Special Technical ArticlesTargeted Muscle Reinnervation for the Upper and Lower ExtremityKuiken, Todd A. MD, PhD*,†,‡,§; Barlow, Ann K. PhD*; Hargrove, Levi J. PhD*,§; Dumanian, Gregorgy A. MD†,§Author Information *Center for Bionic Medicine, Rehabilitation Institute of Chicago †Departments of Surgery §Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago ‡Department of Biomedical Engineering, Northwestern University, Evanston, IL Supported by: NIH/NICHD #N01-HD-53402; NIDILRR #H133G100107; Department of Defense #W81XWH-13-2-0100; NIH/NICHD #R01-HD-81525-02; NIH R01 HD079428-02; Department of Defense W81XWH-14-C-0105. The authors declare that they have nothing to disclose. For reprint requests, or additional information and guidance on the techniques described in the article, please contact Todd A. Kuiken, MD, PhD, at email@example.com or by mail at Center for Bionic Medicine, Rehabilitation Institute of Chicago, 345 E. Superior Street, Chicago, IL 60611. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques. Techniques in Orthopaedics: June 2017 - Volume 32 - Issue 2 - p 109-116 doi: 10.1097/BTO.0000000000000194 Buy Metrics Abstract Myoelectric devices are controlled by electromyographic signals generated by contraction of residual muscles, which thus serve as biological amplifiers of neural control signals. Although nerves severed by amputation continue to carry motor control information intended for the missing limb, loss of muscle effectors due to amputation prevents access to this important control information. Targeted muscle reinnervation (TMR) was developed as a novel strategy to improve control of myoelectric upper limb prostheses. Severed motor nerves are surgically transferred to the motor points of denervated target muscles, which, after reinnervation, contract in response to neural control signals for the missing limb. TMR creates additional control sites, eliminating the need to switch the prosthesis between different control modes. In addition, contraction of target muscles, and operation of the prosthesis, occurs in reponse to attempts to move the missing limb, making control easier and more intuitive. TMR has been performed extensively in individuals with high-level upper limb amputations and has been shown to improve functional prosthesis control. The benefits of TMR are being studied in individuals with transradial amputations and lower limb amputations. TMR is also being investigated in an ongoing clinical trial as a method to prevent or treat painful amputation neuromas. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.