L7: UE Prosthetics Flashcards
1
Q
MOST POPULAR CAUSE UE AMPS:
A
TRAUMA
2
Q
MOST COMMON age group for UE amps:
A
16-35yo
3
Q
Causes UE Amps:
Know the top 3 *‘d
A
- *Acquired→ trauma, concomitant injuries
- *Vascular
- *Infx
- Tumors
- Congenital
4
Q
Congenital Amps:
Can be 3 things:
A
- Agenesis→ total absence OR lack of development
- PARTIAL amp
- COMPLETE amp
5
Q
Congenital Amps: Radial (lat. side) deficiencies
A
Thumb HypOplasia (underdeveloped)
Absent radius
6
Q
Congenital Amps: Ulnar (medial side) deficiencies
A
- Ulnar HypOplasia→ under dev’d vs absent
-
Radio-humeral synostosis
- union of 2 bones to form one
NOTE: Ulnar defs LESS COMMON vs radial
7
Q
Congenital Amps:
Phocomelia
*think of “melia” as “little fingers” to remember!!!
A
- Impaired dev. arm or forearm, hand close to body
- Term digits used to activate myoelectric switches
8
Q
Congenital:
Syndactyly
A
Fusion/webbing
9
Q
MOST COMMON CONGENITAL DEFORMITY
A
POLYDACTYLY
10
Q
Congenital:
Polydactyly
A
Extra digit
most common congenital deformity***
11
Q
Sx Considerations:
Prosthetic NEED aka req’s prosthesis:
A
- Wrist, CMC jts, Thumb, Metacarpals, Prox. phalanges
12
Q
Sx Considerations: DO NOT req. prosthesis
A
Hands retaining a good thumb working against one or more fingers or a surgically constructed post
13
Q
Amp Lvls: Thumb
A
- Considered 40% impair. of UE
-
Pollicization→ transfer of another digit to thumb pad
- Ex. Toe-to-Thumb Transfers (you know what this looks like!)
14
Q
Amp Lvls: Digits
A
-
Index + Long Fingers
- MOST important→ prehension
- power grip
-
Ring and Small Fingers
- isolated inj’s
-
Mult. Digits
- relative usefulness of ea remaining digit
15
Q
See pics
A
LABEL THEM!!!
16
Q
Amp Lvls: Wrist Disarticulation
A
Preserves full SUP/PRO
17
Q
Amp Lvls: Below Elbow (BE) aka
A
Transradial Amp
18
Q
Amp Lvls: Below Elbow (BE)/Transradial Amp
A
- Long
- Med
- Short→ loss of 60% forearm
- NO rotation, ONLY flex/ext
- Very Short→ <35% forearm remains
- flexion limtd
19
Q
Lvl of Amp: Elbow Disarticulation
A
- Diff to fit prosthesis→ bc humeral condyles
- Allows full UE rotation
20
Q
Lvl of Amp: Above Elbow (AE) aka
A
Transhumeral
21
Q
Lvl of Amp: Above Elbow (AE)/Transhumeral
A
- Goal: preserve as much length as poss.
- *<30% humerus remaining==> Treat as shoulder disarticulation
22
Q
<30% humerus remaining===
A
treat as shoulder disarticulation
23
Q
Lvl of Amp: Shoulder Disarticulation
A
Removal of entire humerus
24
Q
Lvl of Amp: Forequarter Amputation aka and what about this to remember??
A
Interscapulothoracic amputation
*heavy prostheses→ less compliance!!!
25
Lvl of Amp: **Forequarter Amp**
aka Interscapulothoracic
* removal **clavicle and scapula**
* **Sx Goal→** good _muscle pad_ for prosth. fitting\*\*\*
26
Psychological Aspects of Amputation:
## Footnote
**What are the _Physical Capacities_**
* Functional **Limitations vs.** Functional **Failures**
* **Limitations→**
* Avoid task OR
* Complete task w/ RL OR
* Use a prosthesis
27
Psychological Aspects of Amp:
## Footnote
**Comfort: includes…**
Pain+pain tolerance, Phantom sensation, Fatigue (lots of energy expenditure @ first)
28
Psychological Aspects of Amps:
## Footnote
**Appearance considerations**
Visual considerations
Auditory considerations (not quiet)
29
Psychological Aspects of Amps:
## Footnote
**Vocational and Economic….**
**Does it interfere w/….**
* **Employability**→ Mgmt vs Manual labor
* **Financial concerns→** maybe now you can't work or provide for family
30
Psychological Aspects of Amps
## Footnote
**Social**
**“Captain Hook” example\*\*\***
Social prejudices
31
Prosthetic Options:
**6 Total:**
**N**o **P**erson **B**eats **E**va's **H**ot **A**ss
1. NONE
2. **Passive** prosthesis→ cosmetic, **some** function
3. **Body-powered** prosth.
4. **Electric-powered** prosth.
5. **Hybrid** prosth.
6. **Activity-specific** prosth.
No Person Beats Eva's Hot Ass
32
**Components** of a Prosth.
## Footnote
**5 Total:**
1. Terminal Device
2. Wrist Unit
3. Socket
4. Elbow Unit
5. Harness + Control Cables
33
Terminal Devices
## Footnote
**Hooks vs. Hands**
* **Hooks→** _Lateral_ pinch
* **Hands→** Tripod/Palmar/3-Jaw Chuck Pinch
34
Terminal Devices
## Footnote
**Hooks**
**2 types:**
1. Voluntary **OPENING** OR
2. Voluntary **CLOSING**
35
**MOST COMMONLY USED TERMINAL DEVICES**
SPLIT HOOKS
36
Terminal Devices: **Split Hooks**
## Footnote
**\*MOST COMMONLY USED**
**Voluntary _OPENING_:**
* Exert force on **control cable to _open fingers_** against rubber bands→ act as spring to close them
* Closing force=\> #/type of rubber bands
\*you've SEEN and USED this!!!
37
Terminal Devices Ex's
see pics
38
Terminal Devices: **Hooks**
## Footnote
**Voluntary _CLOSING_ (more advanced)**
* Amp **closes device** w/ **own body power** by means of **control cable**
* Amp has _precise control_ of **finger pressure or prehension→**
* Ranges from **¼ to ½ lbs _up to_ 20-25lbs\*\*\***
39
Terminal Devices: **Hands**
## Footnote
**3 types:**
* Passive→ **stabilize objs, cosmetic**
* Voluntary OPENING
* Voluntary CLOSING
40
TERM DEVICES:
## Footnote
**Hooks vs Hands comparison:**
* Hands→ **more cosmetic, _better_ for grasping large/round objs**
* Hooks→ **_superior_ for grasping SMALL objs, can be used in _restricted_ areas**
41
BE amp wishes to go back to work. She inspects/updates telephones to put them back into circulation. What type of Term Device does she choose?
Split Hook\*\*\*
42
Wrist Units
## Footnote
**What do they DO?**
* Attaches **terminal device** TO **socket**
* Allows **interchangeable term. units\*\*\***
43
Sockets:
## Footnote
**Standard Socket**
Above Elbow Amp (AEA)
see pics
44
Sockets:
## Footnote
**_Split_ Sockets are for….**
SHORTER RL's
45
Sockets:
## Footnote
**_Split_ Socket**
\*Think **shorter RLs**
* **\<35% of limb**
* **Short or VERY short RLs**
46
This socket eliminates need for **suspension apparatus**
Muenster Socket
47
Sockets:
## Footnote
**Muenster Socket**
goes **over _olecranon_ and _humeral epicondyles_\*\*\***
* **Eliminates need for _suspension apparatus_**
* Need **harness only** for **operating terminal device**
48
Harness and Controls
## Footnote
**Think about your one client and when you used it at JFK…you know this!!!**
* Suspends prosth. from shoulders→ holds socket on stump
* Body motions== sources of power/force
* Forces transmitted via **cable TO term. device**
49
Components of BE Prosth:
## Footnote
**Harness and Controls**
**3 types:**
1. Figure-8
2. Chest Strap w/ Shoulder Saddle
3. Figure-9
50
MOST COMMON HARNESS
FIGURE-8\*\*\*
51
Figure-8 Harness
## Footnote
**Mvmts for term. device control and what it looks like**
**Humeral flexion** w/ **scapular ABD**
## Footnote
**\*you used this one!!!**
52
Chest Strap w/ Shoulder Saddle Harness
## Footnote
**Mvmts for term. device control and what it looks like**
**Chest expansion** w/ **B/L scapular ABD**
53
Figure-9 Harness
## Footnote
**Mvmts for term. device control and what it looks like**
**Humeral flexion** w/ **scapular ABD→** ONLY for term. device control
\*NOT in middle of back like figure-8
54
Motions needed to operate **terminal device w/ Figure-8 harness?**
Humeral FLEXION w/ Scapular ABD
55
ELBOW Units are for….
AEAs
56
Elbow Units:
## Footnote
**2 types:**
Flexible hinge vs Rigid hinge
\***both provide _elbow flexion_**
57
AE Harness+Controls
## Footnote
**Purposes of harness:**
* Suspend prosth from shoulders, transmit power to **flex forearm, lock/unlock elbow, operate term. device**
58
Components of AE Prosth: Harness + Controls
## Footnote
**Mvts to _Operate TD_ and _Lock Elbow_**
* **Operate TD→** Shoulder FLEX and Scapular ABD
* **Lock Elbow→** Shoulder depress, Humeral EXT/ABD
59
AE Prosth harness + controls
## Footnote
**Operate TD?**
Shoulder Flex, scap ABD
60
AE prosth harness + controls:
## Footnote
**LOCK elbow?**
Shoulder depression, humeral EXT/ABD
61
Shoulder Disartic and **Forequarter Amp. Prosthesis**
pics
62
Components of **Shoulder Disartic and Forequarter Amp Prosth.**
## Footnote
**3 things that make it more _usable/comfortable_:**
1. **Abd jts→** permit passive ABD of **humeral** **section**
2. **Elastic Suspensor→** stabilizes **shoulder section**, allows Mvmt of **shoulder girdle**
3. **Excursion Amplifier→** converts Lg force/Sm. excursion INTO Lesser force/Incd excursion
63
Excursion amplifier: shoulder disartic and forequarter amp prostheses
Converts **Larger force/small excursion** INTO **Lesser force/Incd excursion**
64
Mvmts needed to operate TD of **Above Elbow prosth.**
Operate→ Humeral Flex + Scap ABD
Lock elbow→ Shoulder depress + Humeral EXT and ABD
65
What problem is unique to training the UE amputee?
Dom vs Non-dom handedness\*\*\*
Ask them/communication!!!
66
Prosth Training
## Footnote
**Caring for Prosth.**
Never use to hammer, cleanse w/ soap/water daily, never oil hook!
67
Pre-prosthetic training:
## Footnote
**3 Things:**
Stump wrapping (edema/volume)
ROM
Massage
68
Myoelectric or Externally Powered Prosth.
## Footnote
**What is it?**
Uses **residual stump _muscles_** to **control TD**
## Footnote
**ex. Utah Arm**
69
Myoelectric or Ext. Powered Prosth.
## Footnote
**HOW does it _work?_**
* **Surf. electrodes** placed over **specific mm's** to **monitor electrical output from those mm's** and deliver **signals TO amplifier and processor→** then directly to **motor of TD**
***NOTE:** Find **one good EMG site==\>** you can control device*\*\*\*
70
Myoelectric Prosth.
## Footnote
**ADVANTAGES**
High cosmesis, **free from harnessing**
**\*_Superior pinch_** when compared to VO hook of conventional prosth
71
When do we fit a patient w/ **myoelectric prosth?**
3-4wks
72
Myoelectric or Ext Powered Prosth.
## Footnote
**Electrode Placement**
**Considerations:**
Free of **skin grafts/scars**
## Footnote
**\*Located over a _motor point_**
73
ABOVE-Elbow Myoelectric Prosth.
## Footnote
**Indications (who/when?):**
* Adequate stature (for tolerance), motivation, suff. learning abilities, adeq. funding
* **@ Least _One_ EMG site**
* **\*Functional _NEED_ for myoelectric prosth.**
74
ABOVE-Elbow Myoelectric Prosth.
## Footnote
**Contraindications (DO NOT USE):**
* Unable to bear wt of prosth.
* Inadeq. motivation, learning abilities
* Inability to follow usage guides
* **Radical limb/mm tissue removal due to Cx**
75
Advantage of the Myoelectrical prosth. is that it provides **sig. stronger \_\_\_\_\_\_\_\_\_** vs. conventional prosth.
**Pinch strength!!!**
76
Prosth. Hands
## Footnote
**Explain…**
* 5 **_individually powered_** digits\*
* **_Friction_ thumb rotation**
* **Flexion wrist options\***
* **\*\*10-24 grip patterns!!!**
77
Prosthetic Digits
see pics
78
**Functional Uses of _Aesthetic Prostheses_:**
* Stable working surface, restore add. length, **preserve useful sensation,** improve **function,** better rehab pot. (psycho. bennies)
79
Aesthetic Hand Prosth.
## Footnote
**Advantages**
* **Appearance**
* **Low maint.**
* **_Multipos. jts_→** improve ability to grasp objs
80
Aesthetic Hand Prosth.
## Footnote
**Disadvantages:**
* **LIMTD ability to _grasp_**
* Seasonal changes skin tone→ diff to duplicate
81
What age is a **child** fitted w/ a prosthesis?
## Footnote
**Ideally…**
6-8mos old
82
Since a prosth. for a young child **does NOT permit _active prehension_, what is its function?**
## Footnote
**5:**
* Move thru B/L dev. milestones _normally_
* Get used to it
* Body image
* B/L symmetry
* **Lack of sensation to RL _becomes new norm._**
83
Function of **Pediatric UE Prosth.**
* Balance/symmetry, simulates B/L function @ normal dist from body, body image **includes prosth.**
* **DEC dependence on tactile stim/sensation**
* Helps child/family prepare for active prosth. use
84
Peds. UE Amps:
## Footnote
**Terminal Devices**
**All first then later broken down**
* **Infants→** “Baby mitt” (just put on for length, symmetry)
* **6-8mos→** VO (volunt open) hoods, NO cable
* **15-24mos→** control cables attached to hook
* **18-30mos→** Most children operate TD
* **3-5yo→** larger hook reqd, new TD
* **5-15yo→** hooks change dep. on activity lvl
\*NOTE: **prosth must _grow with them_**!!!
85
Peds UE Amps:
## Footnote
**TD's→ Infants**
Baby Mitts for **length/symmetry**
86
Peds UE Amps:
## Footnote
**TD's**
**6-8mos**
VO hooks, NO cable
87
Peds UE Amps:
## Footnote
**TD's**
**15-24mos**
Control cables attached to hook
88
Peds UE Amps:
## Footnote
**TD's**
**18-30mos**
MOST children can operate TD
89
Peds UE Amps:
## Footnote
**TD's**
**3-5yo**
Larger hook reqd or New TD
90
Peds UE Amps:
## Footnote
**TD's**
**5-15yo**
Hooks change depending on **activity lvl**
