UE Amputations Flashcards
What is osseointegration?
Direct attachment to the bone; no socket required
Can be used with myoelectrics; Maximize existing ROM
What is a common problem with osseointegration?
Infection
Where can you receive osseointegration?
Europe (possibly US soon)
Who wore the first UE prosthesis?
Roman general, Marcus Sergius
No advancements until 1800s
What are 6 different UE prothesis we learned about?
None Passive (semi-hensile) Cable-operated Electric Hybrid Adaptive/activity-specific
How many UE amputees wear a prosthesis?
Less than 50%
What are benefits and limitations of no prosthesis? (4,4)
Comfort Proprioception Mobility Simplicity --- Functional range of motion Active prehension (typically) Balance Cosmesis
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).
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
What are limitations of a passive (Semi-Prehensile) Prosthesis? (4)
No active prehension
Limited function
Durability
Patient can have unreal expectations for cosmesis
What are 3 different types of passive (semi-prehensile) prosthesis?
Finger
Partial Hand
Higher Level
How does Cable-Operated Prosthesis work?
Powered and controlled by gross body movements captured by a harness system
What are the 2 basic requirements for cable-operation?
- Excursion (utilize body motions for control)
2. Force (force associated with those body motions)
Benefits of cable-operated prosthesis? (4)
Reduced weight
Reduced maintenance cost
Prehensor shape allows for improved visibility
Increased excursion velocity
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
What is an electrically powered prosthesis?
Powered by battery systems and are controlled by various input methods
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
What is the most common electric system?
Myoelectric control
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
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
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
What prosthesis is used for activities that do not require active prehension?
Passive (Semi-prehensile) Prosthesis
What prosthesis would you use for increased excursion velocity and improved visibility? (assuming you don’t care about poor cosmesis)
Cable-operated prosthesis
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.
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?
No
Is a Final silicone layer necessary for Silicone/Pre-Preg/Silicone?
no
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.
