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Upper and Lower Limb Robotic Prostheses
Published in Pedro Encarnação, Albert M. Cook, Robotic Assistive Technologies, 2017
Patrick M. Pilarski, Jacqueline S. Hebert
Surgical reconstruction of the amputated limb plays an essential role in maximizing outcomes for prosthetic applications. In addition to advances in bone management, residual muscle management, and skin coverage, advanced nerve procedures have been developed to improve the ability to extract the rich control signals that are lost after upper limb amputation. Targeted reinnervation (TR) surgically redirects the amputated nerve endings that used to innervate the hand and wrist muscles to new muscle sites to provide physiologically natural motor command signals for myoelectric control (Kuiken, Schultz Feuser, and Barlow 2013). The surgically redirected nerves reinnervate purposely denervated remaining muscles, which then act as biological amplifiers for the neural signals that are still under voluntary (brain) control. These muscle responses, which are intuitively activated, are then linked to the action of the prosthesis. After reinnervation, patients are able to operate multiple degrees of freedom of advanced prosthetic devices with increased ease. Combining newer surface EMG recording techniques (such as pattern recognition) with TR may allow even more signals to be extracted for prosthetic control. Recently, in subjects with upper limb amputation having undergone TR, simultaneous pattern recognition control was found to be superior in preference and performance to both sequential pattern recognition and conventional myoelectric control (Young et al. 2013).
Identifying priorities and developing strategies for building capacity in amputation research in Canada
Published in Disability and Rehabilitation, 2021
Sander L. Hitzig, Amanda L. Mayo, Ahmed Kayssi, Ricardo Viana, Crystal MacKay, Michael Devlin, Steven Dilkas, Aristotle Domingo, Jacqueline S. Hebert, William C. Miller, Jan Andrysek, Fae Azhari, Heather L. Baltzer, Charles de Mestral, Douglas K. Dittmer, Nancy L. Dudek, Sharon Grad, Sara J. T. Guilcher, Natalie Habra, Susan W. Hunter, W. Shane Journeay, Joel Katz, Sheena King, Michael W. Payne, Heather A. Underwood, José Zariffa, Andrea Aternali, Samantha L. Atkinson, Stephanie G. Brooks, Stephanie R. Cimino, Jorge Rios
In Québec, osseointegration [89], which consists of a surgically inserted titanium rod into the residual limb to connect to an individual’s prosthesis, is now listed as a covered procedure under its public health insurance plan, and offers a unique opportunity to embed a variety of evaluations (lived experience, economic, functional, etc.) to help gather much needed data to facilitate this procedures inclusion in other provincial health care insurance plans. In Alberta, there is recently approved funding for a case series of lower limb osseointegration. These approvals emphasize the need for a standard approach across Canada to provide equal treatment opportunities for all Canadians with limb amputation. Targeted reinnervation surgery has also been clinically available for over a decade in Alberta, and has led to international collaborations exploring novel UEA prostheses and the development of outcome measures to assess their effectiveness [35,90]. Finally, British Columbia has had success in accessing national data sets related to amputation [26] and experience in conducting nationwide surveys to evaluate clinical capacity for rehabilitation care [26,41]. This expertise and experiences can be useful for outreach to limb loss rehabilitation programs across Canada.
Evaluation of dexamethasone treated mesenchymal stem cells for recovery in neurotmesis model of peripheral nerve injury
Published in Neurological Research, 2018
Mehrnaz Moattari, Farahnaz Moattari, Gholamreza Kaka, Homa Mohseni Kouchesfehani, Seyed Homayoon Sadraie, Majid Naghdi, Korosh Mansouri
Peripheral nerve injury is serious and prevalent clinically. Peripheral nerve damages enforce economic impact both on the patients and the society, although these injuries are not life-threatening [1]. Despite the ability of peripheral nerves to regenerate after injury, the amount of regeneration is not remarkable [2]. In the peripheral nervous system, severe type of injuries (neurotmesis) must be treated surgically by direct end-to-end surgical reconnection of the damaged nerve ends [3]. Recent advances in neuroscience, cell culture and biomaterials showed improvements in new treatments for nerve injuries [1,3–6]. For example, use of suitable natural constituents has been studied as alternatives for peripheral nerve restoration [3,5–8]. Chitosan has been considered for several of beneficial properties such as biocompatibility, biodegradability, wound healing, antitumor effects and antibacterial properties [3,7]. As a result, much attention has been given by investigators and clinicians to chitosan. Chitosan is a product of chitin and the second-most abundant natural polysaccharide after cellulose, which is embedded in a protein matrix of a crustacean shell or a squid pen [9]. It is shown that chitosan elude scar formation and provide suitable chamber for the growth of regenerating axons. Gonzales-Perez and Cobianchi showed that chitosan tubes with low and medium degree of acetylation of 43% and 57% are promising in effective regeneration and targeted reinnervation, respectively [10]. Recently, laboratory experimental studies showed the choice of chitosan membranes as appropriate substrates for regeneration and repair of peripheral nerve injury [3,5,6,8]. On the other hand, it is reported that cell-based therapies are defined as safe and effective methods to enhance peripheral nerve regeneration [3,7]. Originally, stem cells were divided into two major categories, including embryonic stem cells and adult stem cells. According to the definition of International Society for Cellular Therapy (ISCT), cells with three criteria are distinguished as human mesenchymal stem cells (MSCs) as follows. MSCs should adhere to the bottom of tissue culture plastic (TCP). MSCs should express CD90, CD73 and CD105 markers and the percentages of the cells expressed for CD45, CD34, CD14 or CD11b, CD79 alpha or CD19 and HLA‐DR are negligible. Also, MSCs should be capable of differentiation toward fat, cartilage and bone cells in vitro conditions [11].