Prostheses & Terminal Devices Advantages/Disadvantages
-Durable
-Can be exposed to environmental conditions (e.g., water and dirt)
-Provides proprioceptive feedback
-Lower maintenance costs THAN myoelectric protheses
Advantages to Body-Powered Prostheses
Uses specific muscles to place tension on cable that opens or closes the TD:
-2 Main Types-
Body-Powered Prostheses
1. HOOK
2. PROSTHETIC HAND
Muscle contractions of 2 different muscle groups are used to control the Myoelectric (electrically powered) TD
Myoelectric Prostheses
1. Electric Hook
2. Hands (Sensor Hand) & (Multi-articulating Hands)
Combination of of Body-Powered and Electrically Powered
Hybrid Prosthesis
STATIC Prosthesis
Passive Prosthesis
Minimal harness or cabling
Activity-Specific Prosthesis
nerve endings adhered(attached) to scar tissue
(can be very painful and hypersensitive)
Neuromas
Pre-prosthetic Interventions
1. Change of dominance activities, if needed
2. ROM of uninvolved joints
3. Strengthening of joints PROXIMAL to the amputation
4. Prepare limb for prosthesis
5. Desensitization
6. Wrapping to shape and shrink the residual limb
7. ADL training, including education in skin care
8. Education in Decubiti prevention (pressure ulcers/bedsores)
9. Supportive counseling to facilitate adjustment
10. Individulaized treatment to enhance physical and psychological adjustment
Functional training with prosthesis
Practice engagement in activities of interest and occupational role activities
Wrapping to _____ residual limb and decrease ________.
What is the alternative?
wrapping to shape the residual limb and decrease swelling
alternative: using different size shrinkers
-Restrictive harness
-DEC grip force compared to myoelectric options
-Force is exerted on the residual limb
-Can be difficult to control for high levels of amputations
Disadvantages to Body-Powered Prostheses
Both HOOKs and HANDs are operated in 1 of 2 ways:
Body-Powered Prostheses
1. VOLUNTARY CLOSING (VC)
2. VOLUNTARY OPENING (VO)
1 of 2 types of Myoelectric Prostheses:
-allows for pinch and fine motor manipulations including opposition
1. Electric Hook - Myoelectric Prostheses
most common for elbow or above elbow amputations
Hybrid Prosthesis
-used for cosmetic appearance
-can be passively adjusted to assist with carrying and grasping items
-no harnessing or control cables
Passive Prosthesis: Static
designed to be used for specific work and leisure tasks
Activity-Specific Prosthesis
sensation of the presence of the amputated limb
Phantom Limb Syndrome
Wrap DISTAL to PROXIMAL
Donning and Doffing the prosthesis
-residual limb sock
-prosthetic liner
-prosthetic socket and/or harness
Desensitization
important treatment for LE amputations, and for ALL amputations
-Improved cosmesis
-INC and proportional grip force
-Minimal to no harnessing
-Provides a larger functional work envelope for use
-Minimal effort needed to control
-Can be fitted early in rehabilitation phase
Advantages to Myoelectric Protheses
Hook remains opened until tension is placed on cable and then it closes
hint: think of opposite
Voluntary Closing (VC) - Body-Powered Prostheses
1 of 2 types of Myoelectric Prostheses:
-2 types-
2. Hands(for cosmetic appearance) - Myoelectric Prostheses
1a. SENSOR Hand = can open and close and has 3-point pinch
2b. MULTI-ARTICULATING Hand = multiple grasp patterns that allow for increased functional use
hybrid
INC grip strength
can be used interchangeably with a Body-Powered or Myoelectric prosthesis
Activity-Specific Prosthesis
sensation of the presence of the amputated limb, but also painful
Phantom Limb Pain
When wrapping residual limb, how is tension applied?
Tension should DECREASE with PROXIMAL wrapping
Increase prosthetic wearing tolerance:
Initial stages?
starts out 15-30 minutes, 3x daily and increases as tolerated
strengthening the UE with the focus on what muscle group?
Triceps (increasing strength in triceps helps person stand or weight shift with a LE amputation)
-INC cost
-Frequency of maintenance and repair for battery
-Lack of sensory feedback
-Susceptible to interference from moisture or other environmental factors
-INC overall weight
Disadvantages to Myoelectric Prostheses
Hook remains closed until tension is placed on cable then it opens
hint: think of opposite; prescribed more than the VC
Voluntary Opening (VO) - Body-Powered Prostheses
Control of Myoelectric/electrically powered Prostheses:
-3 types of control-
Control of Myoelectric/electrically powered Prostheses
1. Transradial Prosthesis
2. Transhumeral Prosthesis
3. Shoulder Disarticulation
Additional potential complications of amputations
1. Infection
2. Knee flexion contractures in transtibial amputation
3. Psychological impairments due to shock/grief
example of education in decubiti prevention
weight shifting
Skin checks - most important?
most important is teaching the person to do skin checks before and after wearing the prosthesis
Transfer training, functional ambulation, and improving standing tolerance
stand pivot transfers, and ambulation often using a walker
-Simultaneous control of Elbow and Wrist or terminal device
-Less weight than an entirely electrically powered prostheses
-INC grip force
Advantages of Hybrid Prostheses
1 of 2 types of Body-Powered Prostheses:
Used to perform functional activities (4 types)
Hook TDs - Body-Powered Prostheses
a. Hook with Slanted Fingertips
b. Lyre Shape Hook
c. Aluminum
d. Stainless Steel
1. TransRADIAL Prosthesis - Myoelectric Postheses
uses wrist flexors and extensors
Important factors/considerations for Individualized pre-prosthetic intervention to enhance physical and psychological adjustments
1. Determination of the most appropriate prosthesis and TD is based on the person's age, amputation level, cognitive ability, interests, roles, and functional goals
2. The earlier a person is fitted for a prosthesis, the better acceptance and functional use of the device
Skin checks - what does the person need to watch for, and how often are they cleaning the residual limb?
teach the person to watch for excessive perspiration and redness, and clean the residual limb DAILY
ADL training - what is often the most difficult?
LE dressing
-Harness is required for operation of Elbow
-May be difficult to operate with a short Transhumeral or higher amputation because of the force required to operate elbow
Disadvantages of Hybrid Prostheses
Hook with Slanted Fingertips - Body-Powered Prostheses
easier for user to see during functional tasks
2. TransHUMERAL Prosthesis -Myoelectric Prostheses
Individualized treatment to enhance ______ and __________ adjustment
individualized treatment to enhance physical and psychological adjustment
preventing knee flexion contractures
wheelchair mobility and residual limb support
-No harnessing or control cables
-Provides cosmetic restoration and positive body image
-Low maintenance
-Lightweight
-Digits can be positioned for static grasp or opposition
Advantages of Passive Prostheses
Lyre Shape Hook - Body-Powered Prostheses
allows for cylindrical grasp
3. Shoulder DISarticulation -Myoelectric Prostheses
uses pectoralis major or infraspinatus
-Does NOT provide active grasping function
-Cosmetic covers that are made of latex or polyvinyl chloride (PVC) can stain easily
Disadvantages of Passive Prostheses
Aluminum - Body-Powered Prostheses
less weight, used mainly for lighter functional tasks
-Allow enhanced function and task-specific participation in a variety of activities
-Minimal harness or cabling
-Durable and low maintenance
-Reduces wear and tear on primary prosthesis
Advantages of Activity-Specific Prostheses
Stainless Steel - Body-Powered Prostheses
sturdier, better for heavier outdoor work
-Does NOT provide active grasp
-Appropriate for specific tasks only, not for a broad range of functions
Disadvantages of Activity-Specific Prostheses
1 of 2 types of Body-Powered Prostheses:
Hand TDs- Body-Powered Prostheses
a. used for cosmetic appearance and have limited pinch force
Control of Body-Powered Prostheses:
-3 Areas of Control-
Body-Powered Prostheses
1. Transradial Prosthesis
2. Transhumeral Prosthesis
3. Shoulder Disarticulation
Control of Body-Powered Prostheses
uses humeral (flexion) and scapular (ABduction)
1. TransRADIAL
Control of Body-Powered Prostheses
-uses humeral (flexion) and scapular (ABduction)
AND
scapula (depression), should (extension), & ABduction to lock and unlock elbow
2. TransHUMERAL
Control of Body-Powered Prostheses
-uses chest (expansion) to control the TD
3. SHOULDER DISarticulation