The Alfred pioneers thought-controlled prosthesis

The procedure, targeted muscle re-innervation (TMR), allows the patient’s brain to directly control a specially engineered prosthetic limb through a process of surgery, rehabilitation, and brain training. The procedure is often combined with the OPRA (Osseointegrated Prosthetic Rehabilitation of the Amputee) system which was first pioneered at The Alfred in 1995.

The first Australian TMR patient, Alan Newey, was this week fitted with his new prosthetic arm after he underwent surgery at The Alfred in August last year. In total, seven patients have now completed the program.

This exciting procedure is possible thanks to a collaboration between The Alfred Director of Plastic Surgery, Frank Bruscino-Raiola and Steven Gray, Director of Osseointegration/TMR, Epworth HealthCare and ProMotion Prosthetics.

Mr Bruscino-Raiola said this procedure was life-changing for patients who had previously been resigned to the limitations of losing one or both arms.

“TMR and osseointegration is a new exciting frontier in the surgical and rehabilitation management of upper limb amputees,” Mr Bruscino-Raiola said.

“All of our patients who have completed the program are really excited about the potential for their new limbs. Where previously their movements were quite limited, this new technology opens up a new realm of what they’re able to achieve.”

Mr Gray said it was rewarding to see Australian patients enjoying the benefits of this innovative technology.

“What we have done here is combine two major surgical developments in collaboration with leading international units,” Mr Gray said.

“There are already trials underway that will take this technology even further and many of our current patients will be eligible for this next step.”

Around six weeks after the surgery, patients work with Epworth Healthcare to begin rehabilitation, movement, strengthening and visualisation — which helps patients to re-learn how to send messages down the native pathways for movement.

Occupational Therapist at Epworth HealthCare Abby Hutchison said patients undergo an extensive virtual training program to help them achieve strong and consistent control of their new prosthetic, along with a home exercise program that takes for up to 30 minutes, four times a day.

“For someone to be able to imagine a movement, and have their prosthesis intuitively respond in real time is a significant development compared to traditional methods,” Ms Hutchison said.

“With this surgery, rehabilitation and prosthetic technology, the simple act of reaching for someone’s hand or cup of coffee will potentially become simple once again. The meaning of that to someone is profound.”

About the procedure

Targeted muscle re-innervation (TMR) is a surgical procedure that rewires nerves that once controlled the arm and the hand.  Doctors can make it possible for people who have had upper-arm amputations to control their prosthetic devices by merely thinking about the action they want to perform.

The OPRA (Osseointegrated Prosthetic Rehabilitation of the Amputee) osseointegration system used by The Alfred plastics unit is a procedure where a titanium implant is ‘integrated’ into the existing bone in an amputated limb. This allows the prosthetic arm to be directly attached to the patient’s body, rather than using a socket, harness or a sling.  

By combining the two procedures, doctors are able to give patients better retention and more natural control of their prosthesis. The specially-engineered prosthetic arm used in the TMR osseointegration, through a series of electrodes, is capable of replicating the movements of the human arm – which is a far greater range than traditional prosthetic arms.

Compared to previous systems which may have only utilized two electrodes for prosthetic control, the next generation “Pattern Recognition” control system used in this program feature up to 16 electrodes that map patterns of activity for intuitive complex movements.

This intuitive movement, improved speed of control and ability for simultaneous movement all contribute to considerably better outcomes.