New methods in the treatment of limb amputations, aimed at the application of bionic prostheses

The demolition surgical treatments of amputation, being usually done in emergency conditions, very often return stumps inadequate to the level of amputation, with poor functionality and pain. These factors considerably hinder the success of the prosthetic treatment.

Alongside the development of innovative prostheses, one of the main challenges is that supported by translational research which aims to increase the success of prosthetic-rehabilitative treatment, focusing on the issue of functional preparation of the stump for the use of the prosthesis. In order to give amputees a complete reintegration into the social and working context, attention to this aspect is crucial, so much so that it can only be taken care of by a team of experts with highly multidisciplinary skills.

Prosthetic replacement in amputations of the upper limb above the elbow also involves additional problems connected with the need to control different movements of the prosthesis, which simultaneously affect the elbow, wrist and hand joints. An original approach to this type of amputation has developed in recent years thanks to the technique of targeted muscle reinnervation, Targeted Muscle Reinnervation (TMR), developed by Dr. Todd Kuiken and Dr. Gregory Dumanian of Northwestern University (USA).

TMR is a relatively complex method, still used in very few centers worldwide, which combines the available prosthetic technology with an anatomical modification of the stump. TMR has as its central act an orthopedic and neurosurgical surgery operation, but this arises from a strong neurophysiological indication and requires subsequent traininging and monitoring of the patient by the neurologist and the rehabilitator, in close interaction with those who integrate the prosthesis.

The surgical technique consists in transferring the stumps of the main nerves of the upper limb to new muscle targets that have otherwise lost their original function. These muscles act as biological amplifiers of nerve signals from the motor nerves that originally controlled the hand and elbow and can be used to achieve more intuitive, simultaneous control of multiple joints in advanced prosthetics.

The continuous search for new treatment methods and new technological solutions are areas in which INAIL actively occupies a leading role while UCBM, for its part, boasts recognized clinical and bio experienceingengineering, also having a University Hospital with clinical research units active in the fields of orthopaedics, neurology, physical and rehabilitation medicine and prosthetic assistance.

The project, which sees the collaboration between the two partners, aims to continue with the scientific, technological and clinical advances on prosthetic systems for the upper limb, with particular reference to the development of surgical and treatment solutions for limb amputations to improve performance in activities of daily living and make the use of new technologies and prosthetic systems more accessible.

The goal of reaching an avant-garde level will go in parallel with the intention of producing concretely translatable results, in the medium-long term, into devices and technologies, as "made in Italy" as possible, to be made available to amputees .

UCBM sees in the collaboration with INAIL the opportunity to be able to put together their respective excellences in the field of scientific, technological and clinical activities for personal assistance in order to obtain high-profile results, sharing with INAIL the objective of being able to make it transferable to the medical/clinical world, for the real application on patients and the effective improvement of the quality of life.

Duration: 3 years
Period: 2017-2020