Summary: Researchers publish guidelines to help determine whether a patient is psychologically suitable for bionic hand reconstruction following amputation.
Source: Medical University of Vienna.
Bionic reconstruction, whereby a patient’s lifeless hand is replaced by a mechatronic hand, restores hope following accidents. However, not everyone is suitable for this programme – certain psychological preconditions must be fulfilled. The research team headed by surgeon Oskar Aszmann from MedUni Vienna’s Department of Surgery has now, for the first time, published the Viennese concept for a structured psychological assessment to determine whether a patient is psychologically suitable for bionic hand reconstruction.
Accidents can cause serious injuries to the nerves that supply the arm and hand. If the function of these nerves is not restored within a few months of the accident, the hand musculature “dies”, so that the hand becomes a non-functional appendage with no sensation. Bionic reconstruction, in which the lifeless hand is replaced by a mechatronic hand, restores hope to these patients. However, not everyone is suitable for this programme – certain psychological preconditions must be fulfilled.
Young motorcyclists, in particular, often suffer nerve root avulsion injuries. Their arms are flung away from their bodies with great force and the considerable tensile strain causes individual nerve roots to tear away from the spinal cord. The brain – spinal cord – nerve pathway is interrupted, so that patients can no longer feel or move their hand.
In most cases it is possible, through timely nerve reconstruction, to restore some function in the shoulder and elbow. However, in most cases the muscles in the hand do not survive this period without a nerve supply. Oskar Aszmann presented the concept of bionic reconstruction for such patients at the Medical University of Vienna in 2015. The procedure involves grafting new muscles into the forearm, so that these can then act a signal amplifier for the remaining nerves. The non-functional hand is then replaced by a mechatronic hand. Even after years without any manual function, patients with this type of prosthetic hand are again able to exert a strong grip and to manipulate objects.
However, bionic reconstruction involves amputating the non-functional hand, which constitutes a serious breach of physical integrity. It is therefore essential to ascertain in advance whether a patient is aware of the ramifications of this decision and understands the amount of rehabilitation required to restore manual function, albeit mechatronic. Laura Hruby and Anna Pittermann, both from Aszmann’s team, have therefore developed a psychosocial assessment procedure that every patient must undergo before the elective amputation.
The assessment consists of several questionnaires and a two-hour interview with experienced clinical psychologist Anna Pittermann. The process aims to ascertain to what extent potential candidates have come to terms with the accident that caused the nerve injury, what expectations they have of a prosthesis and whether these expectations are realistic.
“Again and again, we encounter patients who have cyborg-type fantasies, which are primarily driven by distorted reports in the media,” says Hruby. It is therefore necessary to explain to them that a prosthetic hand is not some fantastic thing. The psychosocial assessment helps to identify early on those patients who have unrealistic expectations, to exclude unsuitable people from the programme and also to be able to offer help with any psychological issues or to work together to develop strategies to overcome these problems.”
As well as the psychosocial assessment, the publication in the internationally renowned medical journal PLOS One also contains new findings about the positive impact of bionic reconstruction on body image and quality-of-life for affected patients.
Source: Verena Müller – Medical University of Vienna
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is adapted from the Medical University of Vienna news release.
Original Research: Full open access research for “The Vienna psychosocial assessment procedure for bionic reconstruction in patients with global brachial plexus injuries” by Laura Antonia Hruby, Anna Pittermann, Agnes Sturma, and Oskar Christian Aszmann in PLOS ONE. Published online January 3 2018 doi:10.1371/journal.pone.0189592
The Vienna psychosocial assessment procedure for bionic reconstruction in patients with global brachial plexus injuries
Global brachial plexopathies cause major sensory and motor deficits in the affected arm and hand. Many patients report of psychosocial consequences including chronic pain, decreased self-sufficiency, and poor body image. Bionic reconstruction, which includes the amputation and prosthetic replacement of the functionless limb, has been shown to restore hand function in patients where classic reconstructions have failed. Patient selection and psychological evaluation before such a life-changing procedure are crucial for optimal functional outcomes. In this paper we describe a psychosocial assessment procedure for bionic reconstruction in patients with complete brachial plexopathies and present psychosocial outcome variables associated with bionic reconstruction.
Between 2013 and 2017 psychosocial assessments were performed in eight patients with global brachial plexopathies. We conducted semi-structured interviews exploring the psychosocial adjustment related to the accident, the overall psychosocial status, as well as motivational aspects related to an anticipated amputation and expectations of functional prosthetic outcome. During the interview patients were asked to respond freely. Their answers were transcribed verbatim by the interviewer and analyzed afterwards on the basis of a pre-defined item scoring system. The interview was augmented by quantitative evaluation of self-reported mental health and social functioning (SF-36 Health Survey), body image (FKB-20) and deafferentation pain (VAS). Additionally, psychosocial outcome variables were presented for seven patients before and after bionic reconstruction.
Qualitative data revealed several psychological stressors with long-term negative effects on patients with complete brachial plexopathies. 88% of patients felt functionally limited to a great extent due to their disability, and all of them reported constant, debilitating pain in the deafferented hand. After bionic reconstruction the physical component summary scale increased from 30.80 ± 5.31 to 37.37 ± 8.41 (p-value = 0.028), the mental component summary scale improved from 43.19 ± 8.32 to 54.76 ± 6.78 (p-value = 0.018). VAS scores indicative of deafferentation pain improved from 7.8 to 5.6 after prosthetic hand replacement (p-value = 0.018). Negative body evaluation improved from 60.71 ± 12.12 to 53.29 ± 11.03 (p-value = 0.075). Vital body dynamics increased from 38.57 ± 13.44 to 44.43 ± 16.15 (p-value = 0.109).
Bionic reconstruction provides hope for patients with complete brachial plexopathies who have lived without hand function for years or even decades. Critical patient selection is crucial and the psychosocial assessment procedure including a semi-structured interview helps identify unresolved psychological issues, which could preclude or delay bionic reconstruction. Bionic reconstruction improves overall quality of life, restores an intact self-image and reduces deafferentation pain.
“The Vienna psychosocial assessment procedure for bionic reconstruction in patients with global brachial plexus injuries” by Laura Antonia Hruby, Anna Pittermann, Agnes Sturma, and Oskar Christian Aszmann in PLOS ONE. Published online January 3 2018 doi:10.1371/journal.pone.0189592