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- Traumas
- Burns
- Accidents at work
- War related traumas
Major contributors to upper limb amputations
- Strength (R and L)
- PROM (R and L)
- AROM (R and L)
- Endurance
- Grip strength
- Pinch strength -- lateral and 3JC (index, middle and thumb)
ROM/Strength/Control site
- Student
- were you employed at the time of limb loss?
- Status of current occupation
- If employed, current job title
Occupation
- Previous prosthesis
- Currently wearing a prosthesis
- If yes, duration
- Did the client have OT to learn to use the prosthesis
Prosthetic history of OT eval
Name the assessment tool:
Area of interest: participation
Variable measured: 14 everyday activities that a client rates on a scale from "very easy" to "cannot perform activity". The client also indicates weather they were using the prosthesis during the activity
Orthotic and prosthesis (OPUS)
Name the assessment tool:
Area of interest: 5 activities that are client priorities for prosthesis use
Variable measured: subjective activity performance; scale of 1-10, 1= unable to perform, 10= able to perform activity at the same level as before the injury or problem
The patient specific functional scale
- Establishing a relationship
- Education
- One handed tasks
- Adaptive equipment options
- HEP (ROM, strengthening)
Pre-surgery period
- Side of limb absence
- Hand dominance
- Level of limb/hand absence
- What was the cause of injury
History of OT eval
Name the assessment tool:
Area of interest: visuospatial/executive function; delayed recall; memory; attention; language skills; abstract thinking; orientation
Variable measurement: 10 item screening tool to determine cognitive ability to use prosthesis; visuospatial/executive functioning; delayed recall; memory; attention; language skills; abstract thinking; orientation
Montreal cognitive assessment (MOCA)
Name the assessment tool:
Area of interest: basic ADLs and IADLs
Variable measured: based on analysis of each activity; the therapist checks off where each step can be done unilaterally/bilaterally with prosthesis
Activity list
Name the assessment tool:
Area of interest: health related quality of life for individuals using UE prosthesis
Variable measurement: 23 item scale that a client rates from "not at all" to "excessively" or "all the time" to "none of the time"
- Must be started early
- Based on the clients emotion and aesthetic need, functional goals, understanding of the technology with certain products, financial limitations, and the uses he/she will have for the prosthesis
Prosthetic planning
- Scar tissue
- Sensation
- Pain in residual limb
- does the pain interfere
- Pain in the sound limb
- other related injury/disability
Limb condition
Classification type:
Cosmetic prosthesis not physically "functional" for ADLs/IADLs performance
Passive
- Goals
- Identifying lifestyles
- Expectations
- Identifying other team members
Pre prosthetic period
- Limb reshaping
- Desensitization
- Continued ROM and strengthening
2-3 weeks post surgery
Classification type:
- Advantages: ease of repair despite moving parts, initial cost and weight is lower than externally powered prosthesis; provides tension feedback to the body
- Disadvantages: use is reliant upon patients physical ability; mechanical in appearance
Body powered prosthesis
- Develop routines
- Create habits
- Success with everyday activities is essential
Name the 4 body driven prosthetics?
1. Naked prosthetics -- PIP driver
2. Nakeprosthetics -- MCP driver
3. Thumb driver
4. Grip lock finger -- digits 2-5 and is passive position able digit prosthesis
What are the (3) types of externally powered prosthesis?
1. Myoelectric
2. Switch controlled prosthesis
3. Hybrid prosthesis (body and externally powered)
- Transhumeral amputation or lower
- Device is activated by contracting the existing muscles
- Full prosthetics are available for shoulder disarticulations
- Increased grip patterns and programmable movements
Myoelectric devices
- Advantages: no harness so looks more natural; physical ability less critical for operation; provides strong grip force
- Myoelectric is for light activities
- Disadvantages: high initial cost and subsequent cost of repairs; heaviness due to battery; dependent on battery life.
Externally powered prosthesis
What are the (2) types of classifications for prosthetics?
1. Passive
2. Body powered prosthesis
- Built up handles
- Bidet
- Long handle sponge
- Sock aid
- Reacher
- Seatbelt extender
- One handed nail care
Adaptive equipment