Occupational Therapy for the Targeted Muscle Reinnervation Patient

A thorough musculoskeletal and sensory exam is required for any patient prior to TMR surgery (see Chapter 5). Special attention should be given to the proximal shoulder on the injured side, as proximal kinetic chain injury is very common with traumatic arm amputation. A thorough evaluation of the patient’s overall posture and core conditioning is also important, as postural musculature plays a significant role in the control of upper limb myoelectric prostheses. In addition, an assessment should be made of the patient’s enthusiasm for using a prosthesis, compliance with past treatment, and understanding of the TMR process. If the patient has already been fit with a prosthesis, the patient’s functional ability with the device should be thoroughly assessed before surgery to provide an indication of prosthesis control prior to TMR surgery and allow comparison to functional control after TMR. This baseline assessment cannot be performed after surgery, as prosthesis control may degrade before the final TMR fitting, due to denervation of original control muscles.