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Assistive Tech > P - UE Prosthetics > Flashcards

P - UE Prosthetics Flashcards

1
Q

what will be a limitation of any UE prosthesis

A

no prosthesis will be able to replicate all of the intact limbs functions:
* fine & gross motor skills
* communication/body language
* 28 simultaneous deg of freedom
* sightless proprioception - position, heat, moisture, pressure
* visually appealing, lightweight, waterproof, and self healing

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2
Q

what is a consideration when determining the best device for a pt

A

consider their goals
- the best device may not be the most technologically advanced version

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3
Q

what are the possible UE amputations

A
  • partial hand
  • wrist disarticulation
  • transradial
  • elbow disartic
  • transhumeral
  • shoulder disartic
  • 4 quarter (part of scap and thoracic wall)
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4
Q

how does a UE prosthetic eval differ from a LE

A

very similar

  • emphasis on activity specific devices & pt goals
  • cognition important - esp if considering myoelectic device
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5
Q

what is a component of holistic care than can be more important in UE amps than LE

A

mental health
- harder to hide UE amp than LE

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6
Q

what are the main objectives of acute care

A

soft tissue mob
scar management
wound care
desensitization (tapping, pressure)

prep limb for prosthesis + manage recovery

similar to LE amp

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7
Q

what are 6 components of pre-prosthetic care (past the acute phase)

A
  • limb shaping
  • strengthening
  • ROM
  • endurance
  • mental health considerations
  • myoelectric specific training
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8
Q

what are components of limb shaping and what is the goal?

A

compression devices
ace wrap

want a cylindrical shape and get edema out

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9
Q

what are strengthening components in pre-prosthetic care

A

sound limb
residual limb
core - so important for function

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10
Q

what are components to myoelectric specific training in pre-prosthetic care and what is the goal

A

EMG signal training
co-contraction/signal separation

goal - get them to create signals w/i limb

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11
Q

what are the 2 prosthetic options for a finger or partial hand amp

A

silicone restoration
functional prosthesis

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12
Q

finger/partial hand

silicone restoration benefits

A

realistic looking, cosmetic

functional:
* provides opposition
* protection if sensitive to touch
* mental health benefits

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13
Q

finger/partial hand

functional prostheses benefits

A
  • functional, durable
  • intuitive grasp
  • restores length of finger/hand
  • returns grip strength
  • provides opposition

opposition esp important w a thumb bc 50% of hand function

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14
Q

what are 4 considerations with transradial amputations

A

residual limb length
- surface area
- leverage
pron/sup ROM
ms strength
krukenberg operation

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15
Q

why is the residual limb length with a transradial amputation an important consideration

A

inc length = inc SA (inc area for force to be distributed on, relevant for heavy things) = inc leverage (control of prosthesis)

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16
Q

why is pronation/supination ROM an important consideration with a transradial amputation

A

by maintaining wrist function of pron/sup, dec amt of compensation needed from shoulder

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17
Q

what is the krukenberg operation and what are the benefits

A

separate ulna and radius to create pincer surface area

gives them ability to grab
still have proprioception/sensation bc of existing residual limb

rare to see today bc of advancement in prostheses

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18
Q

what are 4 considerations of a transhumeral amputation

A

residual limb length
- surface area
- leverage
- interaction w/o prosthesis (suspension may become an issue)
skin integrity
soft tissue coverage
muscular strength/myodesis

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19
Q

what is a myodesis

A

ms attaching well to residual limb (into bone)

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20
Q

what is the general rule when it comes to residual limb length

A

extra length always benefits the pt

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21
Q

what are shoulder disartics often related to (3)

A

malignant lesions
trauma
congenital etiologies

relatively uncommon

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22
Q

what is an important consideration with a shoulder disartic for prosthetics

A

patients often reject prosthetic use
- cumbersome, heavy, not very helpful (have to manage 3 joints)

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23
Q

what is a common cosmetic consideration with shoulder disartics

A

may leave small part of humeral head and neck remaining to preserve cosmesis
- w/o this, very obviously missing shoulder (won’t fill out shirt as well)

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24
Q

what are the 3 prosthetic design principles

A
  1. pressure = force / area
    - inc SA = more comfortable/effective
  2. torque = force x distance
    - larger moment arms dec amt of force needed to control device
  3. sum of forces = 0
    - sum of opposing forces is equal

same as LE

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25
Q

what pt pop is no UE prosthesis common in

A

congenital

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26
Q

what are the 4 options for UE prosthetic designs

A

passive
body powered
myoelectric
hybrid systems

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27
Q

what are the benefits to body powered prostheses

A

lightweight
durable
waterproof
no need to charge
improved sensory feedback to user
less expensive

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28
Q

what are 3 types of UE prosthetic suspension systems

A

harnessing
liner (lanyard/pin)
anatomical suspension

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29
Q

what is the most common UE prosthetic suspension system

A

anatomical

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30
Q

suspension systems

liner (lanyard/pin): how does it work, pros, cons

A

liner engages into locking mechanism at end of socket

**pro: **provides additional protection and cushioning
con: can be hot, donning can be challenging

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31
Q

suspension systems

how does anatomical suspension work

A

donning sleeve is used –> pulls soft tissue in and creates tension on skin against outer wall of socket
- potentially suspend over bony landmarks

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32
Q

passive vs cosmetic UE prostheses

A

passive - lacks actively controlled grasping capability

cosmetic - visually appealing/lifelike

a passive prosthesis may or may not be cosmetically appealing depending on purpose

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33
Q

what are 4 functions of passive terminal devices

A
  1. support/stabilization of objects
  2. restoration of some bimanual activities
  3. use of utensils, tools, grooming instruments (stick them b/w fingers)
  4. functional extension of residual limb to match sound side (good opposition, good balance, good posture)
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34
Q

what are 3 examples of passive terminal devices

A
  • hands
  • mitts
  • devices designed for sport/rec/vocation
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35
Q

what type of suspension is needed with passive terminal devices

A

usually no harnessing need bc typically lightweight

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36
Q

body powered terminal devices

voluntary opening vs voluntary closing

A

opening: closed at rest
- when you activate it, it opens

closing: open at rest
- when you activate it, it closes

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37
Q

body powered terminal devices

how does voluntary opening grip strength work

A

grip strength remains constant until modulated by user –> have to overcome full grip strength to open no matter what is needed for the task

difficult w delicate objects bc have to maintain appropriate tension to prevent crushing the object

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38
Q

body powered terminal devices

how does voluntary closing grip strength work

A

graded prehension is possible

user must apply constant cable tension to maintain grip -> more intuitive and natural
- manipulation of delicate objects requires less work

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39
Q

body powered terminal devices

what pts are better candidates for voluntary closing terminal devices and why

A

longer residual limbs and more distal amp levels bc requires more excursion

40
Q

body powered terminal devices

what is a huge benefit to utilizing a hook

A

it has a better visual field than mechanical hands

canted hooks > lyre

41
Q

body powered terminal devices

what is the locking feature on hooks for

A

to lock the hook in a certain amt of closure

42
Q

body powered terminal devices

what are 5 drawbacks of mechanical hands

A
  1. not very functional
  2. frictional loss of force
  3. glove restriction of motion
  4. limited pinch force
  5. contours block visual inspection

someone would probably use as an interchangeable hand for social occasions

43
Q

body powered terminal devices

what is the typical physical makeup mechanical hands

A

3 jaw check prehension pattern

44
Q

terminal devices: wrists

what is the purpose of a wrist prosthesis

A

attach and position the terminal device

45
Q

terminal devices: wrists

what do wrist prostheses primarily facilitate

A

pronation/supination

some units allow flexion, ext, or other mvmts

46
Q

terminal devices: wrists

what is the significance of having a good wrist unit

A

reduces amt of sound side compensation

47
Q

transradial prostheses

what are the 6 types of hinges

A
  1. flexible
  2. single axis
  3. polycentric
  4. step up
  5. residual limb activated locking
  6. outside locking
48
Q

transradial prostheses

flexible hinges: indications, function, attachments

A

long residual limbs

  • preserves residual forearm rotation
  • permits min of 50% of anatomic sup/pron

prox attach = tricep cuff
distal attach = prosthetic forearm

49
Q

transradial prostheses

how do single axis hinges function

A
  • provide axial/rotational stability
  • doesn’t restrict anatomic flex/ext elbow ROM
  • set in pre-flex to prevent elbow hyper-ext (esp when carrying heavy loads)
50
Q

transradial prostheses

polycentric hinges: indications, function

A

short limbs
- inc stability
- allows for higher trimlines
- dec tendency of soft tissue bunching

51
Q

transradial prostheses

step up hinges: indications, function, set up

A

short transradial limbs
strong pt (requires more force to activate)

amplifies (2xs) anatomic joint motion

requires separate prosthetic socket and forearm sections

52
Q

transradial prostheses

residual limb activated locking hinges: indications, function

A

short residual limb
poor strength
poor ROM
poor load bearing capacity

uses residual limb mvmt to operate locking hinges

53
Q

transradial prostheses

outside locking hinges: indications, function

A

elbow disartics
long transhumeral w/o space for elbow unit

lock on medial side and controlled manually or via shoulder mvmt

54
Q

elbow units for ED and transhumeral

friction vs inside locking elbows

A

friction - requires passive positioning of forearm

inside locking - locking mechanism triggered by cable/string

55
Q

elbow units for ED and transhumeral

who are friction elbows indicated for

A

low-impact
pedi
cosmetic restoration
brachial plexus injuries

56
Q

what is arguably the most important part of ensuring a positive prosthetic outcome

A

good fitting socket design

57
Q

harnessing

what are the 2 functions of a harness

A
  1. suspension - how prosthesis held to residual limb
  2. mvmt from intact body segment causes a transfer of force that actuates body powered componentry
    - move shoulders to pull on cable to activate terminal device
58
Q

harnessing

what is force

A

amt of power body must generate to activate terminal device

59
Q

harnessing

excursion

A

distance intact segment of body must travel to activate terminal device

60
Q

harnessing

what are 3 types of transradial harnesses

A

figure of 8
shoulder saddle
figure of 9

61
Q

harnessing - transradial

what 5 components make up a figure of 8 harness

A

axilla loop - attachment point
ant suspensor strap - hold pro up
control strap - activates cable
harness cross point - anchor
housing - where cable runs

62
Q

harnessing - transradial

how is power generated in a figure 8 harness

A

GH flex of ipsi shoulder with biscapular ABD

63
Q

harnessing - transradial

when is a shoulder saddle indicated for harnessing

A

when heavy lifting w prosthesis frequently required

64
Q

harnessing - transradial

what is the function behind the design of a shoulder saddle harness

A

allows distribution of pressure in areas other than contra deltopectoral groove and axilla
- uses chest wall and ipsi shoulder to support weight/force

65
Q

harnessing - transradial

when is a figure of 9 harnessing appropriate and what is its function

A

when socket design is self-suspending

control only, to activate the cable
- not really suspending prostehsis (doesn’t need an ant suspensor strap)

66
Q

harnessing - transhumeral

what function does a transhumeral harness must have

A

control both elbow and terminal device function

67
Q

harnessing - transhumeral

what sequence does the pt usually have to operate the device in

A
  1. position forearm - passive, cable system
  2. lock elbow - pull on strap, specific motion to lock
  3. activate TD - pull cable again
68
Q

harnessing - transhumeral

what does it mean that the device has split cable housing

A

single cable is responsible for 2 actions (at elbow and TD)

69
Q

harnessing - transhumeral

what are the control motions

A

GH flex and biscap ABD
- performs both elbow flex and TD activation

same control motions as transradial

70
Q

harnessing - transhumeral

what are the body motions to lock/unlock elbow

A

scap depression (down)
GH ext (back)
GH ABD (out)

71
Q

harnessing - transhumeral

what does it mean that the elbow locking mechanism is cyclical

A

each pull alternates b/w locked and unlocked

72
Q

harnessing - transhumeral

where is the elbow locking cable attached to

A

ant suspension strap

73
Q

harnessing - transhumeral

how does the elbow being locked or unlocked change the control cable’s function

A

unlocked = cable activates elbow function
locked = cable activates TD function

74
Q

harnessing - transhumeral

what are the 2 types of harnessing for transhumeral

A

shoulder saddle
nudge switch

75
Q

harnessing - transhumeral

shoulder saddle harnessing: indication, function, drawbacks

A

heavy lifting required

disperses forces across greater surface area using chest wall and ipsi shoulder
- can use rib cage expansion to strengthen anchor points

con: not as effective force transmission

76
Q

harnessing - transhumeral

nudge switch: indication, function, set up

A

insufficient excursion or forces available via harnessing

lever used to create action

typically by socket so pt can push on it w chin

77
Q

myoelectric prostheses

what about the limb length is important to consider when deciding if someone is a candidate

A

build height
residual limb length for electrode surface area

78
Q

myoelectric prostheses

pros and cons

A

pros:
- doesn’t require gross body mvmts
- inc grip strength
- inc envelop of operation
- improved control
- improved cosmesis

cons:
- reliance on external power source
- inc wt
- susceptible to damage
- inc cost

79
Q

myoelectric

what are 3 types of terminal devices

A

single degree of freedom hands
single degree of freedom hooks
multiple degrees of freedom hands

80
Q

myoelectric

single degree of freedom hand: function and pros

A

simple open/close prehension
- rigid IP joints
- articulating at MCP and CMC joint

1-2 motors to oppose thumb against digits 2 and 3 (digits 4 and 5 are passive)

cosmetic appearance, simpler

81
Q

myoelectric

single degree of freedom hooks: function, pros, cons

A

simple open/close prehension
1-2 motors w rigid orientation for opposition

pros: strong pinch force, inc visual feedback, robust/stronger design
con: sacrifice cosmesis

82
Q

myoelectric

multiple degrees of freedom hands: indications, function, cons

A

light/medium duty activities

multi-articulating w inc # of functional graspoing patterns

5-6 motors for more degrees of freedom
- may dec opposition force
- dec battery life

cons: more complicated, heavier

83
Q

myoelectric

what is the most common prosthetic set up for a transhumeral amputee and why

A

passive elbow w myoelectric hand
- cuts down on wt and less cumbersome to control

84
Q

myoelectric

when are myoelectric elbows appropriately indicated

A

need to have enough ms control to do multiple motions (these are heavy)

85
Q

myoelectric

what are common cons in almost all myoelectric devices

A

complicated and heavy

86
Q

myoelectric

what is required for shoulder componentry

A

frame that will go against chest wall

87
Q

myoelectric control

what are myoelectric signals

A

signals associated w ms contraction in the residual limb which can be picked up by external electrodes placed against the skin inside the prosthetic socket

88
Q

myoelectric control

what are the 3 possible control strategies

A

single site
dual site
pattern recognition

89
Q

myoelectric control

what is single site control

A

one place where the electrode is, you contract your ms and it does one thing –> you contract again and does the opposite

90
Q

myoelectric control

what is dual site control

A

separates the motions

91
Q

myoelectric control

what is pattern recognition

A

creating pattern of motion w residual limb and electrodes placed around socket pick up on pattern and create the associated action

92
Q

myoelectric control

what is a needed component bc of the size of ms activity

A

need an amplifier to amplify amt of motion seen

93
Q

myoelectric control

power source vs prosthesis motor

A

power source = allows it to create motion
prosthesis motor = driven by power source to activate prosthesis

94
Q

what is targeted muscle reinnervation (TMR)

A

redirect nerves back to pectoral ms
- so if pt pretends to do motion, activates that nerve associated w the motion –> put sensor on that spot and it will pick up on that to create the action

95
Q

what pt pop is TMR more targeted for

A

it is a way for high level pts to have higher control of their prosthesis

96
Q

what is significant about HiFi socket design

A

about the interface and creating something that focuses on stabilizing the bone w/i limb and preventing any rotation in the socket

socket design is key to fit and outcome

97
Q

pros and cons of osseointegration

A

pros:
- eliminates need for socket
- can still use pattern recognition
- less hot
- more comfortable
- more sensation and feedback

cons: risk of infection

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