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Assistive Tech > P - UE Prosthetics > Flashcards

P - UE Prosthetics Flashcards

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1
Q

what will be a limitation of any UE prosthesis

A

no prosthesis will be able to replicate all of the intact limbs functions:
* fine & gross motor skills
* communication/body language
* 28 simultaneous deg of freedom
* sightless proprioception - position, heat, moisture, pressure
* visually appealing, lightweight, waterproof, and self healing

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2
Q

what is a consideration when determining the best device for a pt

A

consider their goals
- the best device may not be the most technologically advanced version

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3
Q

what are the possible UE amputations

A
  • partial hand
  • wrist disarticulation
  • transradial
  • elbow disartic
  • transhumeral
  • shoulder disartic
  • 4 quarter (part of scap and thoracic wall)
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4
Q

how does a UE prosthetic eval differ from a LE

A

very similar

  • emphasis on activity specific devices & pt goals
  • cognition important - esp if considering myoelectic device
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5
Q

what is a component of holistic care than can be more important in UE amps than LE

A

mental health
- harder to hide UE amp than LE

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6
Q

what are the main objectives of acute care

A

soft tissue mob
scar management
wound care
desensitization (tapping, pressure)

prep limb for prosthesis + manage recovery

similar to LE amp

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7
Q

what are 6 components of pre-prosthetic care (past the acute phase)

A
  • limb shaping
  • strengthening
  • ROM
  • endurance
  • mental health considerations
  • myoelectric specific training
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8
Q

what are components of limb shaping and what is the goal?

A

compression devices
ace wrap

want a cylindrical shape and get edema out

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9
Q

what are strengthening components in pre-prosthetic care

A

sound limb
residual limb
core - so important for function

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10
Q

what are components to myoelectric specific training in pre-prosthetic care and what is the goal

A

EMG signal training
co-contraction/signal separation

goal - get them to create signals w/i limb

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11
Q

what are the 2 prosthetic options for a finger or partial hand amp

A

silicone restoration
functional prosthesis

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12
Q

finger/partial hand

silicone restoration benefits

A

realistic looking, cosmetic

functional:
* provides opposition
* protection if sensitive to touch
* mental health benefits

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13
Q

finger/partial hand

functional prostheses benefits

A
  • functional, durable
  • intuitive grasp
  • restores length of finger/hand
  • returns grip strength
  • provides opposition

opposition esp important w a thumb bc 50% of hand function

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14
Q

what are 4 considerations with transradial amputations

A

residual limb length
- surface area
- leverage
pron/sup ROM
ms strength
krukenberg operation

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15
Q

why is the residual limb length with a transradial amputation an important consideration

A

inc length = inc SA (inc area for force to be distributed on, relevant for heavy things) = inc leverage (control of prosthesis)

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16
Q

why is pronation/supination ROM an important consideration with a transradial amputation

A

by maintaining wrist function of pron/sup, dec amt of compensation needed from shoulder

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17
Q

what is the krukenberg operation and what are the benefits

A

separate ulna and radius to create pincer surface area

gives them ability to grab
still have proprioception/sensation bc of existing residual limb

rare to see today bc of advancement in prostheses

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18
Q

what are 4 considerations of a transhumeral amputation

A

residual limb length
- surface area
- leverage
- interaction w/o prosthesis (suspension may become an issue)
skin integrity
soft tissue coverage
muscular strength/myodesis

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19
Q

what is a myodesis

A

ms attaching well to residual limb (into bone)

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20
Q

what is the general rule when it comes to residual limb length

A

extra length always benefits the pt

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21
Q

what are shoulder disartics often related to (3)

A

malignant lesions
trauma
congenital etiologies

relatively uncommon

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22
Q

what is an important consideration with a shoulder disartic for prosthetics

A

patients often reject prosthetic use
- cumbersome, heavy, not very helpful (have to manage 3 joints)

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23
Q

what is a common cosmetic consideration with shoulder disartics

A

may leave small part of humeral head and neck remaining to preserve cosmesis
- w/o this, very obviously missing shoulder (won’t fill out shirt as well)

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24
Q

what are the 3 prosthetic design principles

A
  1. pressure = force / area
    - inc SA = more comfortable/effective
  2. torque = force x distance
    - larger moment arms dec amt of force needed to control device
  3. sum of forces = 0
    - sum of opposing forces is equal

same as LE

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25
what pt pop is no UE prosthesis common in
congenital
26
what are the 4 options for UE prosthetic designs
passive body powered myoelectric hybrid systems
27
what are the benefits to body powered prostheses
lightweight durable waterproof no need to charge improved sensory feedback to user less expensive
28
what are 3 types of UE prosthetic suspension systems
harnessing liner (lanyard/pin) anatomical suspension
29
what is the most common UE prosthetic suspension system
anatomical
30
# suspension systems liner (lanyard/pin): how does it work, pros, cons
liner engages into locking mechanism at end of socket **pro: **provides additional protection and cushioning **con:** can be hot, donning can be challenging
31
# suspension systems how does anatomical suspension work
donning sleeve is used --> pulls soft tissue in and creates tension on skin against outer wall of socket - potentially suspend over bony landmarks
32
passive vs cosmetic UE prostheses
passive - lacks actively controlled grasping capability cosmetic - visually appealing/lifelike ## Footnote a passive prosthesis may or may not be cosmetically appealing depending on purpose
33
what are 4 functions of passive terminal devices
1. support/stabilization of objects 2. restoration of some bimanual activities 3. use of utensils, tools, grooming instruments (stick them b/w fingers) 4. functional extension of residual limb to match sound side (good opposition, good balance, good posture)
34
what are 3 examples of passive terminal devices
* hands * mitts * devices designed for sport/rec/vocation
35
what type of suspension is needed with passive terminal devices
usually no harnessing need bc typically lightweight
36
# body powered terminal devices voluntary opening vs voluntary closing
opening: closed at rest - when you activate it, it opens closing: open at rest - when you activate it, it closes
37
# body powered terminal devices how does voluntary opening grip strength work
grip strength remains constant until modulated by user --> have to overcome full grip strength to open no matter what is needed for the task difficult w delicate objects bc have to maintain appropriate tension to prevent crushing the object
38
# body powered terminal devices how does voluntary closing grip strength work
graded prehension is possible user must apply constant cable tension to maintain grip -> more intuitive and natural - manipulation of delicate objects requires less work
39
# body powered terminal devices what pts are better candidates for voluntary closing terminal devices and why
longer residual limbs and more distal amp levels bc requires more excursion
40
# body powered terminal devices what is a huge benefit to utilizing a hook
it has a better visual field than mechanical hands ## Footnote canted hooks > lyre
41
# body powered terminal devices what is the locking feature on hooks for
to lock the hook in a certain amt of closure
42
# body powered terminal devices what are 5 drawbacks of mechanical hands
1. not very functional 2. frictional loss of force 3. glove restriction of motion 4. limited pinch force 5. contours block visual inspection ## Footnote someone would probably use as an interchangeable hand for social occasions
43
# body powered terminal devices what is the typical physical makeup mechanical hands
3 jaw check prehension pattern
44
# terminal devices: wrists what is the purpose of a wrist prosthesis
attach and position the terminal device
45
# terminal devices: wrists what do wrist prostheses primarily facilitate
pronation/supination some units allow flexion, ext, or other mvmts
46
# terminal devices: wrists what is the significance of having a good wrist unit
reduces amt of sound side compensation
47
# transradial prostheses what are the 6 types of hinges
1. flexible 2. single axis 3. polycentric 4. step up 5. residual limb activated locking 6. outside locking
48
# transradial prostheses flexible hinges: indications, function, attachments
long residual limbs * preserves residual forearm rotation * permits min of 50% of anatomic sup/pron prox attach = tricep cuff distal attach = prosthetic forearm
49
# transradial prostheses how do single axis hinges function
* provide axial/rotational stability * doesn't restrict anatomic flex/ext elbow ROM * set in pre-flex to prevent elbow hyper-ext (esp when carrying heavy loads)
50
# transradial prostheses polycentric hinges: indications, function
short limbs - inc stability - allows for higher trimlines - dec tendency of soft tissue bunching
51
# transradial prostheses step up hinges: indications, function, set up
**short transradial limbs strong pt** (requires more force to activate) amplifies (2xs) anatomic joint motion requires separate prosthetic socket and forearm sections
52
# transradial prostheses residual limb activated locking hinges: indications, function
short residual limb poor strength poor ROM poor load bearing capacity uses residual limb mvmt to operate locking hinges
53
# transradial prostheses outside locking hinges: indications, function
elbow disartics long transhumeral w/o space for elbow unit lock on medial side and controlled manually or via shoulder mvmt
54
# elbow units for ED and transhumeral friction vs inside locking elbows
**friction** - requires passive positioning of forearm **inside locking** - locking mechanism triggered by cable/string
55
# elbow units for ED and transhumeral who are friction elbows indicated for
low-impact pedi cosmetic restoration brachial plexus injuries
56
what is arguably the most important part of ensuring a positive prosthetic outcome
good fitting socket design
57
# harnessing what are the 2 functions of a harness
1. suspension - how prosthesis held to residual limb 2. mvmt from intact body segment causes a transfer of force that actuates body powered componentry - move shoulders to pull on cable to activate terminal device
58
# harnessing what is force
amt of power body must generate to activate terminal device
59
# harnessing excursion
distance intact segment of body must travel to activate terminal device
60
# harnessing what are 3 types of transradial harnesses
figure of 8 shoulder saddle figure of 9
61
# harnessing - transradial what 5 components make up a figure of 8 harness
axilla loop - attachment point ant suspensor strap - hold pro up control strap - activates cable harness cross point - anchor housing - where cable runs
62
# harnessing - transradial how is power generated in a figure 8 harness
GH flex of ipsi shoulder with biscapular ABD
63
# harnessing - transradial when is a shoulder saddle indicated for harnessing
when heavy lifting w prosthesis frequently required
64
# harnessing - transradial what is the function behind the design of a shoulder saddle harness
allows distribution of pressure in areas other than contra deltopectoral groove and axilla - uses chest wall and ipsi shoulder to support weight/force
65
# harnessing - transradial when is a figure of 9 harnessing appropriate and what is its function
when socket design is self-suspending control only, to activate the cable - not really suspending prostehsis (doesn't need an ant suspensor strap)
66
# harnessing - transhumeral what function does a transhumeral harness must have
control both elbow and terminal device function
67
# harnessing - transhumeral what sequence does the pt usually have to operate the device in
1. position forearm - passive, cable system 2. lock elbow - pull on strap, specific motion to lock 3. activate TD - pull cable again
68
# harnessing - transhumeral what does it mean that the device has split cable housing
single cable is responsible for 2 actions (at elbow and TD)
69
# harnessing - transhumeral what are the control motions
GH flex and biscap ABD - performs both elbow flex and TD activation ## Footnote same control motions as transradial
70
# harnessing - transhumeral what are the body motions to lock/unlock elbow
scap depression (down) GH ext (back) GH ABD (out)
71
# harnessing - transhumeral what does it mean that the elbow locking mechanism is cyclical
each pull alternates b/w locked and unlocked
72
# harnessing - transhumeral where is the elbow locking cable attached to
ant suspension strap
73
# harnessing - transhumeral how does the elbow being locked or unlocked change the control cable's function
unlocked = cable activates elbow function locked = cable activates TD function
74
# harnessing - transhumeral what are the 2 types of harnessing for transhumeral
shoulder saddle nudge switch
75
# harnessing - transhumeral shoulder saddle harnessing: indication, function, drawbacks
heavy lifting required disperses forces across greater surface area using chest wall and ipsi shoulder - can use rib cage expansion to strengthen anchor points con: not as effective force transmission
76
# harnessing - transhumeral nudge switch: indication, function, set up
insufficient excursion or forces available via harnessing lever used to create action typically by socket so pt can push on it w chin
77
# myoelectric prostheses what about the limb length is important to consider when deciding if someone is a candidate
build height residual limb length for electrode surface area
78
# myoelectric prostheses pros and cons
pros: - doesn't require gross body mvmts - inc grip strength - inc envelop of operation - improved control - improved cosmesis cons: - reliance on external power source - inc wt - susceptible to damage - inc cost
79
# myoelectric what are 3 types of terminal devices
single degree of freedom hands single degree of freedom hooks multiple degrees of freedom hands
80
# myoelectric single degree of freedom hand: function and pros
simple open/close prehension - rigid IP joints - articulating at MCP and CMC joint 1-2 motors to oppose thumb against digits 2 and 3 (digits 4 and 5 are passive) cosmetic appearance, simpler
81
# myoelectric single degree of freedom hooks: function, pros, cons
simple open/close prehension 1-2 motors w rigid orientation for opposition pros: strong pinch force, inc visual feedback, robust/stronger design con: sacrifice cosmesis
82
# myoelectric multiple degrees of freedom hands: indications, function, cons
light/medium duty activities multi-articulating w inc # of functional graspoing patterns 5-6 motors for more degrees of freedom - may dec opposition force - dec battery life cons: more complicated, heavier
83
# myoelectric what is the most common prosthetic set up for a transhumeral amputee and why
passive elbow w myoelectric hand - cuts down on wt and less cumbersome to control
84
# myoelectric when are myoelectric elbows appropriately indicated
need to have enough ms control to do multiple motions (these are heavy)
85
# myoelectric what are common cons in almost all myoelectric devices
complicated and heavy
86
# myoelectric what is required for shoulder componentry
frame that will go against chest wall
87
# myoelectric control what are myoelectric signals
signals associated w ms contraction in the residual limb which can be picked up by external electrodes placed against the skin inside the prosthetic socket
88
# myoelectric control what are the 3 possible control strategies
single site dual site pattern recognition
89
# myoelectric control what is single site control
one place where the electrode is, you contract your ms and it does one thing --> you contract again and does the opposite
90
# myoelectric control what is dual site control
separates the motions
91
# myoelectric control what is pattern recognition
creating pattern of motion w residual limb and electrodes placed around socket pick up on pattern and create the associated action
92
# myoelectric control what is a needed component bc of the size of ms activity
need an amplifier to amplify amt of motion seen
93
# myoelectric control power source vs prosthesis motor
power source = allows it to create motion prosthesis motor = driven by power source to activate prosthesis
94
what is targeted muscle reinnervation (TMR)
redirect nerves back to pectoral ms - so if pt pretends to do motion, activates that nerve associated w the motion --> put sensor on that spot and it will pick up on that to create the action
95
what pt pop is TMR more targeted for
it is a way for high level pts to have higher control of their prosthesis
96
what is significant about HiFi socket design
about the interface and creating something that focuses on stabilizing the bone w/i limb and preventing any rotation in the socket ## Footnote socket design is key to fit and outcome
97
pros and cons of osseointegration
pros: - eliminates need for socket - can still use pattern recognition - less hot - more comfortable - more sensation and feedback cons: risk of infection

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