adaptive prosthetics - aztap– shoulder disarticulation – inter-scapulothoracic fore quarter...
TRANSCRIPT
ADAPTIVE PROSTHETICS
Deficits and devices of upper & lower limb amputees
Lorin Merkley, CP
Nextremity Prosthetic DesignNEXTREMITY PROSTHETIC DESIGN
TOPICS COVERED
■ Major amputation levels and prosthetic overview
■ Adaptive Prosthetics – definitions and history
■ Lower Limb overview
■ Upper Limb -
– Amputation deficits
– Upper Limb prosthetic overview
– Activity specific/adaptive prosthetics
– Indications/Contraindications
– The therapist-prosthetist team
MY BACKGROUND
■ AZ Native
■ Studied Biomedical Engineering
at ASU
■ Practiced in Phoenix for 8 years
■ Faculty at Baylor College of
Medicine
■ Returned to AZ to make a
difference
home.
Baylor College of Medicine·
MAJOR AMPUTATION LEVELS – Lower Limb
■ Lower Limb Amputations
– Partial foot
– Ankle disarticulation
– Transtibial
– Knee disarticulation
– Transfemoral
– Hip disarticulation
·l'-- f:""1.1--\'!l'--- V.ry
s
t-+-:t--~ ---M
ovek
kn
S rt below knee
$ nd r, b .tow n
Chop rt -
Ind oot, ,uch 89 Boyd
Toe ,serti onore~tion
MAJOR AMPUTATION LEVELS – Upper Limb
■ Upper Limb Amputations
– Digital amputation
– Partial Hand
– Wrist disarticulation
– Transradial
– Elbow Disarticulation
– Transhumeral
– Shoulder Disarticulation
– Inter-scapulothoracic
Fore quarter amputation (Implies removal of part of scapula, clavicle and all of
upper limb)
Shoulder disarticulation (Amputation through
glenohumeral joint)
Above elbow (AE)
Elbow disarticulation
Below elbow (BE)
a) Short BE
b) Medium BE
c) Long BE
Wrist disarticulation
Metacarpophalangeal disarticulation
Phalangeal amputation
lnterphalangeal disarticulation
PROSTHETIC OVERVIEW■ Terminology:
– Prosthesis (noun) – Any device that replaces a missing part of
the body.
– Prosthetic (adjective) – Describing anything that deals with a
prosthesis.
– Socket - The part of the device that encapsulates and interacts
with the residual limb.
– Foot – It’s a foot…
– Terminal Device – The part of an upper limb prosthesis that
interacts with the environment (hook, hand, etc…).
– Suspension – The method of holding the prosthesis on to the
body.
ADAPTIVE PROSTHETICS
■ Adaptive Prostheses – “Any component or
group of components that enable the amputee
to engage in (adapt to) a specific Physical
activity” 1
■ A lot of overlap
[1] Caroll, Kevin. Adaptive prosthetics for the lower extremity. Foot and Ankle Clinics
, Volume 6 , Issue 2 , 371 - 386
HISTORY ADAPTIVE PROSTHETICS
■ Adaptive prostheses were among the first type of prostheses
■ 201 BC - Marcus Sergius was a Greek general who had an iron hand made to
support his shield.
HISTORY ADAPTIVE PROSTHETICS - 2
■ 1509 AD - A hand made representing armor for Goetz von Berlichingen. The fingers
could be locked shut to hold a weapon
coilhouse.net
HISTORY ADAPTIVE PROSTHETICS - 3
■ Late 19th Century - The civil war left many amputees to fend for themselves and
create novel "home brew" devices. The prosthesis shown here was made out of a
gun stock.
Invention.smithsonian.org
HISTORY ADAPTIVE PROSTHETICS - 4
■ Post WWII - Much was done to get veteran amputees back to their specialized work
LOWER LIMB PROSTHETICS
Ottobock.com
LOWER LIMB ADAPTIVE PROSTHETICS -OVERVIEW
■ Socket
■ Suspension
■ Knee
■ Alignable components
■ Ankle
■ Foot
Ottobock.com
LOWER LIMB ADAPTIVE PROSTHETICS –GOALS & BENEFITS
■ Activity specific
■ Mostly recreational
■ The major goal is increase in
performance
Ottobock.com
LOWER LIMB ADAPTIVE PROSTHETICS -EXAMPLES
■ Knees
– Focus on shock absorption, rather than stance and swing phases of gait
■ Feet
– Running
– Swimming
– Skiing
– Etc…
Hedef prostheticsOssur.com Freedom Innovations
360oandp.com
UPPER LIMB PROSTHETICS
Alternative Limb Project
UPPER LIMB ADAPTIVE PROSTHETICS –Amputation Statistics by site ■ Difference in Goals, in numbers, and in cause of amputation
Kathryn Ziegler-Graham, PhD, et al. “Estimating the Prevalence of Limb Loss in the United States - 2005 to
2050,” Archives of Physical Medicine and Rehabilitation 89 (2008):422-429.2
86% Lower Limb
Upper Limb 14 0
0% 20% 40% 60% 80% 100%
Kathryn Ziegler-Graham, PhD, et al. “Estimating the Prevalence of Limb Loss in the United States - 2005 to
2050,” Archives of Physical Medicine and Rehabilitation 89 (2008):422-429.2
UPPER LIMB ADAPTIVE PROSTHETICS –Amputation Statistics by cause
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
Dysvacular Trauma
• Upper Limb
• Lower Limb
Cancer Congenital
UPPER LIMB ADAPTIVE PROSTHETICS –AMPUTATION DEFICITS – Partial Hand
•Precision finger manipulation
•padded distal end
functional Deficiencies
•Fine palmer positioning (Wrist movement, pronation/supination)
•Elbow and shoulder movement
•Possible fine digital opposition remaining
•Suspension in cubital fold
•Bilateral Oppositional force
•Sensation
Remaining functions
•thumb: 38%UE, 23%WP
•full partial hand: 90%UE, 54%WP
Percent impaired
UPPER LIMB ADAPTIVE PROSTHETICS –AMPUTATION DEFICITS - Transradial
• Large surface area for load bearing
• Pronation/supination?
• Fine palmer positioning
• Precision finger manipulation
• Padded distal end
Deficiencies
• Elbow and shoulder movement
• Suspension in cubital fold
• Bilateral oppositional force
• Sensation
Remaining functions
• TR deficiency: 95%UE, 57%WP
Percent impaired
UPPER LIMB ADAPTIVE PROSTHETICS –AMPUTATION DEFICITS - Transhumeral
•Bilateral opposition
•Humeral Rotation
•Elbow flexion
•Large surface area for load bearing
•Pronation/supination?
•Fine palmer positioning
•Precision finger manipulation
•padded distal end
•Usable sensation
Deficiencies
•Shoulder movement
•Axilla Oppositional force
Remaining functions
•Elbow deficiency: 95%UE, 57%WP
Percent impaired
I
UPPER LIMB ADAPTIVE PROSTHETICS –PROSTHETIC OVERVIEW - BASICS
■ Socket
■ Suspension
■ Elbow
■ Wrist
– Pronation, Supination, Flexion, quick
change
■ TD
– Hook
– Hand
– Activity SpecificOttobock.com
UPPER LIMB ADAPTIVE PROSTHETICS –PROSTHETIC OVERVIEW - BASICS
■ Main types of
Prostheses
– Passive
– Active
– Activity Specific
UPPER LIMB ADAPTIVE PROSTHETICS –PROSTHETIC OVERVIEW - Passive
■ Psychosocial
function
■ Basic Opposition
■ Protection
■ Very Costly
UPPER LIMB ADAPTIVE PROSTHETICS –PROSTHETIC OVERVIEW - ACTIVE
■ Controlled articulations at the elbow
– Flexion & Extension
– Passive humeral rotation
■ Controlled articulations at the wrist
– Supination & Pronation
■ Control of the Terminal Device
– Open and Close
Mobius Bionics
UPPER LIMB ADAPTIVE PROSTHETICS –PROSTHETIC OVERVIEW – BODY POWERED
■ Controlled by shoulder and arm
movements
– Glenohumeral flexion
– Scapular abduction
■ Feedback available
■ Greater precision and speed
■ Less adaptable
O&P Library
UPPER LIMB ADAPTIVE PROSTHETICS –PROSTHETIC OVERVIEW–EXTERNAL POWERED
■ Controlled by:
– Myoelectric signals (EMG)
– Force pads
– Potentiometers
■ Less compensatory movements
■ No harnessing
■ Less effort
■ More adaptive
UPPER LIMB ADAPTIVE PROSTHETICS –Overall Goals
■ Improve function/Ease of
use
■ Reduce onset of overuse
symptoms
UPPER LIMB ADAPTIVE PROSTHETICS –Ease of Use
■ Many tasks require complex
manipulation or movement, but not a
variety of manipulations.
■ Specialization
UPPER LIMB ADAPTIVE PROSTHETICS –Overuse symptoms
■ Overuse in Contralateral Side
– Approximately 50% of patients with a
unilateral amputation will experience
overuse syndrome2
■ Overuse in residual limb
[2] Jones LE, Davidson JH: Save that arm: A study of problems in the remaining arm
of unilateral upper limb amputees. Prosthet Orthot Int 1999;23:55-58
UPPER LIMB ADAPTIVE PROSTHETICS –Examples - Employment
UPPER LIMB ADAPTIVE PROSTHETICS –How to implement
Cuff
Wrist Orthosis
Custom Socket
UPPER LIMB ADAPTIVE PROSTHETICS –So many options
UPPER LIMB ADAPTIVE PROSTHETICS –Examples – House ADL’s (Kitchen)
■ Eating
■ Food Preparation
UPPER LIMB ADAPTIVE PROSTHETICS –Examples – House ADL’s (Outdoors)
H
GC02-0N2
Hand Hoe
Hand Cultivator GS01•0N2
Hand Spade
UPPER LIMB ADAPTIVE PROSTHETICS –Examples – House ADL’s (Out and About)
UPPER LIMB ADAPTIVE PROSTHETICS –Examples - Recreations
UPPER LIMB ADAPTIVE PROSTHETICS –Changing devices
■ Can be difficult for
bilateral patients
■ Quick change
stands are
available
Hands·F ree Tool Changing Station
UPPER LIMB ADAPTIVE PROSTHETICS –Other considerations
■ More than just the terminal device you use.
■ Socket alignment, materials, and flexibility are also critical.
1970 2009
/
UPPER LIMB ADAPTIVE PROSTHETICS –Limitations
■ Task specific
■ No sensation
■ Learning curve
UPPER LIMB ADAPTIVE PROSTHETICS –Indications/Contraindications
■ “The most expensive prosthesis is the
one in the closet.”
■ Aspects to look at
– Gaps in function
– Overuse possibilities
– Motivation
www.motherearthnews.com
WHO WOULD BENEFIT FROM A PROSTHETIC CONSULTATION?
■ Any individual with limb loss
“Education is more empowering than any device.”
THERAPISTS & PROSTHETISTS
■ A team that is…
– Exciting
– Necessary
– Beneficial to all
parties
– Overlooked
no pain TD function
reliefs Trim lines Force
compression required
Ft~ ROM f='tt"'-C~tO"'-
Suspension Working
skin health purchase envelope
loading Cosmesi
cosmetic capacity Excur~io n
QUESTIONS?Thank you for your time!
480-747-1885