Neurorehabilitation in upper limb amputation: understanding how neurophysiological changes can affect functional rehabil
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Neurorehabilitation in upper limb amputation: understanding how neurophysiological changes can affect functional rehabilitation Lewis A. Wheaton
Abstract Background: Significant advances have been made in developing new prosthetic technologies with the goal of restoring function to persons that suffer partial or complete loss of the upper limb. Despite these technological advances, many challenges remain in understanding barriers in patient adoption of technology, and what critical factors should be of focus in prosthetics development from a motor control perspective. This points to a potential opportunity to improve our understanding of amputation using neurophysiology and plasticity, and integrate this knowledge into the development of prosthetics technology in novel ways. Here, argument will be made to include a stronger focus on the neural and behavioral changes that result from amputation, and a better appreciation of the time-scale of changes which may significantly affect device adaptation, functional device utility, and motor learning implemented in rehabilitation environments. Conclusion: By strengthening our understanding of the neuroscience of amputation, we may improve the ability to couple neurorehabilitation with neuroengineering to support clinician needs in yielding improved outcomes in patients. Keywords: Amputation, Neuroplasticity, Prosthetics, Motor learning, Limb loss, Upper limb
Background A common concern in neurorehabilitation is understanding how to use neuroscience to shed light on treatment of neurological disease. In many health concerns such as stroke, movement disorders, and cognitive dysfunction the challenge of “how to treat” has been, and continues to be, shaped by focused and relevant neuroscience research. While this is true for large and growing public health concerns, it is also true for other injuries to the nervous system where, by comparison, the rate of injury may be rarer. The rarity of a problem does not relate to the severity of a problem. As of 2005, of the 1.5 million persons with limb loss (amputees) an estimated 541,000 persons in the United States suffer from some form of upper limb loss, many Correspondence: [email protected] School of Biological Sciences, Georgia Institute of Technology, 555 14th Street, Atlanta, GA 30332-0356, USA
from trauma, but also public health concerns such as dysvascular disease and cancer [1]. It is projected that by 2020, there will be 2.2 million amputees in the United States. Worldwide estimates are difficult to gather largely due to the variability in why amputation happens and underreporting in the developing world. Amputation does not directly affect the vast majority of people in the United States (or the world), but the impact of amputation is severe and the resources available to amputees are not ideal. For amputees, the use of artificial limbs (prostheses) can become a vital part of their lives. Unfortunately, rejection and non-functional use is high [2]. While futuristic devices are being designed and tested
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