Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury

Agnes Sturma; Laura A Hruby; Anna Boesendorfer; Anna Pittermann; Stefan Salminger; Clemens Gstoettner; Olga Politikou; Ivan Vujaklija; Dario Farina; Oskar C Aszmann

doi:10.3389/fnbot.2021.645261

Prosthetic Embodiment and Body Image Changes in Patients Undergoing Bionic Reconstruction Following Brachial Plexus Injury

Front Neurorobot. 2021 Apr 30:15:645261. doi: 10.3389/fnbot.2021.645261. eCollection 2021.

Authors

Agnes Sturma^{1

2}, Laura A Hruby^{1

3}, Anna Boesendorfer¹, Anna Pittermann^{1

4

5}, Stefan Salminger¹, Clemens Gstoettner¹, Olga Politikou¹, Ivan Vujaklija⁶, Dario Farina², Oskar C Aszmann^{1

5}

Affiliations

¹ Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria.
² Neurorehabilitation Engineering Group, Department of Bioengineering, Imperial College London, London, United Kingdom.
³ Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
⁴ Department of Clinical Psychology, General Hospital of Vienna, Vienna, Austria.
⁵ Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
⁶ Bionic and Rehabilitation Engineering Research Group, Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland.

Abstract

Brachial plexus injuries with multiple-root involvement lead to severe and long-lasting impairments in the functionality and appearance of the affected upper extremity. In cases, where biologic reconstruction of hand and arm function is not possible, bionic reconstruction may be considered as a viable clinical option. Bionic reconstruction, through a careful combination of surgical augmentation, amputation, and prosthetic substitution of the functionless hand, has been shown to achieve substantial improvements in function and quality of life. However, it is known that long-term distortions in the body image are present in patients with severe nerve injury as well as in prosthetic users regardless of the level of function. To date, the body image of patients who voluntarily opted for elective amputation and prosthetic reconstruction has not been investigated. Moreover, the degree of embodiment of the prosthesis in these patients is unknown. We have conducted a longitudinal study evaluating changes of body image using the patient-reported Body Image Questionnaire 20 (BIQ-20) and a structured questionnaire about prosthetic embodiment. Six patients have been included. At follow up 2.5-5 years after intervention, a majority of patients reported better BIQ-20 scores including a less negative body evaluation (5 out of 6 patients) and higher vital body dynamics (4 out of 6 patients). Moreover, patients described a strong to moderate prosthesis embodiment. Interestingly, whether patients reported performing bimanual tasks together with the prosthetic hand or not, did not influence their perception of the prosthesis as a body part. In general, this group of patients undergoing prosthetic substitution after brachial plexus injury shows noticeable inter-individual differences. This indicates that the replacement of human anatomy with technology is not a straight-forward process perceived in the same way by everyone opting for it.

Keywords: bionic reconstruction; body image; brachial plexus injury; embodiment/bodily experience; human-machine interfaces; prosthesis; upper limb amputation.