A bionic hand versus a replanted hand

Ulrika Wijk; Anders Björkman; Ingela K. Carlsson; Freyja Kristiansdottir; Ante Mrkonjic; Birgitta Rosén; Christian Antfolk

doi:10.2340/jrmcc.v7.24854

Authors

Ulrika Wijk Department of Translational Medicine – Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
Anders Björkman Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Ingela K. Carlsson Department of Translational Medicine – Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
Freyja Kristiansdottir Department of Translational Medicine – Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
Ante Mrkonjic Department of Translational Medicine – Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
Birgitta Rosén Department of Translational Medicine – Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
Christian Antfolk Deptartment of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden

DOI:

https://doi.org/10.2340/jrmcc.v7.24854

Keywords:

arm amputation, bionic limb, hand prosthesis, hand rehabilitation, hand replantation

Abstract

Objective: Evaluation of the hand function affected when replacing a malfunctioning hand by a bionic hand.

Design: Case report.

Subjects: One individual that wished for a better quality of life after unsatisfying hand function following a replantation.

Methods: A quantitative and qualitative evaluation of body functions as well as activity performance and participation before and after a planned amputation and prosthetic fitting is presented.

Results: Improvements were seen in the patient-reported outcome measures (PROMs) that were used regarding activity (Disability of the Arm, Shoulder and Hand [DASH] and Canadian Occupational Performance Measure [COPM]), pain (Neuropathic Pain Symptom Inventory [NPSI], Brief Pain Inventory [BPI], Visual Analogue Scale [VAS]), cold intolerance (CISS) and health related quality of life (SF-36), as well as in the standardised grip function test, Southampton Hand Assessment Procedure (SHAP). No referred sensations were seen but the discriminative touch on the forearm was improved. In the qualitative interview, a relief of pain, a lack of cold intolerance, improved appearance, better grip function and overall emotional wellbeing were expressed.

Conclusions: The planned amputation and subsequent fitting and usage of a hand prosthesis were satisfying for the individual with positive effects on activity and participation.

Clinical relevance: When the hand function after a hand replantation does not reach satisfactory levels, a planned amputation and a prosthetic hand can be the right solution.

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References

Rosberg HE. Disability and health after replantation or revascularisation in the upper extremity in a population in southern Sweden – a retrospective long time follow up. BMC Musculoskel Disord 2014; 15: 73.

https://doi.org/10.1186/1471-2474-15-73 DOI: https://doi.org/10.1186/1471-2474-15-73

Billington AR, Ogden BW, Le NK, King KS, Rotatori RM, Kim RL, et al. A 17-year experience in hand and digit replantation at an academic center. Plast Reconstr Surg 2021; 148: 816–824.

https://doi.org/10.1097/PRS.0000000000008314 DOI: https://doi.org/10.1097/PRS.0000000000008314

Syrko M, Jabłecki J. Quality of life-oriented evaluation of late functional results of hand replantation. Ortop Traumatol Rehabil 2010; 12: 19–27.

Beris AE, Lykissas MG, Korompilias AV, Mitsionis GI, Vekris MD, Kostas-Agnantis IP. Digit and hand replantation. Arch Orthop Trauma Surg 2010; 130: 1141–1147.

https://doi.org/10.1007/s00402-009-1021-7 DOI: https://doi.org/10.1007/s00402-009-1021-7

Aszmann OC, Vujaklija I, Roche AD, Salminger S, Herceg M, Sturma A, et al. Elective amputation and bionic substitution restore functional hand use after critical soft tissue injuries. Sci Rep 2016; 6: 34960.

https://doi.org/10.1038/srep34960 DOI: https://doi.org/10.1038/srep34960

Aszmann OC, Roche AD, Salminger S, Paternostro-Sluga T, Herceg M, Sturma A, et al. Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients. Lancet 2015; 385: 2183–2189.

https://doi.org/10.1016/S0140-6736(14)61776-1 DOI: https://doi.org/10.1016/S0140-6736(14)61776-1

Hruby LA, Gstoettner C, Sturma A, Salminger S, Mayer JA, Aszmann OC. Bionic upper limb reconstruction: a valuable alternative in global brachial plexus avulsion injuries – a case series. J Clin Med 2019; 9(1): 23.

https://doi.org/10.3390/jcm9010023 DOI: https://doi.org/10.3390/jcm9010023

Salminger S, Roche AD, Sturma A, Hruby LA, Aszmann OC. Improving arm function by prosthetic limb replacement in a patient with severe arthrogryposis multiplex congenita. J Rehabil Med 2016; 48: 725–728.

https://doi.org/10.2340/16501977-2123 DOI: https://doi.org/10.2340/16501977-2123

Murray C. Amputation, prosthesis use, and phantom limb pain. An interdisciplinary perspective. New York, NY: Springer; 2010. DOI: https://doi.org/10.1007/978-0-387-87462-3

Kristjansdottir F, Dahlin LB, Rosberg HE, Carlsson IK. Social participation in persons with upper limb amputation receiving an est-hetic prosthesis. J Hand Ther 2020; 33: 520–527.

https://doi.org/10.1016/j.jht.2019.03.010 DOI: https://doi.org/10.1016/j.jht.2019.03.010

ASHT. American Society of Hand Therapists Clinical Assessment Recommendations. 3rd Ed. Mount Laurel, NJ: American Society of Hand Therapist: 2015

Jumbo SU, MacDermid JC, Kalu ME, Packham TL, Athwal GS, Faber KJ. Measurement properties of the Brief Pain Inventory-Short Form (BPI-SF) and Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) in pain-related musculoskeletal conditions: a systematic review. Clin J Pain 2021; 37: 454–474.

https://doi.org/10.1097/AJP.0000000000000933 DOI: https://doi.org/10.1097/AJP.0000000000000933

Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, et al. Development and validation of the Neuropathic Pain Symptom Inventory. Pain 2004; 108: 248–257.

https://doi.org/10.1016/j.pain.2003.12.024 DOI: https://doi.org/10.1016/j.pain.2003.12.024

Carlsson I, Cederlund R, Höglund P, Lundborg G, Rosén B. Hand injuries and cold sensitivity: reliability and validityof cold sensitivity questionnaires. Disabil Rehabil 2008; 30: 1920–1928.

https://doi.org/10.1080/09638280701679705 DOI: https://doi.org/10.1080/09638280701679705

Burgerhof JG, Vasluian E, Dijkstra PU, Bongers RM, van der Sluis CK. The Southampton Hand Assessment Procedure revisited: A transparent linear scoring system, applied to data of experienced prosthetic users. J Hand Ther 2017; 30: 49–57.

https://doi.org/10.1016/j.jht.2016.05.001 DOI: https://doi.org/10.1016/j.jht.2016.05.001

Resnik L, Borgia M, Cancio JM, Delikat J, Ni P. Psychometric evaluation of the Southampton hand assessment procedure (SHAP) in a sample of upper limb prosthesis users. J Hand Ther 2023; 36(1): 110–120. DOI: https://doi.org/10.1016/j.jht.2021.07.003

https://doi.org/10.1016/ j.jht.2021.07.003 DOI: https://doi.org/10.1088/1475-7516/2021/07/003

Rosén B, Lundborg G. A new model instrument for outcome after nerve repair. Hand Clin 2003; 19: 463–470.

https://doi.org/10.1016/S0749-0712(03)00003-9 DOI: https://doi.org/10.1016/S0749-0712(03)00003-9

Wijk U, Carlsson IK, Antfolk C, Björkman A, Rosén B. Sensory feedback in hand prostheses: a prospective study of everyday use. Front Neurosci 2020; 14: 663.

https://doi.org/10.3389/fnins.2020.00663 DOI: https://doi.org/10.3389/fnins.2020.00663

Atroshi I, Gummesson C, Andersson B, Dahlgren E, Johansson A. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: reliability and validity of the Swedish version evaluated in 176 patients. Acta Orthop Scand 2000; 71: 613–618.

https://doi.org/10.1080/000164700317362262 DOI: https://doi.org/10.1080/000164700317362262

Wressle E, Marcusson J, Henriksson C. Clinical utility of the Canadian Occupational Performance Measure – Swedish version. Can J Occup Ther 2002; 69: 40–48.

https://doi.org/10.1177/000841740206900104 DOI: https://doi.org/10.1177/000841740206900104

Sullivan M, Karlsson J, Ware JE, Jr. The Swedish SF-36 Health Survey – I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med 1995; 41: 1349–1358.

https://doi.org/10.1016/0277-9536(95)00125-Q DOI: https://doi.org/10.1016/0277-9536(95)00125-Q

Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. Eur J Gen Pract 2018; 24: 9–18.

https://doi.org/10.1080/13814788.2017.1375091 DOI: https://doi.org/10.1080/13814788.2017.1375091

Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther 2014; 44: 30–39.

https://doi.org/10.2519/jospt.2014.4893 DOI: https://doi.org/10.2519/jospt.2014.4893

Tintle SM, Baechler MF, Nanos GP, 3rd, Forsberg JA, Potter BK. Traumatic and trauma-related amputations: Part II: Upper extre-mity and future directions. J Bone Joint Surg Am 2010; 92(18): 2934–2945.

https://doi.org/10.2106/JBJS.J.00258 DOI: https://doi.org/10.2106/JBJS.J.00258

Otto IA, Kon M, Schuurman AH, van Minnen LP. Replantation versus prosthetic fitting in traumatic arm amputations: a systematic review. PLoS One 2015; 10: e0137729.

https://doi.org/10.1371/journal.pone.0137729 DOI: https://doi.org/10.1371/journal.pone.0137729

Sherman R. To reconstruct or not to reconstruct? N Engl J Med 2002; 347: 1906–1907.

https://doi.org/10.1056/NEJMp020150 DOI: https://doi.org/10.1056/NEJMp020150

Wijk U, Carlsson I. Forearm amputees’ views of prosthesis use and sensory feedback. J Hand Ther 2015; 28: 269–277.

https://doi.org/10.1016/j.jht.2015.01.013 DOI: https://doi.org/10.1016/j.jht.2015.01.013

Lundborg G. Tomorrow’s artificial hand. Scand J Plast Reconstruct Surg Hand Surg 2000; 34: 97–100.

https://doi.org/10.1080/02844310050159927 DOI: https://doi.org/10.1080/02844310050159927

Björkman A, Waites A, Rosén B, Lundborg G, Larsson EM. Cortical sensory and motor response in a patient whose hand has been replanted: one-year follow up with functional magnetic resonance imaging. Scand J Plast Reconstruct Surg Hand Surg 2007; 41: 70–76.

https://doi.org/10.1080/02844310601140956 DOI: https://doi.org/10.1080/02844310601140956

Ehrsson HH, Rosen B, Stockselius A, Ragnö C, Kohler P, Lundborg G. Upper limb amputees can be induced to experience a rubber hand as their own. Brain 2008; 131: 3443–3452.

https://doi.org/10.1093/brain/awn297 DOI: https://doi.org/10.1093/brain/awn297

Björkman A, Wijk U, Antfolk C, Bjorkman-Burtscher I, Rosen B. Sensory qualities of the phantom hand map in the residual forearm of amputees. J Rehabil Med 2016; 48: 365–370.

https://doi.org/10.2340/16501977-2074 DOI: https://doi.org/10.2340/16501977-2074

Björkman A, Weibull A, Olsrud J, Ehrsson HH, Rosen B, Bjorkman-Burtscher IM. Phantom digit somatotopy: a functional magnetic resonance imaging study in forearm amputees. Euro J Neurosci 2012; 36: 2098–2106.

https://doi.org/10.1111/j.1460-9568.2012.08099.x DOI: https://doi.org/10.1111/j.1460-9568.2012.08099.x

Rosberg H-E, Dahlin LD, Carlsson IK. A qualitative study of long-term censequences and adaptation in daily life after erplantation surgery at a young age. Hand Ther 2022; 27: 112–122. DOI: https://doi.org/10.1177/17589983221118399

Vaksvik T, Hetland K, Røkkum M, Holm I. Cold hypersensitivity 6 to 10 years after replantation or revascularisation of fingers: consequences for work and leisure activities. J Hand Surg Euro 2009; 34: 12–17.

https://doi.org/10.1177/1753193408094440 DOI: https://doi.org/10.1177/1753193408094440

Carlsson IK, Edberg AK, Wann-Hansson C. Hand-injured patients’ experiences of cold sensitivity and the consequences and adaptat-ion for daily life: a qualitative study. J Hand Ther 2010; 23: 53–61. DOI: https://doi.org/10.1016/j.jht.2009.07.008

https://doi.org/10.1016/ j.jht.2009.07.008 DOI: https://doi.org/10.1088/1126-6708/2009/07/008

Murray CD, Forshaw MJ. The experience of amputation and prosthesis use for adults: a metasynthesis. Disabil Rehabil 2013; 35: 1133–1142.

https://doi.org/10.3109/09638288.2012.723790 DOI: https://doi.org/10.3109/09638288.2012.723790

Sturma A, Hruby LA, Boesendorfer A, Pittermann A, Salminger S, Gstoettner C, et al. Prosthetic embodiment and body image changes in patients undergoing bionic reconstruction following brachial plexus injury. Front Neurorobot 2021; 15: 645261.

https://doi.org/10.3389/fnbot.2021.645261 DOI: https://doi.org/10.3389/fnbot.2021.645261

Tsakiris M, Schutz-Bosbach S, Gallagher S. On agency and body-ownership: phenomenological and neurocognitive reflections. Conscious Cogn 2007; 16: 645–660.

https://doi.org/10.1016/j.concog.2007.05.012 DOI: https://doi.org/10.1016/j.concog.2007.05.012

Desteli EE, İmren Y, Erdoğan M, Sarısoy G, Coşgun S. Comparison of upper limb amputees and lower limb amputees: a psychosocial perspective. Eur J Trauma Emerg Surg 2014; 40: 735–739.

https://doi.org/10.1007/s00068-014-0418-3 DOI: https://doi.org/10.1007/s00068-014-0418-3

Verma CV, Vora T, Thatte M, Yardi S. Patient perception after traumatic brachial plexus injury – a qualitative case report. J Hand Ther 2020; 33: 593–597. DOI: https://doi.org/10.1016/j.jht.2019.03.007

https://doi.org/10.1016/ j.jht.2019.03.007 DOI: https://doi.org/10.1088/1475-7516/2019/03/007