Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 30:15:645261.
doi: 10.3389/fnbot.2021.645261. eCollection 2021.

Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury

Agnes Sturma  1   2 , Laura A Hruby  1   3 , Anna Boesendorfer  1 , Anna Pittermann  1   4   5 , Stefan Salminger  1 , Clemens Gstoettner  1 , Olga Politikou  1 , Ivan Vujaklija  6 , Dario Farina  2 , Oskar C Aszmann  1   5
Affiliations

Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury

Agnes Sturma et al. Front Neurorobot. .

Abstract

Brachial plexus injuries with multiple-root involvement lead to severe and long-lasting impairments in the functionality and appearance of the affected upper extremity. In cases, where biologic reconstruction of hand and arm function is not possible, bionic reconstruction may be considered as a viable clinical option. Bionic reconstruction, through a careful combination of surgical augmentation, amputation, and prosthetic substitution of the functionless hand, has been shown to achieve substantial improvements in function and quality of life. However, it is known that long-term distortions in the body image are present in patients with severe nerve injury as well as in prosthetic users regardless of the level of function. To date, the body image of patients who voluntarily opted for elective amputation and prosthetic reconstruction has not been investigated. Moreover, the degree of embodiment of the prosthesis in these patients is unknown. We have conducted a longitudinal study evaluating changes of body image using the patient-reported Body Image Questionnaire 20 (BIQ-20) and a structured questionnaire about prosthetic embodiment. Six patients have been included. At follow up 2.5-5 years after intervention, a majority of patients reported better BIQ-20 scores including a less negative body evaluation (5 out of 6 patients) and higher vital body dynamics (4 out of 6 patients). Moreover, patients described a strong to moderate prosthesis embodiment. Interestingly, whether patients reported performing bimanual tasks together with the prosthetic hand or not, did not influence their perception of the prosthesis as a body part. In general, this group of patients undergoing prosthetic substitution after brachial plexus injury shows noticeable inter-individual differences. This indicates that the replacement of human anatomy with technology is not a straight-forward process perceived in the same way by everyone opting for it.

Keywords: bionic reconstruction; body image; brachial plexus injury; embodiment/bodily experience; human-machine interfaces; prosthesis; upper limb amputation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Lateral view of the hands of two different patients after a brachial plexus avulsion, showing different degrees of atrophy and intrinsic stiffness.
Figure 2
Figure 2
Flowchart of the medical treatment process and assessments performed within this study.
Figure 3
Figure 3
Prosthetic embodiment after bionic reconstruction: the level of agreement from 0 (no agreement/never) to 10 (full agreement/always) is displayed per question and study participant.
See this image and copyright information in PMC

References

    1. Albani C., Blaser G., Geyer M., Daig I., Schmutzer G., Bailer H., et al. (2006). Überprüfung und Normierung des Fragebogen zum Körperbild(FKB-20) von Clement und Löwe (1996) an einer repräsentativen deutschen Bevölkerungsstichprobe. Zeitschrift für Medizinische Psychol. 15, 99–109. Available online at: https://d1wqtxts1xzle7.cloudfront.net/39751101/berprfung_und_Normierung_...
    1. Aszmann O. C., Roche A. D., Salminger S., Paternostro-Sluga T., Herceg M., Sturma A., et al. (2015). Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients. Lancet 385, 2183–2189. 10.1016/S0140-6736(14)61776-1 - DOI - PubMed
    1. Bailey R., Kaskutas V., Fox I., Baum C. M., Mackinnon S. E. (2009). Effect of upper extremity nerve damage on activity participation, pain, depression, and quality of life. J. Hand Surg. Am. 34, 1682–1688. 10.1016/j.jhsa.2009.07.002 - DOI - PubMed
    1. Carlstedt T. (2008). Root repair review: basic science background and clinical outcome. Restor. Neurol. Neurosci 26(2-3):225–241. Available online at: https://content.iospress.com/articles/restorative-neurology-and-neurosci... - PubMed
    1. Clement U., Löwe B. (1996). Validation of the FKB-20 as scale for the detection of body image distortions in psychosomatic patients. Psychother. Psychosom. Med. Psychol. 46, 254–259. - PubMed

LinkOut - more resources