Challenges and Potential in Targeted Muscle Reinnervation in Pediatric Amputees

Targeted muscle reinnervation (TMR) is a powerful new tool in preventing and treating residual limb and phantom limb pain. In the adult population, TMR is rapidly becoming standard of care; however, there is a paucity of literature regarding indications and outcomes of TMR in the pediatric population. We present 2 cases of pediatric patients who sustained amputations and the relevant challenges associated with TMR in their cases. One is a 7-year-old patient who developed severe phantom and residual limb pain after a posttraumatic above-knee amputation. He failed pharmacologic measures and underwent TMR. He obtained complete relief of his symptoms and is continuing to do well 1.5 years postoperatively. The other is a 2-year-old boy with bilateral wrist and below-knee amputations as sequelae of sepsis. TMR was not performed because the patient never demonstrated evidence of phantom limb pain or symptomatic neuroma formation. We use these 2 cases to explore the challenges particular to pediatric patients when considering treatment with TMR, including capacity to report pain, risks of anesthesia, and cortical plasticity. These issues will be critical in determining how TMR will be applied to pediatric patients.

Cognitive Models of Limb Embodiment in Structurally Varying Bodies: A Theoretical Perspective

Using the seminal rubber hand illusion and related paradigms, the last two decades unveiled the multisensory mechanisms underlying the sense of limb embodiment, that is, the cognitive integration of an artificial limb into one's body representation. Since also individuals with amputations can be induced to embody an artificial limb by multimodal sensory stimulation, it can be assumed that the involved computational mechanisms are universal and independent of the perceiver's physical integrity. This is anything but trivial, since experimentally induced embodiment has been related to the embodiment of prostheses in limb amputees, representing a crucial rehabilitative goal with clinical implications. However, until now there is no unified theoretical framework to explain limb embodiment in structurally varying bodies. In the present work, we suggest extensions of the existing Bayesian models on limb embodiment in normally-limbed persons in order to apply them to the specific situation in limb amputees lacking the limb as physical effector. We propose that adjusted weighting of included parameters of a unified modeling framework, rather than qualitatively different model structures for normally-limbed and amputated individuals, is capable of explaining embodiment in structurally varying bodies. Differences in the spatial representation of the close environment (peripersonal space) and the limb (phantom limb awareness) as well as sensorimotor learning processes associated with limb loss and the use of prostheses might be crucial modulators for embodiment of artificial limbs in individuals with limb amputation. We will discuss implications of our extended Bayesian model for basic research and clinical contexts.

Do chronic pain syndromes in lower limb amputees have an effect on the use of prostheses?

BACKGROUND: The use of a prosthesis is critical to regain the ability to walk in lower limb amputees but the relationship between the use of a prosthesis and chronic pain syndromes (PLS, PLP, RLP), common in amputees patients, is still poorly understood. OBJECTIVE: This long-term follow-up study investigates the possible correlation between prosthesis use and the presence of PLP, PLS and RLP in lower limb amputees. METHODS: Patients undergoing transtibial, transfemoral or hemipelvectomy amputation of any aetiology at the Rizzoli Orthopaedic Institute from 2008 to 2018 were included. The Houghton scale was used to assess functional use of the prosthesis. RESULTS: The results show that, in lower limb amputees, prosthesis use is greater in individuals with below-the-knee amputation and in those who were younger at the time of amputation. No significant correlation between the presence of pain syndromes (PLS, PLP, RLP) and the various items on the Houghton scale was found. CONCLUSIONS: The study found no significant correlation indicating that phantom limb pain syndromes affect amputee use of a prosthesis.

“I’m gonna lose my strength, I’m gonna seize and die, And all that Jazz”! Neurological diseases in jazz legends

ABSTRACT Even though jazz is a musical style that excels in improvisation and virtuosity, it is not without its share of anecdotes, drama, and downright tragedy, and the biographies of jazz musicians and their demise are fraught with ominous and dire straits. Unsurprisingly, some would develop chronic and fatal diseases. The neurological diseases that afflicted the following six composers and musicians, all of whom are considered jazz legends, are briefly discussed: Charles Mingus, diagnosed with amyotrophic lateral sclerosis; Lester Young and Charlie Parker, both diagnosed with neurosyphilis; Thelonius Monk, who had possible frontotemporal dementia; George Gershwin, who died as a result of brain glioma; and Cole Porter, who developed phantom limb pain following an amputation. The association of lifestyles, with drug abuse, particularly alcohol and heroin, in addition to great sexual promiscuity factors contributed to the development of a series of diseases such as syphilis. In addition, we also described some fatalities such as neurodegenerative diseases and cerebral glioma.