Prosthetic Intervention for Upper Extremity Amputees

Cody McDonald, CPO Orthotic and Prosthetic Centers @UCSF October 30th, 2009

Overview
Population UE vs LE Types of prostheses

Levels of amputation
Your Role

New Technology

Patient Population
Incidence
Male to female
Of amputation Of prosthetic use

Causes
Trauma Congenital Disease

Cancer

Differences between upper and lower extremity

Differences between upper and lower extremity

Level of function Dexterity Fine Motor vs. Gross Motor

Differences between upper and lower extremity

Sensation Visual Reliance

Differences between upper and lower extremity

Visual Societal concepts 2nd only to face

Differences between upper and lower extremity

Energy
Mental Physical

Training
Control Motions OT

Differences between upper and lower extremity

Percent of use Why?

Types of Prostheses
Passive
Cosmetic restoration
Passively support, stabilize for bimanual activities

Body Powered
Harness captures gross body movements Sensory feedback via harness Most often hook terminal device

Myoelectric
Electrodes use EMG signals to control terminal device Electric/powered, must be charged $$$

Passive Prosthesis

Body Powered Prosthesis

Myoelectric Prosthesis

Levels of amputation

Levels of amputation
Partial hand

Levels of amputation
Wrist disarticulation

Levels of amputation
Transradial

Levels of amputation
Elbow disarticulation and Transhumeral

Levels of amputation
Shoulder disarticulation

Levels of amputation
Interscapular Thoracic

Your Role
When to refer

New amputees
Sooner the better Pre-op consultations Shrinkers Therapy

Prosthetic users
Functionality Skin irritation Pain Questions

Prosthetic Selection
Patient
ROM
Strength Tissue type/coverage Goals/Preference Cosmesis/Function Funding Level of Amp

Pros and Cons body powered prostheses

Low weight Low cost Reliable Reduced work area Restricted if weakness, lack of ROM, or scar tissue Cosmesis

Sensory feedback
Faster response

Harness discomfort
Less grip strength

Pros and Cons external powered prostheses

Grip strength Bigger work envelope Hand cosmesis Bilateral and higher levels better function Wider application when limitations are involved Cost Reliability Slower response

Does not respond in some climate/work environment

I Limb
TD with individually articulating digits More realistic Can grasp round objects Not independently controlled Still grasp/release More moving parts, more maintenance

Targeted Muscle Reinnervation (TMR)

Surgical procedure

Dr. Kuiken
Rehab Institute of Chicago(RIC) Redistribution of nerves from brachial plexus Separate pieces of same muscle (pectoralis major) Multiple electrodes More precise function and less mental energy Think about moving hand and it does

Targeted Muscle Reinnervation (TMR)

Research and Development

Higher levels for now

Skin integrity Success of surgery

DARPA
Government Funded Revolutionizing Prosthetics $30.4 million

John Hopkins (Applied Physics Lab) $18.1 million 2007 DEKA

RIC Dr. Kuiken

DARPA
Fully powered 22 degrees of freedom Shoulder flex/ext, IR/ER, abduct/adduct Elbow flex/ext

Wrist flex/ext, Pro/Sup

Digit flex/extend

Happy Halloween!