A Novel Approach to Lower-Extremity Amputation to Augment Volitional Motor Control and Restore Proprioception
Abstract
Rationale and Objectives: Modern prosthetic limbs are becoming more and more technologically sophisticated, promising to provide more natural movement and function to amputees. To deliver on that promise, these new limb replacements need to connect with the user’s residual limb in a new and dynamic way. Current surgical approaches to lower-limb amputation do not leave the amputee with a way to deliver voluntary nerve signals to the prosthetic limb or to receive feedback to nerves in the stump. Meanwhile, the technology in the latest prosthetics includes drivers and sensors capable of providing far more enhanced walking than ever before witnessed, but standard methods of limb amputation do not give the amputee an effective way to link to these new prosthetic systems. This clinical trial will evaluate a fundamentally new surgical approach to lower-extremity amputation, with the goal of providing significantly improved voluntary motor control, as well as a restored awareness of position (proprioception) and enhanced sensation in the residual limb. The proposed study is aligned with the Peer Reviewed Orthopaedic Research Program Clinical Trial Award Surgical Care Focus Area, specifically, Surgical Techniques to Optimize Gait. Population, Benefits, and Risks: Ten patients, aged 18-60, who have been recommended for elective amputation due to trauma or infection will undergo the proposed novel amputation procedure at either the above- or below-knee level. Candidates will be drawn from the military population as well as from the physically fit civilian population. They will need to undergo independent consultation with at least two lower-extremity surgical specialists to ensure they have exhausted all limb salvage options prior to undergoing amputation. In addition, further testing will be conducted to demonstrate adequate communication skills to convey the status of their sensorimotor recovery throughout rehabilitation after amputation and a proper level of motivation to comply with postoperative follow up requirements. We anticipate that the modified surgical procedure proposed in this study will have the potential to markedly enhance lower-limb amputees’ capacity to provide precise, voluntary control of next-generation lower-limb prostheses. In addition, the proposed surgical techniques may be able to provide lower-limb amputees with sensory feedback, including the possibility of sensing limb position. Within 1 year from amputation with the new surgical procedure, the amputee can expect to see significantly greater function from his or her prosthetic limb compared with those undergoing a standard lower-extremity amputation. Associated risks with the new surgical procedure are the same as those with the current standard amputation procedure. Failure of the innovative components of the proposed novel operation would leave the amputee with a typical lower-extremity residual limb. Impact: If achieved, the expected enhanced capabilities may enable the successful employment of prosthetic limbs that will provide improved function and overall health outcomes. Greater numbers of amputees would be able to return to work, and psychological strain would be reduced for both the amputee and family. Military Benefit: The loss of lower extremities is a vexing problem in the U.S. military. Improvements in body armor, battlefield triage, and subsequent specialized care have led to marked increases in survival rates among Soldiers suffering wartime injuries. Such survivors, however, now present with an unprecedented number of devastating extremity injuries due to the exposure of limbs to ballistic trauma and explosives. Given the sheer size of the military lower-extremity amputee population, any treatment method that can optimize the function of Service members, Veterans, and family members is of great value. We propose that our new approach to limb amputation may represent such a treatment.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1720056
Entities
People
- Matthew J Carty
Organizations
- United States Army