Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface for Myoelectric Prosthesis Control: The State of Evidence

Abstract

Prosthetic rehabilitation after amputation poses significant challenges, often due to functional limitations, residual limb pain (RLP), and phantom limb pain (PLP). These issues not only affect physical health but also mental well-being and quality of life. In this review, we describe targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) and explore their clinical role in the evolution of myoelectric prosthetic control as well as postamputation pain and neuroma management. Early myoelectric prostheses, which detected electrical potentials from muscles to control prosthetic limbs, faced limitations such as inconsistent signal acquisition and complex control modes. Novel microsurgical techniques at the turn of the century such as TMR and RPNI significantly advanced myoelectric prosthetic control. TMR involves reinnervating denervated muscles with residual nerves to create electromyography (EMG) potentials and prevent painful neuromas. Similarly, RPNI relies on small muscle grafts to amplify EMG signals and distinguish from stochastic noise for refined prosthetic control. Techniques like TMR and RPNI not only improved prosthetic function, but also significantly reduced postamputation pain, making them critical in improving amputees' quality of life. Modern myoelectric prostheses evolved with advancements in microprocessor and sensor technologies, enhancing their functionality and user experience. Today, researchers have developed more intuitive and reliable prosthetic control by utilizing pattern recognition software and machine learning algorithms that may supersede reliance on surgically amplifying EMG signals. Future developments in brain-computer interfaces and machine learning hold promise for even greater advancements in prosthetic technology, emphasizing the importance of continued innovation in this field.

Keywords: amputation; myoelectric prosthetic control; neuroma management; neuropathic pain; phantom limb pain; regenerative peripheral nerve interface (RNPI); residual limb pain; targeted muscle reinnervation (TMR).