4. Upper Limb Prosthetics Flashcards
Mention disability rating for UL amputation ๐๐ EXAM 2019
- Thumb 23% (50% of one hand)
- One Hand 45%
- Upper limb 50%
Braddom 6th Edition Chapter 9 Table 9.5
When do you name (x) upper amputee as short or long? ๐๐
๐ก Lower Limb 90-50-20 & 60-35-0
Wrist Disarticulation Pros & Cons. Whats ur advice? ๐๐ Dr. Jamal
Pros
- Spares distal radial ulnar articulation to preserve full forearm supination and pronation.
Cons
- Extremely long residual limb
- Needs special thin wrist unit is used along with terminal device (TD)
- Poor cosmesis
Advice
- Any wrist disarticulation = less options and poor cosmesis
- Drawbacks often outweigh the advantages in the long run
- Below-elbow amputation may be a more appropriate amputation level.
Cuccurollo 4th Edition Chapter 6 P&O pg466
Transradial Amputation Pros & Cons. Mention 3 Levels. ๐๐ What is the minimal length? Dr. Jamal
Pros:
- High level of functional recovery (Longer = More Strength & Supination)
Levels
Long: Residual limb length of 55% to 90%
Retains 60 degrees to 120 degrees of supination and pronation.
Optimal body-powered prosthetic restoration to perform physically demanding work.
Good cosmesis with enough space for electronic components
Short: Residual limb length of 35% to 55%
Limited wrist suspension and elbow ROM and flexion strength
Very short: Residual limb length <35%
Retains <60 degrees
Ulna 1.5 to 2 inches long is able to preserve the elbow joint
Cuccurollo 4th Edition Chapter 6 P&O pg466
Elbow Disarticulation Pros & Cons.
Pros
- Reduction in surgery time and blood loss
- Improved prosthetic self-suspension
- Allows greater lifting, pulling, and pushing power compared to above-elbow amputation.
- No risk of bone spur or heterotopic bone formation at the elbow disarticulation level
Cons:
- Limitations in externally powered elbow mechanisms at this level of amputation
- Poor cosmetic appearance
Cuccurollo 4th Edition Chapter 6 P&O pg467
Transhumeral Amputation. Mention 3 Levels ๐๐
1. Standard transhumeral
Residual limb length of 50% to 90% (best control and function)
2. Short transhumeral
Residual limb length of 30% to 50%
3. Humeral neck
Residual limb length of <30% (shoulder disarticulation)
Cuccurollo 4th Edition Chapter 6 P&O pg467
Shoulder Disarticulation Pros & Cons. Whats ur advice?
No Pros
Cons
- Most difficult to fit with a functional prosthesis
- Suspension is difficult to maintain.
Advice
- Better option is to provide a passive, cosmetic prosthesis (shoulder cap)
- Ultralight passive prosthesis.
Cuccurollo 4th Edition Chapter 6 P&O pg467
What requirements must an amputee meet before fitting a permanent prosthesis? ๐
- Stump must be edema and pain free
- Adequate strength and ROM
- Adequate cognitive ability
PMR Secrets 3rd Edition Chapter 35 pg285 q12
Mention 4 functional grips ๐๐
Passive Prosthesis. Advantages & Disadvantages.
Advantages
- Lighter
- Best cosmesis
- Less harnessing
Disadvantages
- High cost if custom made
- Least function
- Low-cost glove stains easily
Cuccurollo 4th Edition Chapter 6 P&O pg468-469
DeLisa 5th Edition Chapter 74 U & LL Prosthetics pg2036 Table 74.6
Body powered Prosthesis. Types, Advantages & Disadvantages. ๐๐ Dr. Jamal & Abdulrazaq
-
Voluntary opening (Advantage)
- Device maintained in closed position by rubber bands or tension springs
- The amputee uses cable-control harness powered by proximal muscles to open the terminal devices against the force of the rubber bands or spring.
- To grasp, patient releases the opened terminal device on an object; the rubber bands or spring provide the prehensile force.
- Each rubber band provides about 1 lb. of pinch force
- To control the amount of prehensile force, the patient must generate a continued opening force
-
Voluntary closing (Disdvantage)
- Prolonged prehension (grip) requires constant pull on the harness
- Terminal device remains awkwardly open when not in use
Advantages
- Moderate cost
- Moderately lightweight
- Most durable
- Highest sensory feedback
- Variety of prehensors available for various activities
Disadvantages
- Most body movement to operate
- Increased energy expenditure
- Most harnessing
- Least satisfactory appearance
Cuccurollo 4th Edition Chapter 6 P&O pg468-469
DeLisa 5th Edition Chapter 74 U & LL Prosthetics pg2036 Table 74.6
List 4 Advantages of hooks. ๐
๐ก Fits labor worker with low income.
- Ability to grasp small objects
- Durability
- Efficiency
- Lower maintenance and repair cost
- Lighter weight
- Resist heat more than artificial hand
- Basic grasp function
Braddom 6th Edition
Chapter 6 UL Prosthetics pg167 Box 9.12
Battery powered Prosthesis. Types, Advantages & Disadvantages.
-
Myoelectric-controlled
- Use surface electrodes placed on the muscles of the residual limb
-
Microswitch-controlled
- Push-button switch or a pullswitch to activate the TD
Advantages
- Moderate or no harnessing
- Least body movement to operate
- Moderate cosmesis
- More function-proximal areas
- Stronger grasp in some cases
Disadvantages
- Most expensive
- Most maintenance
- Limited sensory feedback
- Extended therapy time
Reasons
- Generate a pinch force greater than that of body-powered controlled hooks (up to 25 lb)
- Allow for more precise control
Cuccurollo 4th Edition Chapter 6 P&O pg468-469
DeLisa 5th Edition Chapter 74 U & LL Prosthetics pg2036 Table 74.6
Wrist Units. Function & Types of Locking Mechanism ๐๐
๐ก Do not add components unnecessarily: They increase weight and cost, and can break and need frequent repair.
WRIST UNITS
- Attach terminal device
- Allow supination pronation
- Allow flexion
LOCKING MECHANISM
- Friction lock
- Made from compressed rubber
- Hold it in a selected position by friction from a compressed rubber washer
- Mechanical lock
- Adjusted by manual rotation and lock
- Prevents unwanted rotation of the terminal device in the wrist unit when a heavy object is grasped.
- Able to add flexion for activities of daily living [ADLs]
- Electric wrist rotator units
WIRST FLEXION UNIT
- Allows manual positioning of the terminal device in either the straight or the flexed position for improved ADL functions.
Cuccurollo 4th Edition Chapter 6 P&O pg469
Components of Transradial (Below-Elbow) Amputation Prostheses. 6 marks ๐๐
- Terminal devices + control cable #1
- Wrist units
- Socket
- Elbow hinge
- Upper arm cuff/pad
- Harness