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Prosthetics&Orthotics > L7: UE Prosthetics > Flashcards

L7: UE Prosthetics Flashcards

1
Q

MOST POPULAR CAUSE UE AMPS:

A

TRAUMA

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2
Q

MOST COMMON age group for UE amps:

A

16-35yo

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3
Q

Causes UE Amps:

Know the top 3 *‘d

A
  • *Acquired→ trauma, concomitant injuries
  • *Vascular
  • *Infx
  • Tumors
  • Congenital
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4
Q

Congenital Amps:

Can be 3 things:

A
  • Agenesis→ total absence OR lack of development
  • PARTIAL amp
  • COMPLETE amp
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5
Q

Congenital Amps: Radial (lat. side) deficiencies

A

Thumb HypOplasia (underdeveloped)

Absent radius

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6
Q

Congenital Amps: Ulnar (medial side) deficiencies

A
  • Ulnar HypOplasia→ under dev’d vs absent
  • Radio-humeral synostosis
    • union of 2 bones to form one

NOTE: Ulnar defs LESS COMMON vs radial

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7
Q

Congenital Amps:

Phocomelia

*think of “melia” as “little fingers” to remember!!!

A
  • Impaired dev. arm or forearm, hand close to body
  • Term digits used to activate myoelectric switches
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8
Q

Congenital:

Syndactyly

A

Fusion/webbing

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9
Q

MOST COMMON CONGENITAL DEFORMITY

A

POLYDACTYLY

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10
Q

Congenital:

Polydactyly

A

Extra digit

most common congenital deformity***

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11
Q

Sx Considerations:

Prosthetic NEED aka req’s prosthesis:

A
  • Wrist, CMC jts, Thumb, Metacarpals, Prox. phalanges
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12
Q

Sx Considerations: DO NOT req. prosthesis

A

Hands retaining a good thumb working against one or more fingers or a surgically constructed post

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13
Q

Amp Lvls: Thumb

A
  • Considered 40% impair. of UE
  • Pollicization→ transfer of another digit to thumb pad
    • Ex. Toe-to-Thumb Transfers (you know what this looks like!)
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14
Q

Amp Lvls: Digits

A
  • Index + Long Fingers
    • MOST important→ prehension
    • power grip
  • Ring and Small Fingers
    • isolated inj’s
  • Mult. Digits
    • relative usefulness of ea remaining digit
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15
Q

See pics

A

LABEL THEM!!!

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16
Q

Amp Lvls: Wrist Disarticulation

A

Preserves full SUP/PRO

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17
Q

Amp Lvls: Below Elbow (BE) aka

A

Transradial Amp

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18
Q

Amp Lvls: Below Elbow (BE)/Transradial Amp

A
  • Long
  • Med
  • Short→ loss of 60% forearm
    • NO rotation, ONLY flex/ext
  • Very Short→ <35% forearm remains
    • flexion limtd
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19
Q

Lvl of Amp: Elbow Disarticulation

A
  • Diff to fit prosthesis→ bc humeral condyles
  • Allows full UE rotation
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20
Q

Lvl of Amp: Above Elbow (AE) aka

A

Transhumeral

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21
Q

Lvl of Amp: Above Elbow (AE)/Transhumeral

A
  • Goal: preserve as much length as poss.
  • *<30% humerus remaining==> Treat as shoulder disarticulation
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22
Q

<30% humerus remaining===

A

treat as shoulder disarticulation

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23
Q

Lvl of Amp: Shoulder Disarticulation

A

Removal of entire humerus

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24
Q

Lvl of Amp: Forequarter Amputation aka and what about this to remember??

A

Interscapulothoracic amputation

*heavy prostheses→ less compliance!!!

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25
Q

Lvl of Amp: Forequarter Amp

A

aka Interscapulothoracic

  • removal clavicle and scapula
  • Sx Goal→ good muscle pad for prosth. fitting***
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26
Q

Psychological Aspects of Amputation:

What are the Physical Capacities

A
  • Functional Limitations vs. Functional Failures
    • Limitations→
      • Avoid task OR
      • Complete task w/ RL OR
      • Use a prosthesis
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27
Q

Psychological Aspects of Amp:

Comfort: includes…

A

Pain+pain tolerance, Phantom sensation, Fatigue (lots of energy expenditure @ first)

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28
Q

Psychological Aspects of Amps:

Appearance considerations

A

Visual considerations

Auditory considerations (not quiet)

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29
Q

Psychological Aspects of Amps:

Vocational and Economic….

Does it interfere w/….

A
  • Employability→ Mgmt vs Manual labor
  • Financial concerns→ maybe now you can’t work or provide for family
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30
Q

Psychological Aspects of Amps

Social

“Captain Hook” example***

A

Social prejudices

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31
Q

Prosthetic Options:

6 Total:

No Person Beats Eva’s Hot Ass

A
  1. NONE
  2. Passive prosthesis→ cosmetic, some function
  3. Body-powered prosth.
  4. Electric-powered prosth.
  5. Hybrid prosth.
  6. Activity-specific prosth.

No Person Beats Eva’s Hot Ass

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32
Q

Components of a Prosth.

5 Total:

A
  1. Terminal Device
  2. Wrist Unit
  3. Socket
  4. Elbow Unit
  5. Harness + Control Cables
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33
Q

Terminal Devices

Hooks vs. Hands

A
  • Hooks→ Lateral pinch
  • Hands→ Tripod/Palmar/3-Jaw Chuck Pinch
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34
Q

Terminal Devices

Hooks

2 types:

A
  1. Voluntary OPENING OR
  2. Voluntary CLOSING
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35
Q

MOST COMMONLY USED TERMINAL DEVICES

A

SPLIT HOOKS

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36
Q

Terminal Devices: Split Hooks

*MOST COMMONLY USED

Voluntary OPENING:

A
  • Exert force on control cable to open fingers against rubber bands→ act as spring to close them
    • Closing force=> #/type of rubber bands

*you’ve SEEN and USED this!!!

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37
Q

Terminal Devices Ex’s

A

see pics

38
Q

Terminal Devices: Hooks

Voluntary CLOSING (more advanced)

A
  • Amp closes device w/ own body power by means of control cable
  • Amp has precise control of finger pressure or prehension→
    • Ranges from ¼ to ½ lbs up to 20-25lbs***
39
Q

Terminal Devices: Hands

3 types:

A
  • Passive→ stabilize objs, cosmetic
  • Voluntary OPENING
  • Voluntary CLOSING
40
Q

TERM DEVICES:

Hooks vs Hands comparison:

A
  • Hands→ more cosmetic, better for grasping large/round objs
  • Hooks→ superior for grasping SMALL objs, can be used in restricted areas
41
Q

BE amp wishes to go back to work. She inspects/updates telephones to put them back into circulation. What type of Term Device does she choose?

A

Split Hook***

42
Q

Wrist Units

What do they DO?

A
  • Attaches terminal device TO socket
  • Allows interchangeable term. units***
43
Q

Sockets:

Standard Socket

A

Above Elbow Amp (AEA)

see pics

44
Q

Sockets:

Split Sockets are for….

A

SHORTER RL’s

45
Q

Sockets:

Split Socket

A

*Think shorter RLs

  • <35% of limb
  • Short or VERY short RLs
46
Q

This socket eliminates need for suspension apparatus

A

Muenster Socket

47
Q

Sockets:

Muenster Socket

A

goes over olecranon and humeral epicondyles***

  • Eliminates need for suspension apparatus
  • Need harness only for operating terminal device
48
Q

Harness and Controls

Think about your one client and when you used it at JFK…you know this!!!

A
  • Suspends prosth. from shoulders→ holds socket on stump
  • Body motions== sources of power/force
  • Forces transmitted via cable TO term. device
49
Q

Components of BE Prosth:

Harness and Controls

3 types:

A
  1. Figure-8
  2. Chest Strap w/ Shoulder Saddle
  3. Figure-9
50
Q

MOST COMMON HARNESS

A

FIGURE-8***

51
Q

Figure-8 Harness

Mvmts for term. device control and what it looks like

A

Humeral flexion w/ scapular ABD

*you used this one!!!

52
Q

Chest Strap w/ Shoulder Saddle Harness

Mvmts for term. device control and what it looks like

A

Chest expansion w/ B/L scapular ABD

53
Q

Figure-9 Harness

Mvmts for term. device control and what it looks like

A

Humeral flexion w/ scapular ABD→ ONLY for term. device control

*NOT in middle of back like figure-8

54
Q

Motions needed to operate terminal device w/ Figure-8 harness?

A

Humeral FLEXION w/ Scapular ABD

55
Q

ELBOW Units are for….

A

AEAs

56
Q

Elbow Units:

2 types:

A

Flexible hinge vs Rigid hinge

*both provide elbow flexion

57
Q

AE Harness+Controls

Purposes of harness:

A
  • Suspend prosth from shoulders, transmit power to flex forearm, lock/unlock elbow, operate term. device
58
Q

Components of AE Prosth: Harness + Controls

Mvts to Operate TD and Lock Elbow

A
  • Operate TD→ Shoulder FLEX and Scapular ABD
  • Lock Elbow→ Shoulder depress, Humeral EXT/ABD
59
Q

AE Prosth harness + controls

Operate TD?

A

Shoulder Flex, scap ABD

60
Q

AE prosth harness + controls:

LOCK elbow?

A

Shoulder depression, humeral EXT/ABD

61
Q

Shoulder Disartic and Forequarter Amp. Prosthesis

A

pics

62
Q

Components of Shoulder Disartic and Forequarter Amp Prosth.

3 things that make it more usable/comfortable:

A
  1. Abd jts→ permit passive ABD of humeral section
  2. Elastic Suspensor→ stabilizes shoulder section, allows Mvmt of shoulder girdle
  3. Excursion Amplifier→ converts Lg force/Sm. excursion INTO Lesser force/Incd excursion
63
Q

Excursion amplifier: shoulder disartic and forequarter amp prostheses

A

Converts Larger force/small excursion INTO Lesser force/Incd excursion

64
Q

Mvmts needed to operate TD of Above Elbow prosth.

A

Operate→ Humeral Flex + Scap ABD

Lock elbow→ Shoulder depress + Humeral EXT and ABD

65
Q

What problem is unique to training the UE amputee?

A

Dom vs Non-dom handedness***

Ask them/communication!!!

66
Q

Prosth Training

Caring for Prosth.

A

Never use to hammer, cleanse w/ soap/water daily, never oil hook!

67
Q

Pre-prosthetic training:

3 Things:

A

Stump wrapping (edema/volume)

ROM

Massage

68
Q

Myoelectric or Externally Powered Prosth.

What is it?

A

Uses residual stump muscles to control TD

ex. Utah Arm

69
Q

Myoelectric or Ext. Powered Prosth.

HOW does it work?

A
  • Surf. electrodes placed over specific mm’s to monitor electrical output from those mm’s and deliver signals TO amplifier and processor→ then directly to motor of TD

NOTE: Find one good EMG site==> you can control device***

70
Q

Myoelectric Prosth.

ADVANTAGES

A

High cosmesis, free from harnessing

*Superior pinch when compared to VO hook of conventional prosth

71
Q

When do we fit a patient w/ myoelectric prosth?

A

3-4wks

72
Q

Myoelectric or Ext Powered Prosth.

Electrode Placement

Considerations:

A

Free of skin grafts/scars

*Located over a motor point

73
Q

ABOVE-Elbow Myoelectric Prosth.

Indications (who/when?):

A
  • Adequate stature (for tolerance), motivation, suff. learning abilities, adeq. funding
  • @ Least One EMG site
  • *Functional NEED for myoelectric prosth.
74
Q

ABOVE-Elbow Myoelectric Prosth.

Contraindications (DO NOT USE):

A
  • Unable to bear wt of prosth.
  • Inadeq. motivation, learning abilities
  • Inability to follow usage guides
  • Radical limb/mm tissue removal due to Cx
75
Q

Advantage of the Myoelectrical prosth. is that it provides sig. stronger _________ vs. conventional prosth.

A

Pinch strength!!!

76
Q

Prosth. Hands

Explain…

A
  • 5 individually powered digits*
  • Friction thumb rotation
  • Flexion wrist options*
  • **10-24 grip patterns!!!
77
Q

Prosthetic Digits

A

see pics

78
Q

Functional Uses of Aesthetic Prostheses:

A
  • Stable working surface, restore add. length, preserve useful sensation, improve function, better rehab pot. (psycho. bennies)
79
Q

Aesthetic Hand Prosth.

Advantages

A
  • Appearance
  • Low maint.
  • Multipos. jts→ improve ability to grasp objs
80
Q

Aesthetic Hand Prosth.

Disadvantages:

A
  • LIMTD ability to grasp
  • Seasonal changes skin tone→ diff to duplicate
81
Q

What age is a child fitted w/ a prosthesis?

Ideally…

A

6-8mos old

82
Q

Since a prosth. for a young child does NOT permit active prehension, what is its function?

5:

A
  • Move thru B/L dev. milestones normally
  • Get used to it
  • Body image
  • B/L symmetry
  • Lack of sensation to RL becomes new norm.
83
Q

Function of Pediatric UE Prosth.

A
  • Balance/symmetry, simulates B/L function @ normal dist from body, body image includes prosth.
  • DEC dependence on tactile stim/sensation
  • Helps child/family prepare for active prosth. use
84
Q

Peds. UE Amps:

Terminal Devices

All first then later broken down

A
  • Infants→ “Baby mitt” (just put on for length, symmetry)
  • 6-8mos→ VO (volunt open) hoods, NO cable
  • 15-24mos→ control cables attached to hook
  • 18-30mos→ Most children operate TD
  • 3-5yo→ larger hook reqd, new TD
  • 5-15yo→ hooks change dep. on activity lvl

*NOTE: prosth must grow with them!!!

85
Q

Peds UE Amps:

TD’s→ Infants

A

Baby Mitts for length/symmetry

86
Q

Peds UE Amps:

TD’s

6-8mos

A

VO hooks, NO cable

87
Q

Peds UE Amps:

TD’s

15-24mos

A

Control cables attached to hook

88
Q

Peds UE Amps:

TD’s

18-30mos

A

MOST children can operate TD

89
Q

Peds UE Amps:

TD’s

3-5yo

A

Larger hook reqd or New TD

90
Q

Peds UE Amps:

TD’s

5-15yo

A

Hooks change depending on activity lvl

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