UE Prosthetics Flashcards
What percentage of UE amputees are not fitted with a prosthetic device
50%
Etiology
Trauma
Disease
Congenital Issues
Tumors
Levels of amputation - Forequarter
Absence of any portion of shoulder complex
Usually sacrifice clavicle, scapula, ribs, and entire UE
Usually the result of a malignancy
Levels of amputation - shoulder disarticulation
through the GH joint
Levels of amputation - Transhumeral - Short and Standard
AE - above elbow
Short = 30-50% of humerus intact
Standard = 50-90% humerus intact
Levels of amputation - Elbow disarticulation
Through the elbow joint
Levels of amputation - Transradial Very Short Short Medium Long
BE - below elbow
Very short - up to 35% forearm intact, 2 to 4 in from lateral epicondyle
Short - 35-55% forearm intact, 4 to 6 in from lateral epicondyle
Medium - 55-75% of forearm intact, 6 to 8 from lateral epicondyle
Long - 75-90% forearm intact - 8 to 10 in from lateral epicondyle
Levels of amputation - wrist disarticulation
Radiocarpal joint/transcarpal
*** Longer residual limb =
more options and the more function they will have
Surgical procedures and post op device - Muscle stabilization
Can reattach tendons/mm
Surgical procedures and post op device - Contour bone
Remove possible sites of pressure intolerance
Provide enough contour to provide stability for device
Surgical procedures and post op device - Immediate post operative prosthesis
IPOP
Prevent edema to help prevent pain and improve healing
Can add terminal device for early function/acceptance
Surgical procedures and post op device - Conventional
Most common
Sterile gauze and ace wrap - questionable edema control
Can’t add terminal device
Acute management - goals
Promote healing
Independence in ADLs
Pt and family education
Acute management - activities
Evaluation Wound healing Edema control Desensitization Scar management Pain control Gross motor activity Psych support
Subacute management includes
Pre prosthetic training
Prosthetic training
Advance training
Subacute management - pre prosthetic training
Postural exercises and strengthening
ADLs/adaptive equipment/hand dominance
Myosite training
Continued residual limb care
Subacute management - prosthetic training
Donning and doffing
Device maintenence
Residual limb tolerance
Long term management
Device replacement
Ongoing residual limb care
Types of prosthetic devices - Cable powered
Prosthesis powered and controlled by gross body movements captured by harness system
Functional use of residual limb to tension the cable
More for labor (picking up child, lumber jack)
Types of prosthetic devices - Externally powered (myoelectric)
Operated by battery system
Uses mm contraction to open and close
More for fine motor activity (painter)
Types of prosthetic devices - Hybrid
Combination of cable and externally powered system
Good for heavy duty and precision use
Hand is usually myoelectric
Elbow myoelectric if moderately heavy duty work/cable if heavy work
Ex - PT
Prosthetic components - terminal devices -
Hands
Hooks
Prosthetic components - terminal devices - Hands
Can be passive or active
Passive - cosmetic
Prosthetic components - terminal devices - Hands - passive
Cosmetic
Covered with flexible plastic glove to match skin
Can passively adjust fingers, use as assist
8 oz.
Prosthetic components - terminal devices - Hands - active
Can be cable operated or myoelectric
Prosthetic components - terminal devices - Hands - Cable operated
Shoulder flexion operates
Only digits 1-3 open
14 oz
Prosthetic components - terminal devices - Hands - Cable operated - adv
cheaper than myoelectric
Prosthetic components - terminal devices - Hands - Cable operated - disadv
not cosmetically appealing
Prosthetic components - terminal devices - Hands - Myoelectric
Skin electrodes in contact with intact mm
grip force 20-30#
Prosthetic components - terminal devices - Hands - Myoelectric - adv
grade grip force/cosmetic
Prosthetic components - terminal devices - Hands - Myoelectric - disadv
slipping
Prosthetic components - terminal devices - Hooks
Aluminum or steel
grip force 10#
lightweight (3 oz) and durable
Can interchange between hook and cable powered hand
Prosthetic components - Wrist unit
Attachment of terminal device
Provides for supination and pronation
Most units are passive
Inc ind for B UE amputees
Prosthetic components - Elbow units
Transradial may use if very short/weak elbow flexors
Can lock in a variety of positions
Prosthetic components - Shoulder joints
Not very common
Use with shoulder disariculation or forequarter
Prosthetic components - harness systems
Function is to suspend prosthesis/control TD and elbow
Prosthetic components - harness system for Transradial
Figure 8 is most common
Chest strap if very short transradial or heavy work
Prosthetic components - harness system for Transhumeral
Dual control harness system
Same cable controls elbow and TD
PT assessment and intervention - ROM
Strive for normal
Transhumeral needs at least 90 shoulder flex/abd and 30 ext
Do not forget cervical and shld complex mobility
PT assessment and intervention - Strength
Residual limb
Myoelectric sites
PT assessment and intervention - EMG training
Use of e stim
Biofeedback
PT assessment and intervention - Posture
Trunk tends to SB towards affected side
Lose arm swing/trunk rotation - balance/gait will be affected
PT assessment and intervention - Pain
Residual limb pain
Phantom pain
PT assessment and intervention - Scar
mobility and desensitization
PT assessment and intervention - Hand dominance
May need to change
Occupational consultatio
PT assessment and intervention - Psychological adaptations
Body image
Loss of function/perceived loss of function
Rehab team members
Physician pt Nursing Family Prosthetist Therapist (PT and/or OT) Counseling Vocational rehab
Functional outcomes - Unilateral transradial
Ind with don/doff Ind with ADLs Drives Retrun to work with weight lifting limitations Tie laces and ties Uses button hook Meal prep with ad Able to use tools for simple household chores Wears prosthesis full time
Functional outcomes - unilateral transhumeral
Same as transradial but more lifting limitations
