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Case: The reconstruction of large nerve gaps remains a reconstructive challenge. Here, we present a case report of brachial plexus reconstruction using nerve grafts harvested as spare parts from an amputated limb. It also allowed us to use motor nerve grafts to reconstruct defects in the posterior cord and musculocutaneous nerve. The patient recovered good shoulder and elbow function at 2.5 years with evidence of innervation distally on electromyography. Conclusion: Spare part surgery should always be kept in a surgeons' reconstructive algorithm. Reconstruction of large nerve gaps can be achieved with autologous nerve grafts in certain circumstances. [ABSTRACT FROM AUTHOR]

Background: Myoelectric prostheses currently used by amputees can be difficult to control. Machine learning, and in particular learned predictions about user intent, could help to reduce the time and cognitive load required by amputees while operating their prosthetic device.Objectives: The goal of this study was to compare two switching-based methods of controlling a myoelectric arm: non-adaptive (or conventional) control and adaptive control (involving real-time prediction learning).Study Design: Case series study.Methods: We compared non-adaptive and adaptive control in two different experiments. In the first, one amputee and one non-amputee subject controlled a robotic arm to perform a simple task; in the second, three able-bodied subjects controlled a robotic arm to perform a more complex task. For both tasks, we calculated the mean time and total number of switches between robotic arm functions over three trials.Results: Adaptive control significantly decreased the number of switches and total switching time for both tasks compared with the conventional control method.Conclusion: Real-time prediction learning was successfully used to improve the control interface of a myoelectric robotic arm during uninterrupted use by an amputee subject and able-bodied subjects.Clinical Relevance: Adaptive control using real-time prediction learning has the potential to help decrease both the time and the cognitive load required by amputees in real-world functional situations when using myoelectric prostheses. [ABSTRACT FROM AUTHOR]

Background: Although targeted muscle reinnervation has been shown to be effective in enhancing prosthetic control for upper limb amputees, restored hand sensations have been variable. An understanding of possible sensory feedback channels is crucial in working toward more effective closed-loop prosthetic control.Objectives: To compare sensory outcomes of different targeted sensory reinnervation approaches.Study Design: Case series, cross-sectional, and retrospective.Methods: Three transhumeral amputees that had undergone different sensory reinnervation approaches were recruited. Skin pressure sensitivity thresholds and anatomic sensory mapping were performed using Semmes-Weinstein monofilaments. The clinical charts of the subjects were reviewed to compare the sensory maps performed during the earlier post-reinnervation period.Results: While the first two subjects achieved return of hand sensations on the stump skin in early follow-up, the maps showed attenuation over time. The last subject developed discrete sensations of all digits in the recipient cutaneous nerve territories away from the reinnervated muscles.Conclusions: These findings confirm that it is feasible to restore hand sensation after transhumeral targeted reinnervation, but there is a significant intersubject variability. The intrafascicular approach may be particularly effective in restoring digit sensation and deserves further exploration, as do factors affecting stability of the hand maps over time.Clinical Relevance: In addition to enabling intuitive motor control of myoelectric prosthesis, targeted reinnervation can also result in sensory restoration of the hand. Documentation of sensory mapping present after reinnervation may assist with exploring future techniques for sensory enhancement, with the goal of working toward closed-loop prosthetic control. [ABSTRACT FROM AUTHOR]

Background: Upper trunk obstetric brachial plexus injury can cause profound shoulder and elbow dysfunction. Although neuroma excision with interpositional sural nerve grafting is the current gold standard, distal nerve transfers have a number of potential advantages. The goal of this study was to compare the clinical outcomes and health care costs between nerve grafting and distal nerve transfers in children with upper trunk obstetric brachial plexus injury., Methods: In this prospective cohort study, children who underwent triple nerve transfers were followed with the Active Movement Scale for 2 years. Their outcomes were compared to those of children who underwent nerve graft reconstruction. To assess health care use, a cost analysis was also performed., Results: Twelve patients who underwent nerve grafting were compared to 14 patients who underwent triple nerve transfers. Both groups had similar baseline characteristics and showed improved shoulder and elbow function following surgery. However, the nerve transfer group displayed significantly greater improvement in shoulder external rotation and forearm supination 2 years after surgery (p < 0.05). The operative time and length of hospital stay were significantly lower (p < 0.05), and the overall cost was approximately 50 percent less in the nerve transfer group., Conclusion: Triple nerve transfer for upper trunk obstetric brachial plexus injury is a feasible option, with better functional shoulder external rotation and forearm supination, faster recovery, and lower cost compared with traditional nerve graft reconstruction., Clinical Question/level of Evidence: Therapeutic, II.

Objective: : To assess the validity and reliability of an office-based surrogate measure of lumbar spine-stabilization endurance capability; to establish norms and reliability in an asymptomatic group; and to compare their measures with those from a group of chronic mechanical low-back pain patients., Design: : Eight healthy subjects participated in the tool-validation portion of the study that consisted of surface electromyographic (EMG) measurements of core muscle activation during prone and supine bridging. Subsequently, normative and test-retest reliability measures of prone and supine bridging duration were recorded from 43 subjects without back pain and were compared with those of 32 subjects with chronic mechanical low-back pain., Results: : Surface EMG indicated significantly preferential activation of anterior core muscles during prone bridging and posterior core muscles during supine bridging. Mean bridge durations for subjects without back pain were 72.5 +/- 32.6 (mean +/- SD) secs in prone and 170.4 +/- 42.5 secs in supine. They were significantly less in subjects with back pain: 28.3 +/- 26.8 secs in prone and 76.7 +/- 48.9 secs in supine. Test-retest reliability using Pearson's correlation for prone and supine bridging was 0.78 and 0.84, respectively., Conclusions: : Bridging maneuvers seem to be practical, reliable, and valid methods of reflecting lumbar spine-stabilization endurance capability. Prone bridging preferentially challenges core flexors, whereas supine bridging recruits primarily the core extensors; both are compromised in patients with low-back pain.

Objective: To identify a scale that is potentially applicable for measuring the fatigue in postpolio patients and to evaluate its validity and reliability in this population., Design: Interview survey of 64 individuals with postpolio syndrome and 25 healthy controls of similar age range, with retest in a subset of postpolio patients. The sample was recruited from a postpolio support group, a postpolio clinic, and the general community. Subjects completed the Piper Fatigue Scale, the Beck Depression Inventory, and the Chalder Fatigue Questionnaire during the interview., Results: Face and content validity of the Piper Fatigue Scale was established by a team of experts and by a group of postpolio patients. The postpolio subjects had significantly higher Piper Fatigue Scale scores than the healthy control subjects (P < 0.001), demonstrating extreme groups validity. Convergent validity was shown with a strong positive correlation between Piper Fatigue Scale scores and Chalder Fatigue Questionnaire scores (r = 0.80). Reliability was also demonstrated with the Piper Fatigue Scale's high internal consistency (alpha = 0.98) and strong test-retest agreement (intraclass correlation coefficient = 0.98)., Conclusions: The Piper Fatigue Scale is a valid and reliable tool for measuring postpolio fatigue. This scale may be useful in other studies of postpolio fatigue, including those gauging the effectiveness of various treatments for this fatigue.