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6 Prosthetics & Orthotics > L10 UE Prosthetics > Flashcards

L10 UE Prosthetics Flashcards

1
Q

Upper Limb prosthesis

A

less relevant than lower limb loss
15-40 times more LE amputations vs UE

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2
Q

Causes of UE loss

A

80% due to trauma in males 15-45
8% due to cancer or vascular
others are congenital, burns, infection

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3
Q

Forequarter/scapulothoracic Amputation

A

usually due to malignancy

difficult to fit w/prosthesis, tolerates a lightweight cosmetic prosthesis best if any at all

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4
Q

Shoulder Disarticulation

A

most commonly due to malignancy or electrical injury

functional prosthetic use possible and will require an external shoulder joint usually passive

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5
Q

Transhumeral amputation

A

most commonly due to trauma
prosthetic options are varied
second most common level of UE ampt
allows self-suspending socket

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6
Q

Elbow disarticulation

A

requires external elbow joint

usually only body powered prosthesis is used

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7
Q

Transradial

A

loss of hand, wrist, forearm function
commonly a result of trauma

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8
Q

Wrist Disarticulation

A

loss of hand function can retain some forearm rotation

goal is to preserve grasp or pinch

toe transfer is a possibility

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9
Q

Digit amputation

A

preserves function if can grasp
prosthetic use limits sensation
conversion to TR if no prehension

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10
Q

Eval Objectives

A

develop rapport
understand pt’s concerns
understand the pts requirements
educate
assist the pt to have achievable goals
establish relationship with prosthetist

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11
Q

Phantom pain

A

pain in missing limb/digits

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12
Q

Phantom Sensation

A

feeling like you can still move the missing limb/digits

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13
Q

Goals should

A

change as stage of care evolves acute, pre-prosthetic, prosthetic, re-integration

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14
Q

Prosthetic Options

A
  1. no prosthesis
  2. passive/cosmetic prosthesis
  3. body powered prosthesis
  4. electric prosthesis
  5. hybrid prosthesis (comb of 2-4)
  6. task-specific prosthesis
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15
Q

Pros of no prosthesis

A

sensory input
comfort
mobility
simplicity
cost

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16
Q

Cons of no prosthesis

A

lack of prehension
balance
cosmesis

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17
Q

Functions of prosthesis

A

stabilize objects
push/pull
support

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18
Q

Pros of Cosmetic Prosthesis

A

cosmesis
light weight
minimal maintenance
assists with bimanual tasks

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19
Q

Cons of cosmetic prosthesis

A

limited function
durability

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20
Q

Passive Prosthesis Controls

A

can be used as paperweight
objects can be placed in the hand
shoulder/elbow jt can be locked into positions

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21
Q

Pros of Body Powered Prosthesis

A

lighter weight
can be used in various environments
less cost
repairs can be less technically demanding

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22
Q

Cons of Body powered prosthesis

A

less grip force
functional envelope is limited
cosmesis of harness and hook
axillary anchor

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23
Q

Components of terminal devcies

A

hook
voluntary opening
volntary closed
hand

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24
Q

Body Powered Controls

A

cable and harness system captures body motion and translates it into movement of the parts of prosthesis

different motions can be separated by using different cable systems

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25
Q

How body powered prosthetic works

A
  1. axillary loop is primary anchor, stanless steel control cable is attached at its proximal end to straps, attaches to the thumb
  2. Tension is applied to movable thumb pulls away from stationary finger
  3. Cable housing maintains constant length of control cable, same amount of body motion is required to operate it in elbow flexion/extension
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26
Q

When is the strap the most efficient in body powered system?

A

ring of axillary straps is placed just below C7 and slightly toward the non-amputated side

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27
Q

Primary body motion used for transradial prosthesis is…

A
  1. GH jt flexion
  2. biscapular abduction can be used for actions close to midline
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28
Q

Figure 9 Harness System

A

used in transradial pts
also socket provides suspension

tail of axillary loop attaches to control cable, anchoring it

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29
Q

Body Powered Controls

A

Biscapular abduction or flexion of humerus for opening or closing, depending on mechanism

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30
Q

Rubber bands

A

prehension of volunatry opening in TD uses them

one band = 2.2 lbs

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31
Q

Shoulder saddle harness with chest strap

A

primarily used for transhumeral pts who use hybrid prosthesis

saddle provides better suspension

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32
Q

Harness for Transhumeral Amputee

A

anterior support strap originates on axillary loop just post to humeral head and attaches to AM aspect of prosthesis

suspends the prosthesis against loading and helps prevent socket rotation

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33
Q

Elbow Locking (body powered controls)

A

occurs with shoulder depression, extension, and abduction of affected side

when elbow is unlocked, GH flexion will control elbow. When its locked, GH flexion will operate the TD

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34
Q

Electric Prosthesis Pros

A

grip force
less energy expenditure
correlates with neuromuscular system
larger functional envelope
reduced or eliminated harness
hand is functional, cosmetic

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35
Q

Electric Prosthesis Cons

A

cost
weight
repairs are more demanding
can be damaged by environment
requires battery power

36
Q

Electrically powered components

A

greifer
ETD
hand
multi-articular hand

37
Q

iLimb

A

individual joints and individual digits move

thumb has powered rotation

38
Q

BeBionic

A

thumb is actively positioned
14 grip patterns, 8 available at 1 time

39
Q

Examples of multiarticular hands

A

iLimb
BeBionic

40
Q

Michaelangelo (Multigrasp hand)

A

powered thumb that positions in lateral pinch or opposition

41
Q

Electrically powered controls

A

less or no harness or cable required
powered by battery, activated by electrodes

contains mechanical switch

has multiple different suspensions
suction, anatomical, sleeve, harness

42
Q

Anatomical suspension

A

pt pushes in and prosthesis suspends supracondylarly

43
Q

Suction suspension

A

pt pulls in to create a vacuum

44
Q

Switch Control

A

if amplitude is greater than a preset threshold then the device will execute an action at a constant speed/force

offers ingle degree of freedom control

45
Q

Proportional Control

A

method can achieve variable speed and force based on the proportion of user input signals

degree of movement can be force, speed, position, or other mechanical outputs

46
Q

Myoelectric Controls

A

myoelectric potential
amplification
conversion to DC voltage
electrodes

47
Q

Single Inputs for myoelectric control

A

voluntary open, automated closing
quick-slow strategy

48
Q

Dual Inputs for myoelectric control

A

Grip increases with duration of contraction

dual inputs can control 4 motions

49
Q

Mode change

A

inputs to change between devices. Ex hand function to wrist function

two actions are 1. co-contraction, 2. quick-slow scheme

50
Q

Quick-slow scheme

A

hand is quick contraction
wrist is slow contraction

51
Q

Positional Control

A

commonly used for elbow control in transhumeral

input is linear potentiometer with 1/2” to 1” of travel that is pulled by a cable

52
Q

Hybrid prosthesis

A

combines a feature of two or more prosthetic options –cosmetic, body-powered, electric

53
Q

Amputee Rehab Protocol

A

healing
pre-prosthetic training
basic prosthetic training
advanced functional training
community re-integration
discharge planning

54
Q

Healing/Pre-Prosthetic Training

A

care of residual limb
general physical rehab
psychological support
change of dominance
ADL training
myosite testing and training

55
Q

Care of Residual Limb

A

wound care
edema control
desensitization
scar management
pain management

56
Q

Wound care MD prescription

A

aquaphor
zeroform/adaptic
mepitel
silvadene
wet to dry dressings
sharps debridement

57
Q

Edema Control

A

elevation
AROM
compression
manual edema mob
ice, contrast baths

58
Q

Desenitization

A

massage
immersion
textures
mini-massager

59
Q

Scar management

A

massage
silicone scar pads
silicone liners
kinesiotape
compression

60
Q

Common contractures

A

shoulder
elbow flexion
forearm

61
Q

Posture

A

make it a habit
keep it simple
prevention

awareness of tendency for forward head and forward shoulder posture

62
Q

Pain control

A

phantom pain, sensation, residual limb pain
medical management
massage
compression
TENS
mirror therapy
recognise app

63
Q

Psychological Support

A

referral to a professional
peer support
support organizations
listen

64
Q

Recovery Process is…

A

enduring (quiet support)
suffering (listening, empathy)
reckoning (info, referrals)
reconciling (validation, info)
normalizing (role model)
thriving (challenge, recruit for peer)

65
Q

change of dominance

A

feeding
brushing teeth
personal hygiene
handwriting
fasteners
containers

66
Q

Myosite Testing Goals

A
  1. find a superficial muscle that pt can contract with enough strength and control to operate a myoelectric prosthesis
  2. in-phase if possible
  3. independent control between muscles
  4. ability to co-contract or perform quick vs slow contraction

should be as proximal within socket as possible

67
Q

Common sites for myosite training

A

TR = wrist flexors and extensors
TH = biceps and triceps
SD = pectoralis and infraspinatus

68
Q

Directions for Myosite Training

A
  1. explain muscle function and reasonable goals
  2. practice on uninvolved side
  3. clean and moisten skin
  4. align electrodes with muscle fibers
  5. place just distal to innervation zone
  6. maintain contact
  7. discuss warm-up or settling period
69
Q

Remember when doing myosite training

A

quality not quantity
frequent rests
use games as skill improves

skill acquisition for contract/relax, contract/hold/relax, signal separation, speed, co-contraction and endurance

70
Q

How to create intuitive control

A

stimulate kinesthetic tactile learning
focus on their learning style
cultivated over time
reimprint other half of brain w/mirror
increased repetition
innovative approaches

71
Q

What is the learning style of patients?

A

Kinesthetic, visual, auditory, reading/writing

72
Q

Elbow Myoelectric operations

A

flexion/extension with linear potentiometer or switch

IR/ER with manual turntable

Free swing

73
Q

Shoulder Operations for Myoelectric

A

manual or electric lock for flex/ext
friction for abd/add

74
Q

Hand operations for myoelectric

A

open/close
pronation/supination/rotation
wrist flexion
changing TD’s

75
Q

Rotation and Wrist

A

friction type manual control

76
Q

Flexion and wrist

A

manual lever control for wrist

77
Q

Voluntary Opening for Body Powered

A

open with humeral flexion of involved side, univolved side acts as an anchor

close with rubber band tension

change the TDs

78
Q

Elbow operations for body powered

A

elbow must be locked to operate TD

elbow is unlocked, humeral flexion on TH side will flex elbow

lock is activated by shoulder depression, humeral extension, and abduction on TH side

79
Q

Arm rotation operations for body powered

A

pt has long TH amputation they may retain anatomic ability to rotate

if amputation is short, turntable may be added to allow for manual rotation of the humeral component

80
Q

Controls Training

A
  1. Begin with prosthesis at midline
  2. Practice open, open partially, close
  3. Practice changing elbow position then open/close
  4. Practice change of speed and change of mode for myoelectric
  5. Have them mimic motions
  6. Have them stand and grasp objects
  7. Have them grasp and then release on different surface
  8. Incorporate all joints in activities, practice control with soft objects
  9. Gross coordination (pouring, turning pages)
  10. develop fine coordination (stacking blocks, placing small pegs, play cards)
81
Q

Partial hand amputations

A

enormous pt population
many pts chose not to wear one

usually fit with some form of opposition post, there is no power in the post

82
Q

Oppositional posts…

A

provide grasp
protect residual limb

83
Q

Electric prostheses for partial hand

A

activated by pressure sensors
freedom of wrist motion
better at prepositioning

84
Q

Future of UE Prosthetics

A

improve sensory feedback
decrease reliance on visual feedback
ossointegration
patterned recognition to increase control
simultaneous control, estimates hand in real time. more intuitive

85
Q

things you can do as a PT

A

listen
support
creativity
energy
motivation

6 Prosthetics & Orthotics (11 decks)

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