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Prosthetic Interventionfor Upper Extremity

Amputees

Cody McDonald, CPO

Orthotic and Prosthetic Centers @UCSF

October 30th, 2009

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Overview

Population

UE vs LE

Types ofprostheses

Levels ofamputation

Your Role

New Technology

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Patient Population

Incidence

Male to female

Of amputation

Of prosthetic use

Causes

Trauma

Congenital

Disease

Cancer

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Differences between upperand lower extremity

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Differences between upperand lower extremity

Level of function

Dexterity

Fine Motor vs.Gross Motor

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Differences between upperand lower extremity

Sensation

Visual Reliance

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Differences between upperand lower extremity

Visual

Societalconcepts

2nd only to face

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Differences between upperand lower extremity

Energy

Mental

Physical

Training

Control Motions

OT

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Differences between upperand lower extremity

Percent of use

Why?

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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 terminaldevice

Electric/powered, must be charged

$$$

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Passive Prosthesis

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Body Powered Prosthesis

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Myoelectric Prosthesis

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Levels of amputation

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Levels of amputation

Partial hand

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Levels of amputation

Wrist disarticulation

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Levels of amputation

Transradial

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Levels of amputation

Elbow disarticulationand Transhumeral

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Levels of amputation

Shoulderdisarticulation

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Levels of amputation

InterscapularThoracic

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Your Role

When to refer

New amputees

Sooner the better

Pre-op consultations

Shrinkers

Therapy

Prosthetic users

Functionality

Skin irritation

Pain

Questions

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Prosthetic Selection

Patient

ROM

Strength

Tissue type/coverage

Goals/Preference

Cosmesis/Function

Funding

Level of Amp

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Pros and Consbody powered prostheses

Low weight

Low cost

Reliable

Sensoryfeedback

Faster response

Reduced workarea

Restricted if

weakness, lackof ROM, or scartissue

Cosmesis

Harnessdiscomfort

Less grip

strength

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Pros and Consexternal powered prostheses

Grip strength

Bigger workenvelope

Hand cosmesis

Bilateral andhigher levels

better function Wider

application whenlimitations are

involved

Cost

Reliability

Slower response

Does notrespond in someclimate/work

environment

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I Limb

TD with individuallyarticulating digits

More realistic

Can grasp roundobjects

Not independently

controlled Still grasp/release

More moving parts,more maintenance

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Targeted MuscleReinnervation (TMR)

Surgical procedure

Dr. Kuiken

Rehab Institute ofChicago(RIC)

Redistribution of nerves frombrachial plexus

Separate pieces of samemuscle (pectoralis major)

Multiple electrodes

More precise function andless mental energy

Think about moving hand and

it does

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Targeted MuscleReinnervation (TMR) Research and Development

Higher levels for now

Skin integrity

Success of surgery

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DARPA

Government Funded

RevolutionizingProsthetics

$30.4 million

John Hopkins (AppliedPhysics Lab)

$18.1 million 2007 DEKA RIC Dr. Kuiken

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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

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Happy Halloween!