L7: UE Prosthetics Flashcards
MOST POPULAR CAUSE UE AMPS:
TRAUMA
MOST COMMON age group for UE amps:
16-35yo
Causes UE Amps:
Know the top 3 *‘d
- *Acquired→ trauma, concomitant injuries
- *Vascular
- *Infx
- Tumors
- Congenital
Congenital Amps:
Can be 3 things:
- Agenesis→ total absence OR lack of development
- PARTIAL amp
- COMPLETE amp
Congenital Amps: Radial (lat. side) deficiencies
Thumb HypOplasia (underdeveloped)
Absent radius
Congenital Amps: Ulnar (medial side) deficiencies
- Ulnar HypOplasia→ under dev’d vs absent
-
Radio-humeral synostosis
- union of 2 bones to form one
NOTE: Ulnar defs LESS COMMON vs radial
Congenital Amps:
Phocomelia
*think of “melia” as “little fingers” to remember!!!
- Impaired dev. arm or forearm, hand close to body
- Term digits used to activate myoelectric switches
Congenital:
Syndactyly
Fusion/webbing
MOST COMMON CONGENITAL DEFORMITY
POLYDACTYLY
Congenital:
Polydactyly
Extra digit
most common congenital deformity***
Sx Considerations:
Prosthetic NEED aka req’s prosthesis:
- Wrist, CMC jts, Thumb, Metacarpals, Prox. phalanges
Sx Considerations: DO NOT req. prosthesis
Hands retaining a good thumb working against one or more fingers or a surgically constructed post
Amp Lvls: Thumb
- Considered 40% impair. of UE
-
Pollicization→ transfer of another digit to thumb pad
- Ex. Toe-to-Thumb Transfers (you know what this looks like!)
Amp Lvls: Digits
-
Index + Long Fingers
- MOST important→ prehension
- power grip
-
Ring and Small Fingers
- isolated inj’s
-
Mult. Digits
- relative usefulness of ea remaining digit
See pics
LABEL THEM!!!
Amp Lvls: Wrist Disarticulation
Preserves full SUP/PRO
Amp Lvls: Below Elbow (BE) aka
Transradial Amp
Amp Lvls: Below Elbow (BE)/Transradial Amp
- Long
- Med
- Short→ loss of 60% forearm
- NO rotation, ONLY flex/ext
- Very Short→ <35% forearm remains
- flexion limtd
Lvl of Amp: Elbow Disarticulation
- Diff to fit prosthesis→ bc humeral condyles
- Allows full UE rotation
Lvl of Amp: Above Elbow (AE) aka
Transhumeral
Lvl of Amp: Above Elbow (AE)/Transhumeral
- Goal: preserve as much length as poss.
- *<30% humerus remaining==> Treat as shoulder disarticulation
<30% humerus remaining===
treat as shoulder disarticulation
Lvl of Amp: Shoulder Disarticulation
Removal of entire humerus
Lvl of Amp: Forequarter Amputation aka and what about this to remember??
Interscapulothoracic amputation
*heavy prostheses→ less compliance!!!
Lvl of Amp: Forequarter Amp
aka Interscapulothoracic
- removal clavicle and scapula
- Sx Goal→ good muscle pad for prosth. fitting***
Psychological Aspects of Amputation:
What are the Physical Capacities
- Functional Limitations vs. Functional Failures
-
Limitations→
- Avoid task OR
- Complete task w/ RL OR
- Use a prosthesis
-
Limitations→
Psychological Aspects of Amp:
Comfort: includes…
Pain+pain tolerance, Phantom sensation, Fatigue (lots of energy expenditure @ first)
Psychological Aspects of Amps:
Appearance considerations
Visual considerations
Auditory considerations (not quiet)
Psychological Aspects of Amps:
Vocational and Economic….
Does it interfere w/….
- Employability→ Mgmt vs Manual labor
- Financial concerns→ maybe now you can’t work or provide for family
Psychological Aspects of Amps
Social
“Captain Hook” example***
Social prejudices
Prosthetic Options:
6 Total:
No Person Beats Eva’s Hot Ass
- NONE
- Passive prosthesis→ cosmetic, some function
- Body-powered prosth.
- Electric-powered prosth.
- Hybrid prosth.
- Activity-specific prosth.
No Person Beats Eva’s Hot Ass
Components of a Prosth.
5 Total:
- Terminal Device
- Wrist Unit
- Socket
- Elbow Unit
- Harness + Control Cables
Terminal Devices
Hooks vs. Hands
- Hooks→ Lateral pinch
- Hands→ Tripod/Palmar/3-Jaw Chuck Pinch
Terminal Devices
Hooks
2 types:
- Voluntary OPENING OR
- Voluntary CLOSING
MOST COMMONLY USED TERMINAL DEVICES
SPLIT HOOKS
Terminal Devices: Split Hooks
*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!!!
Terminal Devices Ex’s
see pics
Terminal Devices: Hooks
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***
Terminal Devices: Hands
3 types:
- Passive→ stabilize objs, cosmetic
- Voluntary OPENING
- Voluntary CLOSING
TERM DEVICES:
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
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***
Wrist Units
What do they DO?
- Attaches terminal device TO socket
- Allows interchangeable term. units***
Sockets:
Standard Socket
Above Elbow Amp (AEA)
see pics
Sockets:
Split Sockets are for….
SHORTER RL’s
Sockets:
Split Socket
*Think shorter RLs
- <35% of limb
- Short or VERY short RLs
This socket eliminates need for suspension apparatus
Muenster Socket
Sockets:
Muenster Socket
goes over olecranon and humeral epicondyles***
- Eliminates need for suspension apparatus
- Need harness only for operating terminal device
Harness and Controls
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
Components of BE Prosth:
Harness and Controls
3 types:
- Figure-8
- Chest Strap w/ Shoulder Saddle
- Figure-9
MOST COMMON HARNESS
FIGURE-8***
Figure-8 Harness
Mvmts for term. device control and what it looks like
Humeral flexion w/ scapular ABD
*you used this one!!!
Chest Strap w/ Shoulder Saddle Harness
Mvmts for term. device control and what it looks like
Chest expansion w/ B/L scapular ABD
Figure-9 Harness
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
Motions needed to operate terminal device w/ Figure-8 harness?
Humeral FLEXION w/ Scapular ABD
ELBOW Units are for….
AEAs
Elbow Units:
2 types:
Flexible hinge vs Rigid hinge
*both provide elbow flexion
AE Harness+Controls
Purposes of harness:
- Suspend prosth from shoulders, transmit power to flex forearm, lock/unlock elbow, operate term. device
Components of AE Prosth: Harness + Controls
Mvts to Operate TD and Lock Elbow
- Operate TD→ Shoulder FLEX and Scapular ABD
- Lock Elbow→ Shoulder depress, Humeral EXT/ABD
AE Prosth harness + controls
Operate TD?
Shoulder Flex, scap ABD
AE prosth harness + controls:
LOCK elbow?
Shoulder depression, humeral EXT/ABD
Shoulder Disartic and Forequarter Amp. Prosthesis
pics
Components of Shoulder Disartic and Forequarter Amp Prosth.
3 things that make it more usable/comfortable:
- Abd jts→ permit passive ABD of humeral section
- Elastic Suspensor→ stabilizes shoulder section, allows Mvmt of shoulder girdle
- Excursion Amplifier→ converts Lg force/Sm. excursion INTO Lesser force/Incd excursion
Excursion amplifier: shoulder disartic and forequarter amp prostheses
Converts Larger force/small excursion INTO Lesser force/Incd excursion
Mvmts needed to operate TD of Above Elbow prosth.
Operate→ Humeral Flex + Scap ABD
Lock elbow→ Shoulder depress + Humeral EXT and ABD
What problem is unique to training the UE amputee?
Dom vs Non-dom handedness***
Ask them/communication!!!
Prosth Training
Caring for Prosth.
Never use to hammer, cleanse w/ soap/water daily, never oil hook!
Pre-prosthetic training:
3 Things:
Stump wrapping (edema/volume)
ROM
Massage
Myoelectric or Externally Powered Prosth.
What is it?
Uses residual stump muscles to control TD
ex. Utah Arm
Myoelectric or Ext. Powered Prosth.
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***
Myoelectric Prosth.
ADVANTAGES
High cosmesis, free from harnessing
*Superior pinch when compared to VO hook of conventional prosth
When do we fit a patient w/ myoelectric prosth?
3-4wks
Myoelectric or Ext Powered Prosth.
Electrode Placement
Considerations:
Free of skin grafts/scars
*Located over a motor point
ABOVE-Elbow Myoelectric Prosth.
Indications (who/when?):
- Adequate stature (for tolerance), motivation, suff. learning abilities, adeq. funding
- @ Least One EMG site
- *Functional NEED for myoelectric prosth.
ABOVE-Elbow Myoelectric Prosth.
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
Advantage of the Myoelectrical prosth. is that it provides sig. stronger _________ vs. conventional prosth.
Pinch strength!!!
Prosth. Hands
Explain…
- 5 individually powered digits*
- Friction thumb rotation
- Flexion wrist options*
- **10-24 grip patterns!!!
Prosthetic Digits
see pics
Functional Uses of Aesthetic Prostheses:
- Stable working surface, restore add. length, preserve useful sensation, improve function, better rehab pot. (psycho. bennies)
Aesthetic Hand Prosth.
Advantages
- Appearance
- Low maint.
- Multipos. jts→ improve ability to grasp objs
Aesthetic Hand Prosth.
Disadvantages:
- LIMTD ability to grasp
- Seasonal changes skin tone→ diff to duplicate
What age is a child fitted w/ a prosthesis?
Ideally…
6-8mos old
Since a prosth. for a young child does NOT permit active prehension, what is its function?
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.
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
Peds. UE Amps:
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!!!
Peds UE Amps:
TD’s→ Infants
Baby Mitts for length/symmetry
Peds UE Amps:
TD’s
6-8mos
VO hooks, NO cable
Peds UE Amps:
TD’s
15-24mos
Control cables attached to hook
Peds UE Amps:
TD’s
18-30mos
MOST children can operate TD
Peds UE Amps:
TD’s
3-5yo
Larger hook reqd or New TD
Peds UE Amps:
TD’s
5-15yo
Hooks change depending on activity lvl
