{"doi":"10.1016/j.brs.2020.01.003","title":"Case study of an amputee regaining sensation and muscle function in a residual limb after peripheral nerve stimulation by intense focused ultrasound","abstract":"•Intense focused ultrasound activated a once dormant peripheral nerve in an amputee’s residual limb.•This activation occurred within moments of application of sufficient ultrasound, after a year of nerve-function dormancy.•Our study conceptually overlaps with other’s that show ultrasound stimulation of the thalamus can re-animate neural circuits. Standard amputation surgery places the distal transected nerve ending in soft tissue to minimize pain from external pressure. Despite this, nerve-related pain often occurs due to a variety of peripheral and central sources [[1]Reiber G.E. McFarland L.V. Hubbard S. Maynard C. Blough D.K. Gambel J.M. et al.Servicemembers and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: survey methods, participants, and summary findings.J Rehabil Res Dev. 2010; 47: 275https://doi.org/10.1682/JRRD.2010.01.0009Crossref PubMed Scopus (130) Google Scholar]. Targeted muscle reinnervation (TMR) connects the distal transected nerve to a neuromuscular junction in the residual limb during amputation surgery in order to facilitate myoelectric prosthesis use and to reduce the incidence and severity of neuroma-related pain [[2]Valerio I.L. Dumanian G.A. Jordan S.W. Mioton L.M. Bowen J.B. West J.M. et al.Preemptive treatment of phantom and residual limb pain with targeted muscle reinnervation at the time of major limb amputation.J Am Coll Surg. 2019; 228: 217-226https://doi.org/10.1016/j.jamcollsurg.2018.12.015Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar]. During a study to determine the relative sensitivity to external stimulation of transected nerves after standard amputation versus TMR, we encountered a single participant who recovered motor and sensory function of their tibial nerve after TMR surgery during ultrasound stimulation of the nerve. We used intense focused ultrasound (iFU), delivered under real-time ultrasound image guidance, to stimulate at or near the distal tip of major transected nerves in amputated limbs following a previously described protocol [[3]Mourad P.D. Friedly J.L. McClintic A.M. Olmstead T.A. Loeser J.D. Intense focused ultrasound preferentially stimulates transected nerves within residual limbs: pilot study.Pain Med. 2017; https://doi.org/10.1093/pm/pnx188Crossref Scopus (9) Google Scholar,[4]Bobola M.S. Ezeokeke C.K. Kuznetslova K. Lahti A.C. Loeser J.D. Olmstead T.A. et al.A pre-clinical study of the response threshold of intact and transected nerves to stimulation by transcutaneous intense focused ultrasound.Ultrasound Med Biol. 2019; 45: 2094-2103https://doi.org/10.1016/j.ultrasmedbio.2019.04.014Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. In this way we determined the minimum iFU intensity capable of generating a first discernable sensation through use of a ramp-up paradigm that started at low intensity values and increased until we achieved that aim or reached the maximum intensity value of our device. We obtained University of Washington Institutional Review Board (IRB) and military Human Research Protection Office (HRPO) approvals for our study. All participants in the study provided informed consent. The participant in question had a below-knee amputation in March of 2003 due to posttraumatic arthritis, then a surgical revision in February of 2016 using TMR to address three painful neuromas in his residual limb, one for each of the peroneal, tibial and sural nerves. Prior to his participation in our study in February of 2017, our participant reported his inability to contract his lateral gastrocnemius muscle to which the tibial nerve was connected via the lateral motor branch of the gastrocnemius nerve using the TMR procedure (Fig. 1a). He also could not detect sensations from the posterior portion of his leg – that associated with the site of tibial nerve implantation. This lack of motor and sensory function of the tibial nerve persisted for the entire twelve months after TMR surgery until the day","journal":"Brain stimulation","year":2020,"id":112756,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9553,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":283411,"name":"M S Bobola","orcid":null,"position":1,"is_corresponding":false},{"id":534086,"name":"Madison L. Selby","orcid":null,"position":2,"is_corresponding":false},{"id":533191,"name":"Jung Hwa Ko","orcid":"0000-0002-1014-3270","position":3,"is_corresponding":false},{"id":372165,"name":"Janna Friedly","orcid":"0000-0002-7483-7888","position":4,"is_corresponding":false},{"id":281286,"name":"Pierre D. Mourad","orcid":"0000-0003-2645-4177","position":5,"is_corresponding":false},{"id":283412,"name":"C.K. Ezeokeke","orcid":null,"position":0,"is_corresponding":true}],"reference_count":12,"raw_metadata":null,"created_at":"2026-07-18T23:13:17.845093Z","pmid":"32289669","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}