Central Programming in Patients With a Bionic Hand After Traumatic Brachial Plexus Injury

Study Overview
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Brief Summary
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Traumatic brachial plexus lesions may lead to permanent impairment of hand function despite brachial plexus surgery. In selected cases the affected forearm can be amputated and replaced by a bionic hand. It is unclear how cortical activation patterns change after the injury and after acquisition of the hand prosthesis considering the complex changes in sensory and motor feedback. The aim of the study is to measure cortical activity with fMRI during actual and imagery movements with the affected and healthy arm in a group of patients after traumatic brachial plexus injury and a group in whom this was followed by replacement with a bionic hand. In this prospective study three groups of patients will participate: 1) 3 adult patients with a traumatic brachial plexus lesion eligible for a bionic arm but prior to its acquisition, 2) 3 patients with a traumatic brachial plexus lesion who have acquired the bionic arm already, and 3) 10 healthy subjects. The investigators will measure cortical activity using fMRI BOLD tasks of closing the hand and motor imagery of this movement. Cortical activity will be compared between the three groups. Additionally, regional gray matter volume, resting-state, and DTI networks will be studied. Written informed consent will be provided prior to the investigation. The complete examination has a duration of approximately 45 minutes.

Official Title
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Central Programming in Patients With a Bionic Hand After Traumatic Brachial Plexus Injury

Conditions
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Brachial Plexus Neuropathies, Traumatic Brachial Plexus Lesion, Bionic Hand Reconstruction

Intervention / Treatment
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* Diagnostic Test: MRI


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age above 18 years participants should understand German or English patients with a bionic hand are selected who are able to open and close the hand prosthesis. Exclusion Criteria: the standard contraindications for MRI will be checked for according to hospital protocol (ferromagnetic devices such as clips, claustrophobia, etc.) and, if necessary, patients will be excluded from participation.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients - bionic hand acquired<br>3 adult patients who acquired a bionic hand at the Medical University of Vienna after a traumatic brachial plexus lesion. | Diagnostic Test: MRI<br>* MRI scan<br>* Other names: fMRI;|
| Patients - bionic hand not yet acquired<br>3 patients eligible for the bionic hand prior to a possible amputation. | Diagnostic Test: MRI<br>* MRI scan<br>* Other names: fMRI;|
| Control subjects<br>Ten control subjects will be included for comparison. | Diagnostic Test: MRI<br>* MRI scan<br>* Other names: fMRI;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| task-related cortical activity - fMRI BOLD signal | The investigators will measure cortical activity measured as a fMRI BOLD (blood-oxygen-level-dependent) signal, during four tasks: closing the hand (lef tand right) and motor imagery of this movement. | MRI task scanning approximately 20 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| resting state activity - fMRI BOLD signal | The investigators will measure brain activity measured as a fMRI BOLD signal (blood-oxygen-level-dependent) during rest. | MRI resting state scanning approximately 10 minutes | 
| diffusion tensor imaging (DTI) MRI | The investigators will measure mean diffusivity of the brain with DTI. | DTI scanning approximately 10 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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traumatic brachial plexus lesion, bionic hand reconstruction, hand amputation, hand prosthesis, central programming, fMRI, resting state networks, DTI