Bionic hand reconstruction shows initial promise in brachial plexus injuries

1. Bionic hand reconstruction with prosthesis partially restored lost hand function in patients with lower root avulsion brachial plexus injuries.

2. All measures of quality of life, functional hand outcomes, and pain scores improved after bionic reconstruction surgery in all patients.

Evidence Rating Level: 4 (Below Average)

Study Rundown: Brachial plexus injuries with lower root avulsions are a reconstructive challenge. The existing reconstructive techniques result in poor hand function outcomes. This case series describes 3 patients with global brachial plexus injury that had failure with all previous biological reconstruction procedures who then underwent bionic hand reconstruction. Global arm function was assessed before and after the intervention with the Action Research Arm Test (ARAT). Activities of daily living related to hand and arm function were assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the Southampton Hand Assessment Procedure (SHAP) before and after bionic prosthesis fitting. Pain scores, measures of quality of life and functional outcomes all improved after surgery. This study suggests that bionic hand reconstruction offers a means to restore hand function for patients with global brachial plexus injury with lower root avulsions who have no alternative treatment. This trial’s positive results are promising, but the study is limited by the small sample size. As the procedure involves elective hand amputation, any potential benefits must be carefully weighed against the risks. A larger study of a longer follow up period is needed to assess long term prognoses.

The study was funded by Austrian Council for Research and Technology Development, Austrian Federal Ministry of Science, Research & Economy, and European Research Council Advanced Grant DEMOVE.

Click to read the study, published today in The Lancet

Relevant Reading: Design of a myoelectric prosthetic hand implementing postural synergy mechanically

In-Depth [case series]: This is a case series involving 3 patients who have suffered brachial plexus injuries with lower root avulsions and have failed previous biological reconstructive procedures. Patients underwent elective hand amputation and reconstruction with a bionic prosthesis.

Before reconstruction and 3 months after fitting with bionic prosthesis device, participants were assessed for global arm function, activities of daily living related to hand and arm function, and pain using validated survey tools. The Action Research Arm Test (ARAT) consists of different tasks with a maximum of 57 points attainable. Normal hand function is regarded as equal to or above 100 points in the SHAP. A score of 100 indicates the worst and 0 indicates the best hand function on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Visual analogue scales were used to evaluate pain. The mean ARAT score was 5.3 (standard deviation, SD, 4.7) before intervention and after final prosthetic fitting was 30.7 (SD14.0). Mean SHAP score was 9.3 (SD 1.5) before intervention, and 65.3 (SD 19.4) with the final prosthetic. Outcome scores for DASH improved from 46.5 (SD 18.7) to 11.7 (SD 8.4). The SF-36 outcomes also showed a substantial improvement of physical functioning and mental health.

Image: PD

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