#reinnervation

[madocactus]

Cautionne Design Notes!

Part 1: Arm.

I’m making a series of design notes on Cautionne! Specifically, it’s about stuff I couldn’t show in malViolence for spoiler/reveal reasons. They’ll also help me as a future reference. 

For those who can’t read my handwriting, I’ve included a transcription below the cut.

Image 1

[To the left of the limb’s front view. Text below is from top to bottom.]

Soft limb battery light.

Wheel joint.

Rubber/silicone covering for grip/more “natural” hand look.

[To the right of the limb’s front view.]

Sleeker upper arm made of leftover STOP cybernetic parts.

[To the right of the limb’s back view. Text below is from top to bottom.]

Peg for ‘plugging in’ limb.

Silicone palm for squish.

Fingertip sensors.

Image 2

[Top left image set]

How it works.

“Hey lab rat!”

[To the right of the top-left image set]

In an advanced form of targeted muscle reinnervation surgery, Dr. Danger reassigned nerves that once controlled Cautionne’s hand/arm muscles to his residual limb (which is at shoulder level).

This helped Cautionne improve his control of his arm without relying too much on his brain chip implant. 

It also removed his neuromas - which made him have less day-to-day pain.

[Above the Dr. Danger image]

“Allow me to demonstrate.”

[Below the Dr. Danger image]

Dr. Danger also created a more effective shoulder socket for Cautionne’s prosthetics.

[Above bottom left image set]

Cautionne’s homemade arm is basically a technologically more advanced version of a myoelectric prosthetic.

However, like real myoelectric prosthetics - there are downsides...

[Bottom left image set - To the right of Image 1]

The battery and motor can run out. Cautionne’s limb (arm) has an 8-9 hour battery life.

[To the right of Image 2]

His prosthetic arm’s heavier than his flesh arm, so it takes more energy to use...

[To the right of Image 3]

Cleaning it every day is a process in of itself...

So...

[To the right of Image 4]

...sometimes Cautionne doesn’t use his arm.

“One’s just dandy.”

[sasuhinasno1fan]

Secret wedding

@etherealxgenie guess who's your secret santa again this year? So, I struggled a little coming up with an idea for wedding , and then this came out. This is an au where the miraculous don't exist, so apologies for the long explanation of the before. I hope you like it and happy new year!

Soft music played through her speakers, allowing her to focus. Hand sewing a design might be incredibly time consuming but she was fine with this. the crescent moons along the lapels of the suit would match perfectly with the suns on the matching jacket. She still wished it could be white, but she was thankful that the lapel design was even agreed to.

“Marinette?” her mother called, knocking on the door before it was pushed open slightly and her head poked in. “You have a visitor.”

“Is it Nathalie?” she asked, feeling tense. Her mother usually waited for her to invite her in, so her coming in without waiting felt nerve wracking.

“No, no. um,” her mother hesitated.

“Dupain Cheng, let me in. we have a problem!”

“Chloe?”

Not seeing much reason to stall, her mother opened the door and the blonde walked into her room, looking perfect as always. Her oversized sunglasses were blocking her eyes and she looked untouchable as always, even with this supposed problem.

“What are you doing here?”

She and Chloe weren’t friends. Well, sort of. They didn’t go out of their way to hang out, not unless their buffer of Adrien was also present. Life in middle school made it very hard to be around each other, but after learning a bit about Chloe, Marinette found it hard to hate her as much. She had her moments where she pushed her, that was for sure, but she learned to see past the immediate reaction of snark. She’d gotten better at seeing when she meant it versus when she was hiding behind it.

“Have you spoke with Adrien recently?”

“Um, sort of? We had a fitting a few days ago.”

“And he wore that?” it was hard to tell with her glasses, but Marinette assumed she was looking at the suit jacket she’d been working on. The black fabric with silver moons lining the edge was opposite of the white jacket and original blue moons she originally had Adrien request.

“His dad suggested it. Adrien agreed.”

“I’m sure he also agreed to the 50-course dinner at the reception.”

“50?” she noticed her mother hadn’t left and she looked as stunned as she felt. “The reception I had with your father only had 10 courses, and that’s because we had a hard time picking foods both he and I agreed on and matched each other so they had separate rounds.

“I’m so guessing Luka is fine with the 2000 guests who’ll be attending this wedding at the Notre Dame Church.”

“2000? Wait, Notre Dame? Isn’t it still technically closed for reinnervations? They’re still attempting to replace the stained glass.”

“Thus is the problem. The Lukadrien wedding isn’t about Lukadrien anymore.”

Marinette would credit herself with getting Adrien and Luka together. It wasn’t her plan, far from it. She had a crush on Adrien since he gave her his umbrella during his first few days. She’d only seen Chloe’s best friend, not the kind person he was until that moment. She could admit now she went way too far in how she felt, her crush an obsession at first. She felt entitled to his love because he went out of his way to be nice to her. God, it still made her cringe remembering how she acted whenever anyone gained a crush on him themselves. She had a full schedule to know where to find him! She didn’t realise in her attempts to get him to like her, even with her awkward ways and inability to speak a full sentence to him, she was just setting him up for someone else.

Juleka she’d known forever, since her first day of school, but she’d never known she had a sibling until they became better friends in their second year. She got to meet said sibling when invited for the debut of Kitty Section during the city-wide music festival. She’d been upset that Adrien had to cancel last minute and was instructed by Captain Anarka to go get Luka. She’d been impressed with his calm demeanour, how confident he was with how he teased her and back off when he felt like he went too far, his ability to calm her with such a simple song. She was sure if she wasn’t obsessed with Adrien, she would have given Luka a fair chance. After a large fight between the Captain and Agent Roger, Adrien had appeared, saying his dad changed his mind. She’d been so eager to see him she hadn’t thought to give him a warning of the piano right where he was walking. She watched him gush over it and Luka easily invite him to join their band. After their performance, Luka asked Adrien if he’d consider joining officially, even as a temporary member, to which he agreed. She should have noticed when she’d find Adrien texting Luka. But she believed Alya when she talked about how Luka must like her and how it would be a matter of time before Adrien figured out how he felt.

God, how was Kagami still friends with her? Her crush on Adrien made her do some insane things.

She and Alya had been blinded by the idea that their friend group would all be together, but others had started to see. Kagami tried to warn her, but she’d been too focused on trying to beat her. Kagami didn’t shy away from making it known she liked Adrien and she was more than happy to be his practise date. She managed to get herself invited and dragged Luka along with her. It was supposed to be ice skating, a ploy to get Adrien jealous.

God, Luka was so sweet, knowing exactly what was going on and still willing to be used. To this day it felt like she couldn’t apologise enough for what she’d do. She’d stare right at him and call him Adrien. How was he still friends with her, even now? Kagami picked it out very quickly that day, telling her her attempts at getting closer to Adrien was actually pushing him closer to Luka. The two had spent an hour of the practise date skating with each other, Adrien laughing and squealing as Luka lifted him easily. She said that if she wasn’t careful, Marinette would be pushing him straight to Luka. She thought it was some tactic to throw her off.

Things all came to a head when they participated in the Bob Roth video contest. Since Adrien wasn’t involved in public performances that wasn’t on the Liberty, the band wanted him in the video, which helped birth the idea of the masks and complimenting shoulder pads and braces to hide their identity. When they found out the contest was just a way for XY to get new material to copy, they’d all stormed over to the TVi studios. Adrien got him, Luka and herself inside and when Bob Roth threatened to have them framed as copycats and go after their families, it had been Adrien who stopped Luka from getting into a fight with him.

“Luka, don’t! If he wants to act like he can outsmart us, fine. We’ll just have to see which of us is more popular. Paris’ angel or a hack of a DJ.”

He’d gotten them back to the Liberty and gone live on his Instagram, revealing he was in the band before telling the whole of Paris what happened, how they signed up for Bob Roth’s contest, the video Marinette had filmed and edited, making sure to show the time stamp for then the file was created, how XY stole it. He even talked about how, yes, he could be lying, but asked them why he’d go through the effort of showing evidence instead of just asking for those to take his word on it. Turned out Adrien had more followers. Kitty Section got their song back and a contract to boot though Adrien got into trouble with his dad for being in the band. He had to officially withdraw from them but Luka told him he was more than welcome to join their jam sessions anytime.

“Kitty Section won’t be the same without you.” Luka had said. “Even if we won the fight, losing you doesn’t seem worth what we got.”

If anything, that had to be the moment, the one that filled Adrien’s heart. Because on Adrien’s fifth name day, the day Marinette felt confident enough to give him her gift and tell him how she felt, Luka had been waiting for him at school. Adrien had talked about how he always wanted flower as a gift, like someone going out of their way to buy him flowers and give them to him just because, not because of who he was. With a massive bouquet that she found out from Juleka that he made himself, he told Adrien he liked him, a lot and if Adrien was up for it, he wanted to take him out on a date. Adrien agreed, happily. Her heart broken then, since she didn’t quite realise just how right for each other they were at the time. Her friends, minus Juleka and Alix, were surprised and Alya was mad. She refused to go to school, refused to answer his concerned calls or texts and just followed what he did during then on social media.

Adrien gave up a lot to do the things he wanted. He got to attend school but with the pressure of placing first always, being the best in fencing and doing what his father wanted no matter what, it kept him from having normal things he wanted. She hadn’t known it at the time, since he kept it a secret for so long, but in order for his father to not dismantle Kitty Section himself, Adrien offered to leave himself, giving the excuse of a busy schedule to any people who came to Kitty Section for him. Adrien’s schedule got busier when news about dating Luka got out, but that wasn’t the only thing. She later learn he accepted more jobs and orders to keep Luka, to not break up with him. His father wasn’t allowed to touch Luka, not change him to fit the brand and in return, Adrien looked near exhausted with all his jobs he’d been doing. Marinette finally talked to him after finding out he threatened Lila after she got her expelled with the stolen necklace trick, finally explaining why she’d been so quiet.

“I’m sorry Marinette. If I’d known…I wish I could say I’d feel different but I think I always had a crush on Luka, ever since I met him. I am sorry that I made you suffer though.”

And how was she supposed to be mad at him? She hadn’t talked to him for weeks and he still went out of his way to protect her because to him, she was his friend and that’s all that mattered. She’d looked at those dark circles, how he was laser focused on his phone anytime Luka would text and she knew what she had to do. Chloe had actually been the one to help her expose Lila, to embarrass Gabriel a little so he had to ease up on Adrien to save face. She eventually got over her crush, apologised more times than she could count and gave out her parents’ pastries like band-aids. She was there to see their relationship grow from casual boyfriends to something strong enough to withstand so much. Adrien’s dad in general, the knowledge of Luka’s dad, the public’s opinion, Bob Roth being Kitty Section’s manager, Adrien’s career and his fight to get Felix to be friends with him again and Luka’s anxiety with school coming to a head when offered a place in his dream university, but for in person only. Through it all, they supported each other, any fights were resolved with honest and real apologies and never wavered from each other.

So, when Luka came to her to ask for help with a proposal, she jumped at the chance. Somehow, they managed to hide it from the whole of France and the two had their private proposal inside one of the Le Hotel Paris event rooms, the one Chloe said Adrien would daydream about being proposed in as a child. It was when the announcement was made and planning started, that things took a turn.

With school and the influx of jobs Adrien had been shouldered with and Kitty Section about to go on their first tour around France – since the international tour was agreed upon for that summer between semesters – Gabriel and Nathalie took on most of the planning. Both grooms wanted small. Adrien even wanted it at his house, so the statue of his mother could represent his mother being there, even though he hadn’t been back to the mansion since he moved out to a shared place with Nino, Luka and Nathaniel. Adrien wanted to wear white, another nod to his mother who loved dressing him in white formal wear and also sneakers. Luka agreed that most formal shoes hurt after an hour. Luka didn’t want a big cake, as he didn’t really like it, or a strings quartet for the band. He wanted a local band the two liked and for their first dance to be the last thing they did before leaving as a moment between them to calm everything down. Marinette had been commissioned to make their suits and was working on the little details – crescent moons and suns on suit jackets – when Nathalie interrupted.

“Adrien would look much sleeker in black and they should match. So, you’ll need to change your design.”

Adrien had look flustered but he told Marinette to switch it, apologising. She had brushed it off as being busy but she should have known it was more. He gave up a lot of freedom to have what he wanted before, why would it change now? Everyone knew Gabriel didn’t like Luka, it wouldn’t be a stretch for Adrien to hand over control just to still be able to marry Luka in the first place.

“How bad is it?” she asked Chloe.

“Rocker boy called to say Adrien is hiding inside their closet after a meeting with his dad about the order of the ceremony. I don’t know what was said, but this is getting insane. The original list was 120, and that was with others plus ones. If we don’t do something, the wedding might be off and I have not given up on Adrien and trusted him with that rocker for that to happen. So, let’s go.” She turned heading to the door when the designer called after her.

“Go where?”

“To plan a secret wedding for them to elope. Can’t stop them after that.” She stated. “Hurry up!”

Marinette had no other choice but to pin the needle in the lapel, dumping her sewing equipment on the desk and grabbing her bag before she ran off after the blonde. If anything, she needed to make sure Chloe knew what secret event meant. She had a habit of going overboard with planning.

________________

“Hey kitty.” Luka said, softly knocking on the door of the amoire – Adrien begged for them to have it when Felix offered it, but Luka still thought it looked stupidly ostentatious next to their other items – hoping to get an answer. Calling Chloe had been a last-ditch attempt. Nino had no luck and a meeting to run off for, being a well-established DJ. He already knew he had zero luck and he’d hoped Chloe could do something. All she said was, “Oh fuck this. enough is enough.”

He was a little scared about what that meant. He still had a fiancée in the closet who refused to move after explaining the decisions his father made about their wedding. He didn’t argue about Gabriel being involved orginally, hoping he’d actually listen to what his son wanted, but seeing how he’d done this since Adrien was in collége, choosing what he wanted the brand to look like rather than his own son wanted, was clear things weren’t going to change and Adrien was bearing the brunt of it. He wish he argued against it more. He wanted to keep him safe from his dad and he was failing at that.

“Kitty, can I please come in?”

The door swung out, revealing Adrien sitting surrounded by their longer clothes. He shuffled to the side and Luka climbed in next to him, shoving the clothes over as much as he could. He stayed quiet as Adrien pulled the door closed, leaving them in the dark. He understood why Adrien was hiding here, it felt nice. When he went searching for Adrien’s hand, it gripped his tight as Adrien dropped his head onto his shoulder.

“I should have never accepted my father’s help. I should have seen the increase of schedule for what it was, his way of breaking me down so I had no choice. I mean, the Notre Dame?”

“It’s a beautiful church.” He said, knowing the silence meant Adrien was glaring at him. “I’m not happy about it either but Adrien? All I was is to get to say I do and call you, my husband. Do I wish we could do it our way? Yes, but I just want the day to end with us together.”

It was clumsy, but Adrien was able to pull him down to kiss him. He pressed an extra kiss against his forehead, holding tight to his hand.

“I just wanted this to be perfect for us. I was going to step away from the Agreste brand after the wedding but its like nothing I do will get us away from him.”

Luka couldn’t disagree. Everything down to Adrien’s major in university was chosen by his father. Adrien wanted to be a teacher, either a music or physics, even fencing, but Adrien was majoring in business. It felt unfair he was able to work on his anxity to get his degree in music while attending school was all Adrien wanted but he wasn’t allowed to persue what he wanted. Fighting and arguing with Gabriel Agreste was a tempting thing but he knew as easily as he defended Adrien, his father would easily snatch Adrien away. He meant it about not caring how he married Adrien, just as long as he got to call him his husband at the end, but with how much Adrien has lost or given up in his life, he wanted Adrien to have the wedding of his dreams, not something that reflected the Agreste brand.

“I just kept saying yes. Why did I keep saying yes?” Adrien moaned, mad at himself.

“I said yes too. I knew you didn’t want it but I still agreed.” Luka reminded.

“Because I told you it would be easier to tell them what we want and for them to deal with everything. You’re just as busy too. Now this dream is becoming a nightmare and I don’t know how to wake up.”

As much as he could in the space, he hugged Adrien, pressing kisses into his hair. His phone rang, finally giving light to the closet.

“If it’s Nathalie or my father.” Adrien started.

“It’s Chloe. I’ll put it on speaker.”

“Luka?”

“Marinette?” had Chloe gone to Marinette? “You’re with Chloe?”

“More like she burst into my room but yes.”

“Oh, who cares Dupain Cheng? Couffaine, where’s Adrikins?”

“I’m right here Chloe.”

“Good. Less relaying of messages. Have you gotten your marriage lisence?”

In the dim light, the couple were able to share confused looks.

“Yeah? Everything’s been turned in. Nathalie took care of it weeks ago. I even checked.” Luka said.

“Perfect. Adrien, come over to my hotel room tonight and Couffaine, go see Dupain Cheng an hour after.”

“Why? Chloe, what are you planning?”

“You’ll see.”

“Are you sure this is gonna work?” Marinette asked. “Don’t they have to do this in city hall?

Chloe didn’t say much before she hung up, leaving the two to share confused looks.

_________________

“Techincally it just has to be officiated by an elected official, such as Daddy.” Chloe said, watching the garden be set up. “I already had him check, technically this isn’t against the law. Besides don’t you want them to be happy?”

“Of course, I’m just worried. We’re going against Gabriel Agreste. Aren’t you worried?”

“Please, my mother loves Adrien, she’ll ruin his father to make him happy.”

Marinette still worried but decided to trust her. Adrien was Chloe’s best friend and she was risking Gabriel’s anger to do this. She already managed to book a private garden and get a team to set up a flower arch and a long farm table for the guests. If she managed to come up with this and leagelly execute it, she was going to have to trust her.

“Mari, they’re here!” Alya called from where she had Nino’s phone.

“Perfect. You’ve got it here?”

“Go Dupain Cheng.” Chloe ordered.

Felix met Adrien and Luka until she got there, looking unmoved by his cousin’s multiple questions, instead admiring Luka’s motorcycle.

“Finally. Marinette, he’s not telling us anything. What’s going on?”

“You’ll see. Adrien, go with Felix. Luka, with me.”

More begging for answers happened but eventually, they followed orders. Leading Luka to the trailer Jagged got – because he was all for annoying his father-in-law and making his son happy even if he couldn’t be at the wedding to keep the chances of being found out low – Luka was silent until they got there.

“Is this something that’ll make Adrien happy?” He asked.

“Has he guessed what it is?”

“With what Chloe asked, he has hopes but isn’t sure.”

Smiling, Marinette nodded. “Yes, it’ll make him happy.”

Luka stared at her, no doubt looking for a lie in her song. He eventually nodded. “Alright then.”

“When you’re done changing, follow the path where you’ll meet up with Adrien. From there, just trust us.”

___________________________

Adrien stilled in the doorway, staring at the suit on the hanger. His mom liked dressing him in white formal wear, saying he brought light to dim events. She was still around when he realised, he was bi and she took the news easily.

“Do you think one of us would have to be in white?” He asked, when talking about his dream wedding, this time to a guy.

“Why can’t you both be in white? Sweetie, remember, white doesn’t make the bride. Queen Elizabeth started that trend. I could care less what you wear, as long as the person you marry is someone who makes your heart sing and be full of love.”

When he found Luka and when he proposed to him, he knew then he would be in white, so his mom would know that man made his heart so full. The added blue moons were to represent Luka, blue being his favourite colour and the moon representing the times Adrien snuck out of his house at night so they could hang out. Luka’s suit would have suns on the cuffs since he called Adrien sunshine for so long. But then his dad wanted him to be fitting of the Agreste brand. They would be in sleek black with no colour. He just bearly got his father to agree to the silver moons, Luka’s suns having to disappear completely. He’d only gotten to try on the original jacket once but there the full suit was. Blue crestent moons clustered on the lapels on the top and the lining of somehow subtle black cats against the grey background. It was his suit, the suit he was going to get married in.

“Felix? Did Chloe plan a wedding for me? With Marinette’s help?”

“The most surprising thing is that they didn’t kill each other through this.” was all Felix said before ordering him to get changed and leaving him.

Adrien pulled on the suit carefully, taking his time to put on every piece and notice the details, like the stitched peacock, with his mother’s initials on the side that sat over his heart. Luka’s initials was on the cuffs, like he assumes Luka’s suns were, on the arm closest to his heart. Like all of her creations, like Marinette was able to hide her name, she was able to disguse the initials so they didn’t look heavy, but he knew they were there. A pair of neon green sneakers sat on the table, the letters AC painted onto the heel of them, the date painted on the side. He took in the whole look in the mirror, smiling at what looked back at him. This was everything he wanted to see on his wedding day.

Remembering Felix’s instructions, he left the trailer and walked up the path. Waiting in the middle was Luka. Adrien couldn’t help but smile at the navy suit, seeing the specks of yellow on the cuffs. His own sneakers were the same colour as the lettering on his, his own lettering matching Adrien’s sneaker colour. His fingers looked oddly empty without his normal rings but by the end of this, they’d have matching rings.

“Hi.” He called, smiling at Luka, who smiled back at him and easily took him in his arms.

“Hello. You look amazing.” He said, fingering the blue crescent moons. “figured out what’s going on?”

“If I knew you weren’t that amazing of a liar, I’d think you had something to do with this.” Adrien said, already spotting the initials of Juleka and their mother on his sleeve, just above the suns. “Who do you have on your heart?” Adrien asked, wondering if Marinette sewed it like his.

“Yours.”

“I have my mom’s. I hope that’s ok.”

“Trust me, she’s the only one I’d willing give my place too. I think she would have been in on this, if she were here. I already feel close to crying seeing you, so who knows how she’d cope.”

Adrien laughed, dropping his head on Luka’s shoulder. “Not well.” the two stayed silent, taking in the feeling of what they were about to do. “We’re doing this right?”

“Adrien, I meant what I said. I just want to be married to you. but I also want you to have the wedding you want.” Luka reiterated, hugging him close.

“It’s starting to look pretty good so far.”

“Alright boys!” Alix, in a fitted suit and her hair pushed back, appeared behind them, gesturing to the rickshaw covered in flowers. “Your chariot awaits!”

The sight and knowledge of what was going to happen, caused them to burst into giddy giggles, before they climbed in. It got even funnier when Alix started tossing rose petals behind her as she pedalled them down the pathway.

“Alix! We’re getting covered here!”

“Go with it cinnamon roll.”

Luka dusted off as many petals as he could, tilting Adrien’s face up to press a kiss against his lips. “I love you.”

“I love you too. Ready to do this?”

“I’ve been ready since I knew I loved you.” Luka said, pressing their foreheads together, right before they both got a face full of petals.

“Whoops, sorry!”

Finally, petals stopped being flung as Alix slowed to a stop and the two got to see what Chloe had been working on. On one side was the decorated farm table, two almost throne like chairs sitting next to each other on one side, their friends all sitting in their seats at the table. On the opposite side, was a stage covered by a tent covered in flowers and ribbon, with the band the two wanted waiting by their instruments. Their alter was a flower arch, covered in peonies, Luka’s favourite flower, in every colour imaginable. M. Bourgeois Chloe standing underneath, Marinette and Juleka all waited for them at the top of their aisle as they got off and Alix ran to join the others in her seat.

“This is for you.” Juleka handed one bouquet of roses to Adrien, “and this is for you.” she said, handing the bouquet of peonies to her brother.

“Are we going together?” Adrien asked for clarification.

“Seems silly to make you go separately now. You two had to fight to be together, might as well stand with each other for the biggest moment of your lives.” Marinette said, making sure their suits were straight and everything was ready. “Did you notice your shoes?”

“What about them?” Luka asked, looking back at the ‘LC’ painted on his. Then he noticed Adrien’s. he looked at Marinette, who just smiled at him. A glance at Adrien with a sheepishly shy smile confirmed it. Adrien wanted his last name instead of Agreste. Without Gabriel breathing down their necks, Luka would happily give it all if Chloe’s dad could get the paperwork in quickly enough.

“Chloe?” he said, watching her arch a brow, “Thank you.”

“You’d better keep that promise even more now. I didn’t give him up for you to make him sad, do you understand me?”

“I won’t.” Luka said, letting Adrien lace their fingers together. “I promise.”

With the band playing ‘Endlessly’ by Amaranthine, their closest friends and chosen family watched them walk down their aisle, still holding hands when they arrived to Chloe’s father.

“Dearly beloved, we’re gathered here today for the union between Luka Couffaine and Adrien Agreste. We are witnesses to their love and to see the commitment and promise they’ll make to each other. Now, because I was told the actual ceremony I do takes too long,” the crowd laughed as Chloe shrugged, “And the planned wedding was also going to take too long, we’ll skip to the vows. Who would like to go first?”

“I will.” The two turned to each other, and Adrien took a deep breath. His father wanted him to write his vows ahead of time so they could be edited and he’d been putting it off for so long because of it. but looking up at Luka, he knew exactly what he wanted to say. “Luka, when we first met you, I had no clue how important you were going to become. You didn’t know me, past what all of Paris knew and your sister telling you I was pretty nice, but you welcomed me so easily, it felt like you weren’t real. You are an incredible listen and I always felt at ease with you. getting to know you everyday we texted or got to hang out made me wonder how a relationship would work. I didn’t know yet how I felt, though Kagami tried really hard to get me to see it. but I wouldn’t change what happened after. You always put others ahead of yourself and you were ready to fight Bob Roth for us and I wanted to be your shield for once. Having to officially leave Kitty Section sucked but what you said that day suddenly made it so clear to me. I wanted to scream it from the rooftops but I also wanted to keep it to myself. You knew the life I had, the things I had to give up, the troubles and you still decided you wanted me. I knew I was going to fight for you, but that made me fight harder. I’ll still fight for you, even if it meant dealing with wedding details, I didn’t want just so I’d still end up at an alter and marrying you. I love you Luka Couffaine and I am so glad you choose me.”

“I would choose you 1000 times over. I didn’t know the bright sunshine I’d get in my life when I met you. you were like a curious kitten, not knowing the world but wanting to know everything. It took a while to realise you knew how to use your claws. Skating with you that day, watching you have fun and smiling, I knew any other crushes I had weren’t going to compare to what I had for you. watching you rip into XY and Roth made it even more clear. Seeing you sad that you had to leave Kitty Section, I knew I wanted to do whatever possible to make you smile. it didn’t matter what your dad threw at me, I wasn’t going to give up after you said yes. You always give up things you want to get something in return and I’m making it my mission that you won’t ever have to do that again. Even if you answer with ‘I’m fine’. I’ll protect you with all I can.”

Adrien couldn’t help but kiss Luka, biting down a smile when the Mayor coughed to interrupt them.

“Can I have the rings please?”

The two shared panicked looks, as Nathalie was the one who held their wedding rings they choose, one of the few things they could pick. Nino, however, ran up and handed the Mayor a small string bag. Overturning it into his palm, the Mayor held out their rings.

“Let’s just say, Felix is really good at not getting caught.” Nino explained as he headed back to his seat.

Adrien shot a look to his cousin who just raised an eyebrow. Normally he’d scold him, but he wouldn’t this time.

“Luka, repeat after me.”

“With this ring, I thee wed, to have and to hold, through sickness and health, till death do us part, for all my days.”

“Adrien?”

“With this ring, I thee wed, to have and to hold, through sickness and health, till death do us part, for all my days.”

“By the power invested in me, by me and the city of Paris, I now pronounce you wed. you may kiss your partner.”

Everyone cheered, but Luka and Adrien were deaf to it as they lost themselves in the kiss that sealed them together for life. They pulled away, pressing their foreheads together, smiling at each other.

“We did it.”

“Good wedding?” Luka asked.

“I got you so I think we’re doing good so far.”

“And it’s only just the start.” Luka promised.

__________________

Gabreil found out about his son’s engagement from social media, two days after the fact. Pictures of the actual proposal and a selfie of Adrien showing off his ring. Seemed only fitting he found about the marriage the same way. He’d tasked Nathalie with making sure no information about the wedding he planned was leaked, to make sure it was perfect. When she came running in and shoved her iPad in his face, he thought she lost her senses. A video of Adrien and his fiancée walking down the aisle, bouquets in their hands. A photo of them at an alter of a flower arch, Andre Bourgeois standing as officiant. Their first kiss as husbands. at a table cutting into a simple round cake, decorated to look like the setting sun. multiple candid shots and videos of them and their guests – all of their friends and no parents or adults around – dancing with that band he’d forbidden playing. A short clip of the married couple slow dancing to a Disney song as the others held sprinklers to surround them in sparkling light.

And to round the post off, a selfie of Adrien and Luka, holding up the wedding rings that had gone missing when Felix was last at the mansion.

Finally married to the love of my life. Can’t wait to spend the rest of my life as a Couffaine.

[witchhazelevesque]

reinnervation

Reinnervation: the restoration, through grating or regrowth, of what has been lost. With everything behind Leo now unsteady, the only way left is forward. Words: 7770

The cure is not a miracle. 

It is disparate parts roughly hewn together and left with ragged seams, and it hurts. 

It reaches through the planes of life and death and takes hold of something bound for Erebus, something Erebus has laid rightful claim to. If the cure is sharp edged, the path backward is a jagged toothed maw rivaling that of Charybdis. Through this path the cure brings back the burnt soul of a boy into the burnt husk of a body and leaves him there. 

The boy remembers this theft and the wounds he gathered. The scars they leave will ensure he always remembers. 

companion to scotoma

read on ao3

[healthcaremarketanalysis]

Understanding the Different Types of Nerve Repair: A Comprehensive Guide

Nerve injuries can have a significant impact on a person’s mobility, sensation, and overall quality of life. Fortunately, modern medicine has developed several techniques for nerve repair, helping patients regain function and recover from these debilitating injuries. In this blog, we will explore the various types of nerve repair and their importance in restoring damaged nerves.

1. Direct Nerve Repair (Neurorrhaphy)

Direct nerve repair, also known as neurorrhaphy, is one of the most common types of nerve repair. It is used when there is a clean break or a gap between nerve ends that can be easily approximated. This technique involves suturing the two ends of the injured nerve together to restore continuity. The goal is to allow the nerve fibers (axons) to regenerate across the suture line.

Download PDF Brochure

When is it used?

Small, clean nerve injuries.

Situations where tension-free closure of the nerve is possible.

2. Nerve Grafting

In cases where a direct repair is not possible due to a large gap between the nerve ends, nerve grafting is employed. This procedure involves harvesting a healthy nerve from another part of the body (often from the leg) and using it to bridge the gap between the damaged nerve ends.

When is it used?

Large nerve gaps.

Nerve injuries where direct repair would place too much tension on the nerve ends.

Challenges:

The area where the donor nerve is harvested may experience some sensory loss.

Nerve regeneration through the graft can be slow.

3. Nerve Transfer (Neurotization)

Nerve transfer, or neurotization, is a technique used when the damaged nerve cannot be directly repaired or grafted. In this procedure, a healthy, functioning nerve that is close to the injury site is rerouted to restore function to the damaged area. The healthy nerve takes over the role of the injured nerve, allowing for the reinnervation of muscles or skin.

When is it used?

Complex nerve injuries where direct repair or grafting may not be feasible.

Situations where motor function restoration is urgent, such as in brachial plexus injuries.

4. End-to-Side Nerve Repair

In end-to-side nerve repair, the injured nerve is sutured to the side of a nearby healthy nerve. This allows nerve fibers from the healthy nerve to grow into the damaged nerve, promoting recovery.

Request Sample Pages

When is it used?

Cases where a nerve is not completely severed but has lost function.

Situations where traditional repair techniques are not possible.

5. Nerve Conduits and Tubes

Another advanced method for nerve repair is the use of nerve conduits or tubes. These conduits, made from biological or synthetic materials, are used to guide nerve regeneration. The damaged nerve ends are placed within the conduit, which serves as a bridge, promoting natural nerve regrowth while protecting the injury site.

When is it used?

Small to moderate gaps in the nerve.

Situations where direct repair or grafting may not be ideal.

The Future of Nerve Repair: Emerging Techniques

Researchers are constantly exploring new and improved methods for nerve repair. Some of the most exciting advancements include the use of stem cells and bioengineered scaffolds to promote faster and more effective nerve regeneration. These techniques hold great promise for patients with severe nerve injuries that were once considered untreatable.

Conclusion

Nerve repair is a critical aspect of recovery for individuals who have sustained nerve injuries. With various techniques such as direct repair, nerve grafting, and nerve transfers, medical professionals can restore function and improve the quality of life for patients. As research and technology advance, the future of nerve repair looks even more promising, providing hope for better outcomes and faster recoveries.

Content Source:

[vulcanprosthetic]

The Evolution and Impact of Prosthetic Arms: Empowering Individuals with Limb Differences

Prosthetic arms have played a transformative role in the lives of individuals with upper limb amputations or limb differences, offering them the opportunity to regain independence, functionality, and confidence. From traditional hook prostheses to advanced myoelectric arms, the evolution of prosthetic technology has paved the way for more natural-looking and highly functional prosthetic solutions. In this article, we explore the history, advancements, and impact of prosthetic arms on individuals with limb differences, highlighting the profound benefits these devices provide.

Historical Evolution of Prosthetic Arms

The history of prosthetic arms dates back centuries, with early prosthetic devices crafted from materials such as wood, leather, and metal. In the 16th century, Ambroise Paré, a French surgeon, pioneered the use of mechanical prosthetic hands with articulated fingers, laying the foundation for the development of more sophisticated prosthetic limbs in the centuries that followed. The advent of World War I and II further catalyzed advancements in prosthetic technology, leading to the creation of more functional and lifelike prosthetic arms for amputees.

Types of Prosthetic Arms

Prosthetic arms come in various types, each designed to meet the unique needs and preferences of individuals with upper limb amputations. Common types of prosthetic arms include:

Body-Powered Prostheses: Body-powered prosthetic arms are controlled through cables and harness systems that rely on the movement of the opposite shoulder or body to operate the prosthetic hand or hook.

Myoelectric Prostheses: Myoelectric prosthetic arms use electromyographic signals generated by the user's remaining muscles to control the movements of the prosthetic hand or arm, offering more intuitive and natural control.

Hybrid Prostheses: Hybrid prosthetic arms combine elements of both body-powered and myoelectric systems, providing users with a balance of control, functionality, and ease of use.

Cosmetic Prostheses: Cosmetic prosthetic arms are designed to closely resemble the natural appearance of a human arm, enhancing the wearer's aesthetics and self-image.

Advancements in Prosthetic Arm Technology

Recent advancements in prosthetic arm technology have revolutionized the field of prosthetics, offering individuals with limb differences unprecedented levels of functionality and customization. Key advancements include:

Advanced Materials: The use of lightweight and durable materials such as carbon fiber and silicone has made prosthetic arms more comfortable, functional, and aesthetically appealing.

Microprocessor-Controlled Systems: Microprocessor-controlled prosthetic arms feature advanced sensors and algorithms that enable precise control of hand movements and grip patterns, enhancing functionality and adaptability in various tasks.

Targeted Muscle Reinnervation (TMR): TMR is a surgical technique that reroutes nerves from the residual limb to specific muscles, allowing users to intuitively control their prosthetic arm through natural muscle contractions.

3D Printing: 3D printing technology has revolutionized the customization and fabrication of prosthetic arms, enabling rapid prototyping, cost-effective production, and personalized design options for users.

Impact of Prosthetic Arms on Individuals

Prosthetic arms have a profound impact on the lives of individuals with limb differences, empowering them to perform daily activities, pursue their passions, and engage more fully in social and professional settings. Benefits of prosthetic arms include:

Improved Functionality: Prosthetic arms enable users to perform a wide range of tasks, such as grasping objects, writing, cooking, and engaging in recreational activities, enhancing their independence and quality of life.

Enhanced Self-Confidence: Prosthetic arms can boost self-esteem and confidence by restoring a sense of wholeness and normalcy, allowing users to interact with others more comfortably and participate in social activities with greater ease.

Increased Mobility: Prosthetic arms enhance mobility and dexterity, enabling users to navigate their environment more effectively and participate in physical activities that contribute to their overall well-being.

Psychological Well-Being: Prosthetic arms can have a positive impact on mental health by reducing feelings of self-consciousness, anxiety, and depression commonly associated with limb loss, promoting a sense of empowerment and resilience.

Conclusion

Prosthetic arms represent a remarkable fusion of art, science, and engineering, offering individuals with limb differences a pathway to independence, functionality, and self-expression. The evolution of prosthetic technology has ushered in a new era of personalized and sophisticated prosthetic solutions that empower users to embrace life with confidence and resilience. By providing individuals with the tools to overcome physical challenges and redefine their capabilities, prosthetic arms serve as symbols of innovation, inclusivity, and human potential, highlighting the transformative power of technology in enhancing the lives of individuals with limb differences.

[bloomburnburial]

the concept of graft reinnervation as part of top surgery is fascinating (link leads to article with graphic pictures; fair warning). I can’t wait to see these techniques become more widely available

[support1212]

Laryngologia,

Laryngologia,

Laryngologia, derived from the Greek words "larynx" meaning voice box and "logos" meaning study, is a medical specialty focused on the diagnosis and treatment of disorders related to the larynx, also known as the voice box. This intricate field delves into the anatomy, physiology, and pathology of the larynx, aiming to preserve and enhance one of humanity's most essential means of communication: the voice.

Understanding the Larynx:

The larynx is a complex structure located in the neck, consisting of cartilage, muscles, and mucous membranes. It plays a crucial role in phonation, respiration, and protecting the airway during swallowing. The vocal folds, situated within the larynx, are pivotal for voice production. Any abnormalities or dysfunctions in this delicate organ can lead to a myriad of voice disorders, ranging from hoarseness and vocal nodules to more severe conditions like laryngeal cancer.

The Scope of Laryngology:

Laryngologists are highly specialized physicians trained to diagnose and treat a wide array of laryngeal disorders. Their expertise extends beyond traditional medical examination, often incorporating advanced technologies such as laryngoscopy, stroboscopy, and videolaryngoscopy for precise visualization of the larynx. This enables them to accurately assess vocal cord function, detect lesions or abnormalities, and formulate tailored treatment plans.

Treatment Modalities:

Treatment strategies in laryngology vary depending on the nature and severity of the condition. Conservative approaches may include voice therapy, lifestyle modifications, and medications to alleviate symptoms and promote vocal health. In cases of structural abnormalities or lesions, surgical interventions such as microsurgery, laser therapy, or phonosurgery may be recommended to restore vocal function and optimize outcomes. For patients with laryngeal cancer, a multidisciplinary approach involving surgery, radiation therapy, and chemotherapy may be necessary to achieve the best possible prognosis.

Advancements in Laryngology:

Recent advancements in laryngology have revolutionized the field, offering innovative solutions for voice restoration and preservation. Techniques such as vocal fold augmentation, injection laryngoplasty, and laryngeal reinnervation have provided new avenues for managing vocal cord paralysis and other debilitating conditions. Additionally, research into regenerative medicine and tissue engineering holds promise for future therapies aimed at repairing damaged laryngeal tissue and restoring vocal function.

[normal-with-adhd-is-a-joke]

It helped her phantom pain! This is huge! One of the most common issues post-amputation is phantom sensation, a neurological phenomenon where the nerves misfire and send often extremely uncomfortable signals like itchiness and pain to the brain. There's no real way to fix it, mirror therapy can help by tricking the brain into thinking the limb has returned, but sometimes it doesn't work or doesn't last. Pain meds are often ineffective and sometimes more surgeries have to be performed post-amputation to reduce unbearable pain, targeted muscle reinnervation (TMR) is the one I've heard of, not sure if there are others. Being able to work fixes for phantom pain into the first amputation surgery could prevent a lot of suffering and might open up a door of hope for people suffering with long-term severe phantom pain.

A 50-year-old Swedish woman who lost her hand in a farming accident has been fitted with a cutting-edge prosthesis that has proved transformational. The bionic hand is based on revolutionary technology that connects directly to a user's bones, muscles, and nerves – creating a human-machine interface that allows AI to translate brain signals into precise yet simple movements. The woman who received the bionic hand, Karin (whose full name is undisclosed), now has a limited sense of touch and can move all five of her bionic fingers individually with a success rate of 95 percent. After two decades of living without a right hand, she can now carry out 80 percent of her usual daily activities, like preparing food, picking up objects, zipping and unzipping clothes or bags, and turning door knobs or screws. What's more, after receiving the prosthetic hand, Karin's excruciating phantom pain, which she said felt as though her hand was going through a meat grinder, decreased significantly.

Continue Reading.

[gendronrecherche]

New Nerve Procedure Reduces Complications Post-Amputation

Targeted muscle reinnervation decreases phantom and residual limb pain. http://dlvr.it/T115Fm

[anumberofhobbies]

Untrue YouTube about cats

Saw a YouTube short about cat facts on a popular cat channel with 12,000 subscribers where point Four was that "cats have a hard time walking on smooth surfaces because they do not have sweat glands on their feet" -- that is SO EASILY documentable as UNTRUE ...

And has been documentably untrue for at least half a century ...

If there were no sweat glands in cat paws why would this exist?

AND ...

"The results obtained confirm the view that the normal biological functions of the eccrine glands of the feline foot pad are to improve the frictional capacities of the paw and to leave typical scent marks."

Here's the short,

[milfchilde847]

actually this is more because i forgot most people dont have skin grafts and that having strangely behaving swatches of skin is not a universal experience. anyways i was reading publications about reinnervation and regeneration of epithelial structures in grafted tissues (or, lack thereof) and was like hey. huh

u ever logically know things but just forget that these things apply to urself too until ur reading things out of boredom and go hey.. wait a minute...

[bpod-bpod]

Muscle Breaking

When nerves meet muscle during development, something special happens – connections called neuromuscular junctions (NMJs) form. Nerve damage can cause NMJs to lose their nerve connections (denervation). Rebuilding these connections (reinnervation) is difficult in humans. So researchers now investigate what's happening using mice. The nerve supplying a muscle in mice was either temporarily or permanently damaged. Fluorescence microscopy of healthy NMJs (pictured, top left) and of damaged NMJs examined after reinnervation (remaining panels) revealed the breakdown of the NMJ on the muscle side (cyan) after both permanent or temporary nerve damage, even three months later. Tracking reinnervation over time showed that multiple nerves (magenta) sometimes resupplied NMJs (bottom right). Together, this uncovers long-lasting changes in NMJs after nerve damage, which may not always reflect the NMJ failing to recover but instead reflect the NMJ trying to rebuild. Further research could shed light on how to encourage such changes for recovery.

Written by Lux Fatimathas

Image from work by Francisca Bermedo-García and colleagues

Laboratory of Neuromuscular Studies (NeSt Lab), Group for the Study of Developmental Processes (GDeP), Department of Cell Biology, Faculty of Biological Sciences, Universidad de Concepción, Concepción, Chile

Image originally published with a Creative Commons Attribution 4.0 International (CC BY 4.0)

Published in BMC Biology, July 2022

You can also follow BPoD on Instagram, Twitter and Facebook

[themedicalstate]

Hand Transplants Demonstrate the Nervous System’s Amazing Adaptability

This article was originally published with the title "New Connections" in Scientific American 323, 6, 62-69 (December 2020) doi:10.1038/scientificamerican1220-62. By Scott H. Frey. Image by Lyndon French. Infographic by David Cheney.

A radical procedure restores touch and grasping in former amputees

In February 1964 Roberto Gilbert Elizalde, a Mayo Clinic–trained surgeon in Guayaquil, Ecuador, found the ideal candidate for a radical procedure being developed in his laboratory. Julio Luna was a 28-year-old sailor who had lost his right hand in a grenade explosion. Gilbert Elizalde, inspired by the successful transplantation of a kidney harvested from a cadaver in the U.S., intended to replace Luna's missing appendage with a donor's.

For nine long hours Gilbert Elizalde and his team worked to prepare Luna's injured limb before skillfully marrying his bones, tendons, blood vessels, muscles, and skin with the forearm of a laborer who had died from a bleeding stomach ulcer. Using recently developed microsurgical techniques, the team stitched together the delicate, tubelike fascicles, nerve-surrounding sheaths that they hoped would guide sprouting sensory and motor nerves from Luna's injured forearm to reinnervate the new hand over the ensuing months.

Exhausted, the team watched nervously as the surgical clamps were released, and Luna's blood perfused his pale new hand to life. Long-distance congratulatory calls circulated. The news made the New York Times: “Dead Man's Hand Is Transplanted.” The hand became one of the first human body parts to be transplanted, after the kidney and cornea. It was a long shot. “Several specialists who were questioned yesterday agreed that the odds against ultimate success were huge,” the Times reported.

For the first week it looked like the skeptics might be proved wrong. When Luna contracted his forearm muscles, tendons in the new hand curled the fingers. Doctors gave Luna an early immunosuppressant, azathioprine, to stop his body from rejecting the foreign appendage. But in the second week it became clear that the immunosuppressant was not enough. When evidence of gangrene appeared, Luna was flown to Boston, where last-ditch efforts to save the hand failed. Twenty-three days after the transplant he became an amputee again.

The medical community both praised and condemned Gilbert Elizalde for this risky surgery. Critics called the procedure unethical, dangerous and unnecessary because it was not needed to save Luna's life—a position on hand transplantation that some experts still hold today. It took another three decades before hand transplantation received a second look.

Over those years surgical techniques evolved, and the development of more effective immunosuppressants (cyclosporine, followed by rapamycin and tacrolimus) allowed transplantation of certain solid organs—kidneys, livers, hearts—to become nearly routine. By the 1990s the success of these powerful pharmacological agents raised hopes of preventing rejection of transplants consisting of multiple tissue types—muscle, skin, bone, nerve and vascular tissue. The field of composite tissue allotransplantation was born. In 1998 a team in France performed the second hand transplant in history, followed shortly thereafter by a group at Louisville's Jewish Hospital in Kentucky. That recipient, Matthew Scott, will soon celebrate the 22nd anniversary of his successful transplant.

Yet hand transplantation remains experimental and, in some circles, controversial. The procedure has been performed only 100 or so times worldwide. Unlike other organ transplants, hand transplantation does not save lives. Recipients undergo a major operation followed by a lengthy recovery and intensive rehabilitation. They face a lifetime regimen of immunosuppressant drugs that can be hard on internal organs and that can increase the risks of certain cancers, infections and other illnesses. Twelve years after receiving his transplant David Savage, lost his life to a cancer that may have been related to immunosuppression.

So why not just use a prosthesis? A transplant recipient Erik Hondusky was asked this question, his answer was simple: “It is a two-handed world.” Hondusky's observation captures feelings expressed by other hand transplant recipients who also shared their dissatisfaction with prosthetics and the strong desire to feel whole again. Prostheses remain insensitive tools; you cannot use them to feel the glance of a spiderweb, or the little bumps marking “F” and “J” on a keyboard, or tiny temperature changes in a cup of coffee. Sadly, Erik developed a staph infection that led to the amputation of his hand nine years after his transplant. He uses a prosthesis reluctantly, only while riding his motorcycle.

Prosthetics come with their own challenges. Despite major advances in technology, a high percentage of amputees choose to give up their upper-extremity prostheses. Scott H. Frey’s longtime collaborator in Louisville, Christina Kaufman, notes that overall the record of surgical outcomes for hand transplants—and prevention of their rejection—remains impressive, with approximately 80 percent of recipients retaining the hand for at least five years. As techniques for matching immunologically compatible donors and recipients improve, this percentage is expected to grow, along with the number of recipients. Consequently, a successful transplant is no longer simply one that survives rejection. Instead success is increasingly defined based on the extent to which recipients develop functional use of their new hands. And that is where brain science comes into play.

Amputation And The Brain

My curiosity about how the brain controls the hands began early, inspired by watching my mother struggle with everyday tasks as a result of her multiple sclerosis, a disease in which one's own immune system ravages the fatty myelin that surrounds neurons in the brain and spinal cord. Her loss of hand function, balance, muscle weakness and spasticity linger as vivid memories and have driven my quest to understand how the brain controls the hands. Our brains dedicate a vast amount of real estate to planning and controlling hand actions. For more than 20 years my lab has been exploring this territory. We investigate the neural mechanisms of hand movements with functional magnetic resonance imaging (fMRI), a technique that allows us to noninvasively assess brain function by tracking local fluctuations in blood flow and oxygenation levels that are coupled to local changes in neural activity.

On a practical level, here is how fMRI works: Imagine that you volunteer for a common (and painfully boring) fMRI experiment that involves alternating the tapping of your fingers interspersed with periods of rest. When moving the fingers on your right side, a population of specialized neurons in the hand region of your left motor cortex (each brain hemisphere controls movements and processes sensations of the opposite side of the body) produces descending impulses, called action potentials. These signals pass through the brain's subcortical structures and down the spinal cord before triggering peripheral motor nerves that cause the appropriate muscles of your right forearm and hand to contract. Specialized receptors in your skin, tendons and joints are stimulated by your finger movements and send feedback signals through peripheral sensory nerves to the spinal cord. There, ascending impulses are relayed via subcortical structures to a specific pool of neurons in the hand area of your left somatosensory cortex, which processes incoming sensory signals.

All of this activity consumes energy. Within fractions of a second tiny capillaries dilate and saturate more active areas of your brain with an excess of oxygen-rich blood (hemoglobin). Changes in local blood oxygen concentrations that accompany neural activity affect the fMRI's magnetic field. Without oxygen bound to it, hemoglobin is strongly attracted to a magnetic field in what is called a paramagnetic state, and oxygenated hemoglobin is weakly repelled (a diamagnetic state). These effects can be captured as a blood-oxygen-level-dependent signal tethered to neural activity. During the little finger-tapping experiment, the hand areas of your left motor and sensory cortices glow with activity on the scanner console.

FMRI can even detect this brain activity in some people whose hands have been amputated. Many amputees experience powerful illusory sensations of a “phantom limb,” the sensation that the amputated appendage is still present. If a researcher asks a person with an amputation to move their phantom fingers, fMRI detects increased activity in the former hand areas. These findings suggest that the brains of at least some amputees retain a representation of the amputated hand even after the physical one is gone—although the story is not quite that simple.

Decades of basic neuroscience research in animals show that the organization of the cerebral cortex changes profoundly when it is deprived of routine activity from a limb—the result of damage to the peripheral nerves. That is, maps of sensory and motor functions in the cortex depend on stimulation. At least in part, the same appears to be true for humans as well. When amputees perform a task with their remaining hand, they exhibit increased activity in sensory and motor cortical areas formerly devoted to the now missing hand. This involvement of the former hand areas occurs in addition to typical activity within those areas dedicated to the healthy hand. Similarly, some brain-imaging studies have shown that movements of the lips may also increase activity in the former hand areas of amputees.

This is where hand transplantation gets very interesting to a brain scientist. Does the mature human brain retain enough plasticity years or even decades after amputation in areas formerly devoted to the amputated hand to take on control of the transplanted hand? The answer to this question could have broad implications for understanding the potential for recovery of function following injuries to the body, spinal cord or even the brain itself.

Brain Recovery

If ever there was a case to test the boundaries of post-transplant recovery, David's was it. As a young man, he lost his right hand in a shop accident, and before the transplant he had lived as an amputee for almost 35 years. While we talked, David unzipped the Velcro straps that held his removable splint in place and nonchalantly began opening and closing his new hand. When he saw the stunned look on my face, he cracked a smile, grasped my pen and wrote his name in my notebook. Immediately it became clear who was the professor and who was the student.

Before getting into David's exciting results, we need a short aside to discuss the workings of the peripheral nerves in your hand and arm. Unlike the brain or spinal cord, peripheral nerves are capable of regrowing when injured. They regrow quickly, too—at the astonishingly speedy rate of up to two millimeters per day. A skilled microsurgeon will prepare a patient for this regeneration by carefully segregating the fascicles that encompass the various nerve branches and then delicately suture them to matched fascicles in the donor hand. These fascicles surround vast numbers of microscopic axons—the slender projections growing from the cell bodies of individual neurons—much like conduits surrounding the bundles of multicolored phone wires you might see at a construction site. Once surgically joined, the fascicles guide sprouting motor axons toward hand muscles, where they form neuromuscular junctions. Similarly, axons that send sensory signals to the brain are steered toward the skin, tendons and joints. There sensory nerves produce specialized receptors sensitive to changes in pressure, vibration, and temperature. The process through which peripheral nerves grow back and rejoin the sensory network is called reinnervation.

But even a gifted microsurgeon has limited control over where individual peripheral nerve axons actually terminate in the donor hand. The upshot is that subsequent reinnervation errors present a challenge for recovery of hand function. In David's forearm, the regenerating sensory nerves had inched their way through the repaired fascicles. Along the way, some axons had veered off and innervated patches of skin on his new palm, forming numerous branches capped by tiny sensory receptors. We know this because at this early point in his recovery, David was able to detect and localize light touch along the base of his thumb even though the rest of his hand still lacked sensation. His brain was receiving input originating in peripheral nerves that had last carried sensory signals from a hand more than three decades ago. These impulses were arising from specialized receptors that had only recently set up camp in an entirely different hand.

Reinnervation error was an issue for David, but his brain still found ways to compensate. A sensory nerve in the forearm that once received input from a patch of skin located, say, on the base of his birth thumb might now carry signals arising from an entirely different location on his transplanted palm. Somehow, in a very short period, David's brain had, nonetheless, learned to interpret the new input it received correctly; if anyone probed his palm, he experienced the feeling as arising from there and not from his thumb. These perceptions were a few millimeters off but still remarkable considering that until recently David had no right hand for more than three decades. Exactly how the brain solves this puzzle remains unclear. Working hypothesis is that through the repeated pairing of visual and tactile feedback—seeing and touching at the same time during hand use—brain mechanisms learn to correct for reinnervation error.

As if having waited patiently all this time for the opportunity to again process signals arriving from the hand, the appropriate area of David's sensory cortex responded vigorously when gently brushed his transplanted palm during an fMRI scan. That is not to say, however, that postamputation reorganization had been fully reversed. As with other amputees, brushing the palm of David's intact left hand also elicited responses in this same area, the right sensory cortex. But he never showed any uncertainty about whether these sensations were coming from his intact or transplanted hand.

David eventually succumbed to cancer, but a transplanted hand can last for decades without any apparent consequences. At more than 21 years postsurgery Matthew Scott—the first case performed in Louisville—has kept his transplanted hand longer than anyone else who has had this operation. He spent 13 years as an amputee after losing his dominant left hand in a fireworks accident that occurred in his 20s. Matt visited us in 2008, nine and a half years after his operation. Feeling had long ago emerged throughout his new hand, indicating that regenerating sensory nerves had completed their journey. He localized touch at all locations on his transplanted hand; on average, he was only a few millimeters less accurate than on his uninjured one. We created a computer-controlled system to stimulate the tips of his fingers during an fMRI session, which revealed distinct maps of each individual digit within the hand area of his sensory cortex.

Although tempting to conclude that the organization of Matt's sensory cortex had sprung back to its preamputation organization, this conjecture would be overreaching. We lack data on his brain prior to his amputation, and the fact is that we all have slight differences in the fine-grained organization of our brains, which result from genetics and differing life experiences. We can safely say that Matt's sensory cortex appears to contain a map of his transplanted hand that is within the range of natural variation that we observe in healthy adults. Still, even eight years' post-transplant Matt's brain showed lingering evidence of his amputation. Stimulating his intact right hand also increased activity within the former hand area. How then can his hand function be so good? Part of the answer may involve contributions from other brain regions, located upstream from the hand regions, that are not directly involved in sensing and motor functions.

Simple tasks such as finger tapping or passively experiencing touch are useful means to probe the organization of the motor and sensory cortices. Everyday life, however, requires the ability to grasp and manipulate objects. These more complex, goal-directed actions involve areas of the brain involved with higher-level processing, such as the parietal and premotor areas. These cortical regions use multisensory information about the properties of the object and the positioning of one's body to plan movements targeted to a specific goal, such as grasping a cup to take a drink.

Ken Valyear led a project that used motion capture and fMRI techniques to study the recovery of visually guided grasping in transplant recipient Donald Rickelman, who had lived as a left-hand amputee for 14 years after losing his hand in an industrial accident. We were particularly interested in the role of the anterior intraparietal cortex (aIPC)—a small region located just behind the sensory hand area that is involved in properly shaping the hand to conform to the perception of objects' shapes, orientations and sizes.

At both 26 and 41 months after receiving his transplant, Donnie, like the other transplant recipients we have studied, showed evidence of persistent reorganization in his motor and sensory hand areas. Not surprisingly, he also experienced impediments in some basic hand functions. Detailed analyses of his hand motions, captured at high resolution as he reached for and grasped objects, revealed substantial improvements in coordination over this same period. How was he compensating for his motor and sensory impairments? To find out, we built a special apparatus that allowed us to ask this question with fMRI. When Donnie grasped objects at 26 months post-transplant, his aIPC and premotor cortex showed weak levels of grasp-related activity relative to people with intact limbs. At 41 months patterns of grasp-related activity had increased within the aIPC and premotor cortex and more closely resembled those of control subjects. We speculate that his improved ability to reach and grasp with his transplanted hand over time may be linked to these higher-level regions picking up the slack for the lagging performance of his reorganized motor and sensory areas.

Donnie and Matt continue to improve their sensory and motor functions many years after receiving their transplants, suggesting that the learning-related changes in the brain may continue to contribute to recovery long after the peripheral nerves have fully regenerated. If the superpower of the peripheral nerves is their ability to regenerate when injured, the brain's is its capacity to reconfigure itself in response to changes in stimulation. Both play complementary roles in recovery from bodily injuries. Though in its infancy, work with hand transplant recipients is already showing us that the human brain can respond to the reinstatement of stimulation even after many years of deprivation. These findings challenge fundamental notions about the limits of neuroplasticity in mature adults and may give hope to those struggling to overcome the effects of amputation and other devastating bodily injuries. It may indeed be possible to reinstate the grasping and touch that had been lost decades earlier.

[disordersofresonanceandairflow]

that was fighting for gay rights and people were reinnervated by the chromatism.

[cookie-earning-things]

Pride month is here❤💙💚💛💜

Can you share some Final Space headcanon of yours for this special occasion?👀👀👀

Happy Pride!!!

(starring my friend's Gary "Lightning Edge" Badspeed)

One for each color of the rainbow...and +1 for luck

1.) If there's a royal ventrexian prince somewhere, their actual name is Licksian / Lixian of the Pawpurri Pedigree line

2.) Gary stans Mothra (not just because I am a huge Godzilla fan, no)

3.) Avocato has tinnitus in his left ear that never fully healed from the pod or Sammy's vitamin after the bomb

4.) Fox actually played up to four instruments and was considered something like an up-and-coming prodigy

5.) Gary's installed arm was a bit haphazardly applied but somehow works with TMR (targeted muscle reinnervation); that said, it definitely causes some pretty bad pain that can take him out for a while...Little Cato likes to hang with him sometimes while he's resting, and that's how games like "This Is Serious" developed

6.) Quinn graduated in top honors across the board for her academy studies; she struggled with the aqua-immersion for gravity-counterbalance portion and had to retake the sessions multiple times (no one knew why)

7.) John was an excellent student in aviation and technology for hyperspace travel and flight engineering. His charisma and penchant for great leadership kept him out of shop and dock work, though.

[smallfrost]

if helen!scylla lied about being a necro liutenant, maybe we can assume the necros aren't part of the war college ranking system? i assumed necros don't go into war college. they probably work as a research institute of some sort in fort salem with a different set of ranking system.

Oh most definitely. Necros who graduate basic training (two year pre-med crash course) go work at the Fort Salem Research Institute. (If they fail, they become the bomb squad for combat infantry). The Institute is attached to War College but has its own buildings on base. There, they study the medicinal and life channeling properties of mushrooms and the fine line between Fixing and Necromancy Work. Their ultimate goal is to find a way to combine their Work to help heal witches using a technique which more appropriately fulfills the Law of Equivalent Exchange (aka without impacting the ecosystem around them). 

Minimum 2 years of mushroom dissecting experience needed for entry level research positions - they are delicate little things after all... Necros need steady HANDS

Other areas of research include understanding how diseases cause death so the Fixers can learn how to heal those afflicted and searching for alternative ways of communicating with the dead (besides the high energy demand of the death current). They do this by creating sentient mushrooms to reinnervate the body and access the hippocampus. Totally a thing, 100%, and the Institute’s ranking system would reflect their research positions.

Excited baby Necros ready to play with dead things not Porter and mushrooms 

Of course, I’m sure there are Necros that DO go into War College or transfer from the Institute to go into military leadership & intelligence. Dead bodies are great for surveillance after all.