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.

中文翻译：

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臂丛神经损伤后进行仿生重建的患者的修复体和身体图像变化

臂丛神经损伤多发性受累会导致受影响的上肢功能和外观严重而持久的损伤。在无法进行手和手臂功能的生物学重建的情况下，仿生重建可能被认为是可行的临床选择。仿生重建通过仔细地结合手术增强，截肢和假肢替代无功能的手，已被证明可以实现功能和生活质量的显着改善。但是，已知在严重的神经损伤患者以及假肢使用者中，无论功能水平如何，身体图像都会长期变形。迄今为止，尚未选择自愿截肢和修复假体的患者的身体图像。而且，在这些患者中假体的具体实施程度是未知的。我们进行了一项纵向研究，使用患者报告的身体图像问卷20（BIQ-20）和有关义肢实施的结构化问卷来评估身体图像的变化。已包括六名患者。在干预后2.5-5年进行随访时，大多数患者报告的BIQ-20评分更高，包括较低的阴性身体评估（6名患者中的5名）和较高的生命体动力学（6名患者中的4名）。此外，患者描述了强到中的假体实施方案。有趣的是，无论患者报告是否与义肢一起执行了双向任务，并没有影响他们对假肢作为身体一部分的看法。通常，这一组在臂丛神经损伤后进行假体置换的患者之间存在明显的个体差异。这表明用技术代替人体解剖学并不是每个选择它的人都以相同的方式直截了当的过程。