Redirection of cutaneous sensation from the hand to the chest skin of human amputees with targeted reinnervation

TLDR

Amputees cannot feel what they touch with their artificial hands, severely limiting the usefulness of those hands. The study develops a technique that transfers remaining arm nerves to residual chest muscles after amputation. This technique enables sensory nerves from the amputated limb to reinnervate the overlying chest skin. Reinnervated chest skin elicits near‑normal touch thresholds, distinct perceptual identity from the chest, and even proprioceptive and temperature/pain sensations, suggesting that stimulation of this skin can provide useful prosthetic feedback and reveals mechanisms of neural plasticity and peripheral regeneration.

Abstract

Amputees cannot feel what they touch with their artificial hands, which severely limits usefulness of those hands. We have developed a technique that transfers remaining arm nerves to residual chest muscles after an amputation. This technique allows some sensory nerves from the amputated limb to reinnervate overlying chest skin. When this reinnervated skin is touched, the amputees perceive that they are being touched on their missing limb. We found that touch thresholds of the reinnervated chest skin fall within near-normal ranges, indicating the regeneration of large-fiber afferents. The perceptual identity of the limb and chest was maintained separately even though they shared a common skin surface. A cutaneous expression of proprioception also occurred in one reinnervated individual. Experiments with peltier temperature probes and surface electrical stimulation of the reinnervated skin indicate the regeneration of small diameter temperature and pain afferents. The perception of an amputated limb arising from stimulation of reinnervated chest skin may allow useful sensory feedback from prosthetic devices and provides insight into the mechanisms of neural plasticity and peripheral regeneration in humans.