Vibrotactile detection thresholds for chest skin of amputees following targeted reinnervation surgery

Recent advances in the design of prosthetic arms have helped upper limb amputees achieve greater levels of function. However, control of upper limb prostheses is limited by the lack of sensory feedback to the user. Targeted reinnervation, a novel surgical technique for amputees, offers the potential for returning this lost sensation. During targeted reinnervation surgery, truncated nerves are directed to reinnervate new muscle and skin sites. Contractions of reinnervated muscles generate electrical signals that are used to control prosthetic arms. In addition, stimulation of reinnervated skin is perceived on the missing limb. Vibration detection thresholds were measured at four frequencies on the reinnervated chest skin of three shoulder-level amputees following targeted reinnervation surgery. Thresholds were also measured on the contralateral chest and arm skin of these amputees, as well as on the chest and arm skin of a control population. Vibrations applied to reinnervated skin were perceived at various locations on the missing arm and hand. Thresholds for the reinnervated chest skin were generally within the range of values measured on the chests of the control population. For the two unilateral amputees, these thresholds were similar to measures on their contralateral chests, but greater than measures on their contralateral hands. Targeted reinnervation appears to result in near-normal vibration-detection ability with respect to the target tissue, suggesting the functional reinnervation of mechanoreceptors by the reinnervating afferents. The functional limb sensation following targeted reinnervation could be used to provide prosthesis users with a sense of touch. (c) 2008 Elsevier B.V. All rights reserved.