheses are left untouched in the patient's closet because the sequence of movements that is required to effectively use the prosthetic arm actions does not occur in a workable time frame for the patient.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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