Toward the use of muscle reinnveration for chronic bidirectional control of prostheses to improve functional outcomes of end users

Regenerative peripheral nerve interfaces (RPNI) and targeted muscle reinnervation (TMR) are surgical approaches for redirecting peripheral nerve growth to denervated muscle targets after amputation. These approaches have demonstrated promise at reducing post-amputation pain and are now frequently performed at the time of amputation. Both TMR and RPNI can also serve as bioamplifiers for efferent neural signals that once went to the lost limb. Through reinnervation of muscle and skin, patients may also afford meaningful afferent feedback. Accordingly, these surgical approaches can be beneficial for bidirectional prostheses. This review discusses recent literature on management of post-amputation pain, prosthetic control, and sensory feedback with each approach. We also discuss how these approaches can be incorporated into wearable systems to improve function in daily life.