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Neurotechnologies; autotranslplantation; motor control; Arthrogryposis; Rehabilitation; Neuroprosthesis
Abstract:
Muscles autotransplantation is an important way to restore motor activity in case of injury or diseases associated with a loss of muscles ability. One of the typical examples of such pathology is arthrogryposis multiplex congenita (AMC). Arthrogryposis is one of the most serious congenital malformations of the musculoskeletal system. It is characterized by the presence of two or more major joint contractures, muscle damage, and motoneuronal dysfunction in the anterior horns of the spinal cord. One of the main problems that determines the limitation or even impossibility of self-care of patients suffering from arthrogryposis is the lack of active movements in the upper limb joints, which can be restored by autotransplantation of the muscles of various donor areas (Hall, 1997; Bamshad et al., 2009; Loeffler and Lewis, 2016).
A major limiting factor for the adequate self-care in patients with this pathology is a lack of the active elbow flexion due to the fibro-fatty degeneration of the flexors of the forearm. Such deficits significantly affect the quality of life because many vital functions are associated with the elbow movements, for example, bringing food to the mouth. Thus, for these patients it is important to secure functional recovery of the biceps brachii muscle, which is performed by non-free (with preservation of the vascular-muscular bundle) autotransplantation of the muscles surrounding the shoulder joint (commonly by the pectoralis major or the latissimus dorsi muscles) (Oishi et al., 2017). The loss of the muscle function in the donor region does not cause any significant functional impairment due to the work of the remaining synergistic muscles (Mikati, 2007; Zargarbashi et al., 2017).
There are two pivotal and non-trivial aspects witch should be addressed for such surgeries:
1. Which muscle is the most suitable for the autotransplantation?
2. How to facilitate the rehabilitation processes after the muscle autotransplantation?
Next, we discuss these two issues in more detail.
