UE Amputations Flashcards by Clint Boone

What is osseointegration?

Direct attachment to the bone; no socket required

Can be used with myoelectrics; Maximize existing ROM

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What is a common problem with osseointegration?

Infection

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Where can you receive osseointegration?

Europe (possibly US soon)

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Who wore the first UE prosthesis?

Roman general, Marcus Sergius

No advancements until 1800s

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What are 6 different UE prothesis we learned about?

None
Passive (semi-hensile)
Cable-operated
Electric
Hybrid
Adaptive/activity-specific

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How many UE amputees wear a prosthesis?

Less than 50%

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What are benefits and limitations of no prosthesis? (4,4)

Comfort
Proprioception
Mobility 
Simplicity
---
Functional range of motion
Active prehension (typically)
Balance
Cosmesis

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What is a Passive (Semi-Prehensile) Prosthesis?

A cosmetic restoration with limited functional capabilities.

Used for functional activities that do not require active prehension.

(Typically digits can be manipulated to enhance function).

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What are benefits of a passive (Semi-Prehensile) Prosthesis? (6)

Provides opposition
Can be cosmetic
Can be lightweight
Most are simple
Usually little maintenance
Can be inexpensive

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What are limitations of a passive (Semi-Prehensile) Prosthesis? (4)

No active prehension
Limited function
Durability
Patient can have unreal expectations for cosmesis

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What are 3 different types of passive (semi-prehensile) prosthesis?

Finger
Partial Hand
Higher Level

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How does Cable-Operated Prosthesis work?

Powered and controlled by gross body movements captured by a harness system

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What are the 2 basic requirements for cable-operation?

Excursion (utilize body motions for control)

2. Force (force associated with those body motions)

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Benefits of cable-operated prosthesis? (4)

Reduced weight

Reduced maintenance cost

Prehensor shape allows for improved visibility

Increased excursion velocity

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Limitations of Cable-Operated Prosthesis?

Grip strength or pinch force

Functional range of motion

Restrictive and uncomfortable harness

Poor static and dynamic cosmesis

Axilla anchor (possible nerve entrapment syndrome)

Atrophy of intrinsic muscles within encapsulated limb

Poor correlation between the neuromuscular system utilized for prosthetic action and that utilized for normal human movement

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What is an electrically powered prosthesis?

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What are the different control options for an electrically powered prosthesis? (7)

Myoelectric (single or dual side)
Switch:
-Rocker
-Pull
-Push
Touch Pads (FSR's)
Servo
Linear Potentiometers

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What is the most common electric system?

Myoelectric control

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How does myoelectric control work?

Surface EMG signals are developed by muscle contractions that are used by microporcessors to control elbows, wrists, and hands, or other terminal devices

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What are benefits of an electrically powered prosthesis? (5)

Increased functional ROM
Provides functional cosmetic restoration
Increased grip strength
Harness system reduced or eliminated
-Improved comfort

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What are 6 reasons people may choose to not use a UE prosthesis?

Bad first experience

Financial concerns

Unaware of options

Limited functional ability

Not worth the “hassle”

No rehabilitation program

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What prosthesis is used for activities that do not require active prehension?

Passive (Semi-prehensile) Prosthesis

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What prosthesis would you use for increased excursion velocity and improved visibility? (assuming you don’t care about poor cosmesis)

Cable-operated prosthesis

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What type of battery is separated for more options?

Split cell

Split cell batteries are a nice option if space is limited within the prosthesis. As shown in the transcarpal fitting, the split cell batteries were placed inside the 4th and 5th digit of the hand shell, therefore reducing the bulk inside the prosthesis.

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What are 9 different terminal devices we learned about in class?

Sensorhand Speed Transcarpal hand DMC hand Motion Control hand ETD Greifer VASI System 2000 I-Limb

What terminal limb uses coding plugs to change the control mode?

Sensorhand speed Myoselect Increased speed- 300mm/sec Auto grasp feature Flexigrip feature

Which prosthetic hand offers an auto grasp feature?

Otto Bock Sensorhand Speed-

What terminal limb is: Available as DMC or Digital twin 1/3 the weight and length of adult hands?

Transcarpal hand Direct lamination to socket or QD option Good lightweight option with endoskeletal adapter

T or F: The transcarpal hand is not available with a quick disconnect feature

False (it does have a quick disconnect feature)

What are features of a motion control hand? (6)

Can operate with up to 18 volts (faster) Made of high strength lightweight composite Battery save feature (shuts off power when max force is reached) Wide finger opening (4 inches) With or without controlled Available with flexion wrist

What are features of ETD (Motion control) (8)

``` Lightweight electric option Good visibility With or without controller Wrist flexion option Titanium finger option Anodized black finger option Water resistant Optional nylon sleeve ```

What is "a nice lightweight option if fine prehension is desired?" (allows for grasping of larger shaped objects)

ETD (Motion Control) Available in different flexion and extension positions. Titanium fingers are available to help improve strength and durability and anodized black fingers are also an option

What has the only available electric hook prehensor which is water resistant and an optional water resistant sleeve can be added to protect the wrist and other components from debris and moisture.

ETD (Motion Control)

The software used to program the Motion Control hand and ETD is:

ProControl 2

What terminal limb has: Safety release lever Manual grip force control wheel Max speed 180 mm/sec Extended finger tip option Built in friction flexion/deviation feature High grip force

Otto Bock greifer

What terminal limb has a removable plug that is used to activate the PLUS feature?

Otto Bock greifer

What terminal limb: The fingers can also be opened or closed manually by rotating the grip force control wheel. The grip force control wheel can give the individual fine prehension which may not be possible through EMG control. Extended finger tips can also be added to improve prehension and visibility

Otto Bock greifer

What terminal limb was designed with a built in wrist flexion feature to help position the hand in the most functional position?

Otto Bock greifer

``` What terminal limb: Sizes from 0-11 years Many wrist options Proportional control Wide opening Single or dual site Programmable ```

VASI pediatric hands

What terminal limb: Sizes- 5, 5.5, 6, 6.5 Control options with 4-in-1 controller Proportional or digital

Otto Bock System 2000

What are different UE arm prosthesis available?

``` Motion Control Utah 3 Boston Digital Arm VASI elbow Otto Bock 12K50 Microporcessors and Controllers ```

What elbow holds more weight, Utah or Boston?

Boston Digital Arm (9 lbs) vs Motion Control Utah 3 (2 lbs)

What elbow is used for kids?

VASI

What is a hybrid elbow which offers body powered control of the elbow and electric power to the terminal device?

Otto Bock 12K50

Are microprocessors built in or external?

Both; Can be either.

The new titanium hook from Hosmer is similar to which hook design?

Model 5X

What Must be used with teflon lining?

Spectra Cable | 3x less friction than steel on steel

What is an alternative to myoelectrodes that is a Good option for patients with little or no EMG?

Linear potentiometers

What is the most common UE amputation?

Fingers, by a lot Then thumb, prox to wrist, and hand

What terminal limb is designed for the TMC amputee?

I-Limb Digits

What terminal limb is Microprocessor controlled and used I-MO technology (Gesture control)

I-Limb

How are fingers aligned for the I-Limb?

``` Fingers aligned for function, not appearance --- Custom silicone socket interface Improved ROM Improved comfort Very durable Carbon fiber frame Very thin and strong ```

What are 5 different thumb options we learned about in class?

``` Two position M-Thumb Powered thumb (passive rotation) Powered thumb (powered rotation) Static post ```

What are considerations for bilateral UE amputees in regards to their prosthesis?

Modified, teeth friendly zipper pulls Confirm that patient will be able to independently don during evaluation fitting Goals: independent donn/doff Maximize function with and without prosthesis

What 4 things does the M-Thumb provide?

``` Opposition (adjustable) Flexion/extension (adjustable) Rotation Durability (and ability to use power tools) ```

What are 3 ideal candidates for finger prostheses?

Proximal to PIP PIP where multiple fingers are affected Someone seeking active function

How do finger prosthesis (e.g. M-Thumb) work?

MCP motion drives Partial M-Finger Very natural motion Finger nail improves grasp Good strength and ROM required

What socket: Works well with multiple fingers, Trim-lines coated with plasti-dip, but No adjustability

Pre-Preq

Is it easy to make a Silicone/Pre-Preg/Silicone low profile?

Is a Final silicone layer necessary for Silicone/Pre-Preg/Silicone?

Do you want to use Silicone/Pre-Preg/Silicone on single or multi finger involvement?

Single!

Who are candidates for silicone or pre-preg designs?

Ideal length proximal to PIP (.4 inches) Strength and ROM are essential Silicone and Pre-Preg currently optimal design Fabrication services available

What are the 4 objectives for this lecture?

Describe the common causes of UE amputation, and the most common level (e.g. fingers vs. whole arm). Discuss the pros & cons of using an UE prosthesis, from a patient’s perspective. Identify the various types of “hands” that are available for UE prosthetic options, and compare / contrast the more functional hands vs. the more aesthetic hands. Explain the advantages & disadvantages of cable vs. electric vs. myoelectric powered prostheses.