Clinical Nurse Leader

First U.S. Patient reaches major milestone toward a bionic arm anchored to bone, nerves and muscles. September 17, 2026 Shirley Ryan AbilityLab, in partnership with Northwestern Medicine, University of Chicago and Integrum, is pioneering a first-of-its-kind clinical study that could redefine the future of upper-limb prosthetics. A Chicago-area man is set to become the first person in the United States to receive a bionic arm connected directly to his bone, nerves and muscles - an advanced prosthesis designed to be controlled by his own neural signals and return sensory feedback in real time. The man lost his left arm above the elbow in a construction-site accident in 2016. Now, he is the first participant in a five-year osseointegration clinical study led by Levi Hargrove, PhD, scientific chair of the Regenstein Foundation Center for Bionic Medicine at Shirley Ryan AbilityLab and professor of Physical Medicine and Rehabilitation at Northwestern University Feinberg School of Medicine. On July 15, in an eight-hour operation at Northwestern Memorial Hospital, a combined team of plastic and orthopedic surgeons - led by Jason Ko, MD, vice chair of clinical operations, Department of Surgery at Northwestern Medicine, and Terrance Peabody, MD, chair of the Department of Orthopaedic Surgery at Northwestern Medicine - implanted a titanium fixture into the bone of the man's residual limb and placed electrodes onto his muscles and around his nerves. The procedure was conducted under an investigational device exemption (IDE) from the U.S. Food and Drug Administration. How it works. Osseointegration is a technique in which a metal implant is anchored into a person's residual bone. Over several months, bone grows into the implant's surface, making it a structural extension of the skeleton. A second component then passes through the skin, allowing a prosthesis to attach directly to the bone, eliminating the socket that conventional prostheses rely on - and, by extension, associated discomfort, poor fit and limited range of motion. The e-OPRA (Enhanced Osseoanchored Prostheses for the Rehabilitation of Amputees) system builds on that foundation by routing signals through the same implant. Electrodes placed on muscle record the electrical activity generated when a person intends to move, and those signals are decoded to drive the prosthesis. Separately, electrodes placed around peripheral nerves deliver stimulation that creates sensations perceived as coming from the missing limb. The study will evaluate whether that feedback improves how well and how naturally research subjects can use the arm. "This is about the interface, not the arm," Dr. Hargrove said. "e-OPRA takes on two of the hardest problems in the field at once. It anchors the prosthesis directly to the skeleton, which eliminates the socket entirely, and it puts the electrodes on the muscles and around the nerves - where the signals are clean, stable, and can travel in both directions." What's new. The study is the first to combine osseointegration, targeted muscle reinnervation (TMR) and pattern-recognition control using implanted electromyography (EMG) sensors and nerve cuff electrodes for sensory feedback. TMR - a surgical technique developed in 2002 by collaborators at Shirley Ryan AbilityLab and Northwestern Medicine that revolutionized the neuroprosthetics industry - reroutes nerves that once served the missing hand to remaining muscles in the residual limb, giving those nerves a place to produce signals a prosthesis can read. Eight participants will be enrolled in the study. Surgeons at Northwestern Medicine are implanting the devices and, depending on each participant's history, performing TMR at the time of implantation or revising nerve transfers done previously. Rickard Brånemark, MD, PhD - who developed the OPRA osseointegrated implant system on which e-OPRA is built - traveled from Sweden to Chicago and was in the operating room on July 15, providing technical guidance to the surgical team. He is chairman of the board of Integrum AB, whose U.S. subsidiary, Integrum Inc., is a study partner. Researchers at the University of Chicago, led by Charles Greenspon, PhD, are leading the sensory feedback component of the work. The study is supported by an $8.7 million award from the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, through a phased mechanism designed to move early-stage neural technologies into patient trials. Next steps: rehabilitation and evaluation. Today, the man who underwent surgery July 15, as well as a prior surgery in preparation, is recovering as his body adapts to the implant. "This e-OPRA surgery was unique because the implanted nerve cuffs will provide sensory feedback to the missing hand when the patient uses his new bionic arm, considered to be the 'holy grail' for neuroprosthetics," said Dr. Ko, the lead study investigator for Northwestern Medicine. "The combination of a bone-anchored prosthesis, internal muscle and nerve electrodes represents a major advancement in prosthetic technology. Now, the electrical signals that control the bionic arm will not be affected by sweat, skin motion, swelling or other external factors that prevented our patient from successfully using a bionic arm previously." "These e-OPRA surgeries are another example of the decades-long teamwork and deep collaboration between Northwestern Medicine's Orthoplastic Program and Shirley Ryan AbilityLab that are focused on advanced limb restoration and bionic reconstruction," said Dr. Peabody. "The surgeries are technically demanding and require both the bone expertise from orthopaedic surgery and the soft tissue and nerve techniques pioneered by plastic surgery at Northwestern Medicine. Our patient's surgeries were successful. He is recovering as expected and is very excited about what he is already able to do with his practice bionic arm." The research team can already capture muscle signals from the implanted electrodes - the signals that will eventually control the prosthesis. In the coming months, the man will begin rehabilitation at Shirley Ryan AbilityLab and training with the bionic arm. The study is expected to conclude in 2030, at which point results will be made publicly available. This research is supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number UH3NS127063. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the U.S. Department of Health and Human Services.

Renowned POTS expert authors review article in JAMA. August 31, 2026 Tae Hwan Chung, MD, physician-scientist at Shirley Ryan AbilityLab, recently authored a review article in JAMA about postural orthostatic tachycardia syndrome (POTS). Dr. Chung is one of the world's foremost experts on POTS, a chronic autonomic disorder in which patients may experience a rapid heart rate increase (tachycardia) and symptoms such as dizziness, chronic fatigue and brain fog. Dr. Chung joined Shirley Ryan AbilityLab in 2026 to launch a comprehensive, multidisciplinary POTS and autonomic disorders program. POTS affects as many as 1 to 3 million individuals in the United States, and Dr. Chung hopes to establish the rehabilitation hospital as a global leader in POTS and autonomic medicine to better serve this patient population. For the JAMA review, Dr. Chung examined existing medical literature about POTS and provided comprehensive observations about the symptoms, diagnosis and management of the condition. "POTS can substantially impair daily functioning and quality of life for patients, yet obtaining an accurate diagnosis and specialized care remains challenging," said Dr. Chung. "This review aims to provide physicians who may be less familiar with POTS a practical guide to recognizing the condition, making the diagnosis and helping patients manage their symptoms." Key takeaways. * POTS is characterized by chronic symptoms of "orthostatic intolerance," meaning patients may develop symptoms when they move into an upright position, like standing up. * Patients with POTS may experience an increased heart rate, heart palpitations, fatigue, lightheadedness, gastrointestinal issues, generalized weakness and muscle pain - without having other cardiovascular, GI or neurological conditions. * Approximately 90% of patients with POTS are female, with peak incidence from ages 13 to 29. However, POTS' true prevalence is uncertain because the condition is often underdiagnosed and has only recently received a specific ICD-10 diagnostic code. * In a survey reviewed by Dr. Chung for the JAMA article, approximately 70% of patients with POTS reported experiencing substantial functional impairment and loss of school or work participation. The survey also found that it typically took patients about two years to receive a POTS diagnosis. * In 30-40% of POTS cases, symptoms began within three months after infections (e.g., COVID-19, Epstein-Barr virus and influenza). * Recommended first-line treatment for POTS is nonpharmacological measures, such as increased fluid and sodium intake; wearing lower-body compression garments; and participating in structured, supervised aerobic training, such as via rehabilitation therapy. Patients also should avoid heat exposure, dehydration and prolonged standing to mitigate their symptoms. They may further benefit from medication tailored to their needs. Visit JAMA to read the POTS review abstract; a subscription is required for the full article.