Upper limb functional prosthesis

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Upper limb functional prosthesis

  1. 1. Dr. TAUSEEF UL HASSAN<br />TMO PLASTIC SURGERY<br />UPPER LIMB FUNCTIONAL PROSTHESIS<br />
  2. 2. A Prosthesis is a device that is designed to replace, as much possible , the function or appearance of a missing limb or a body part.<br />
  3. 3. CHARACTERISTICS OF A SUCCESSFUL PROSTHESIS:<br /><ul><li> Comfortable to wear
  4. 4. Easy to put on and remove
  5. 5. Light-weight
  6. 6. Durable
  7. 7. Cosmetically pleasing
  8. 8. Must Function well mechanically
  9. 9. Require only reasonable maintainace.</li></li></ul><li>Finally, Prosthetic use largely depends on the motivation of the individual, as nothing matters if the patient does not wish to wear prosthesis.<br />
  10. 10. CONSIDERATIONS WHEN CHOOSING A PROSTHESIS:<br /><ul><li> Amputation level
  11. 11. Contour of the Residual limb
  12. 12. Expected function of the Prosthesis
  13. 13. Congnitivefuntion of the Patient
  14. 14. Voacation of the Patient (Desk Job vs Manual Labour)
  15. 15. Avocational interests of the Patient (e.g; Hobbies)
  16. 16. Cosmetic Importance of the Prosthesis
  17. 17. Financial resources of the Patient.</li></li></ul><li>Reasons for an Upper Limb Amputations:<br />THIS IS MOSTLY CORRELATED BY AGE.<br /><ul><li>(0-15 years) CONGENITAL DEFORMITY OR TUMOR
  18. 18. (15-45 years) TRAUMA
  19. 19. (>60years) SECONDARY TO TUMOR OR MEDICAL DISEASE </li></li></ul><li>AMPUTATION LEVELS:<br /><ul><li>Trans-Phalangeal Amputation
  20. 20. DIP
  21. 21. PIP
  22. 22. MCP
  23. 23. Anywhere in Between.
  24. 24. Trans-Metacarpal Amputation
  25. 25. Trans Carpel Amputation
  26. 26. Wrist Disarticulation
  27. 27. Trans-Radial Amputation
  28. 28. Elbow Disarticulation
  29. 29. Trans-Humeral Amputation
  30. 30. Shoulder Disarticulation
  31. 31. ForeQuarter</li></ul> (Inter-Scapular Disarticulation).<br />
  32. 32. TYPES OF PROSTHESIS<br />COSMETIC<br />FUNCTIONAL<br /> Mostly passive or cosmetic types on one end to primarily functional types on the other. The purpose of most prosthesis falls somewhere in between.<br /> Cosmetic prosthesis look extremely natural but they often are more difficult to clean, can be expensive and usually sacrifice some function for increased cosmetic appearance.<br />
  33. 33.
  34. 34. TYPES OF FUNCTIONAL PROSTHESIS:<br /><ul><li>BODY-POWERED PROSTHESIS </li></ul> (Cable Controlled)<br /><ul><li>EXTERNALLY POWERED (BATTERY) PROSTHESIS </li></ul> (Electrically Controlled)<br /><ul><li>MYOELECTRIC PROSTHESIS
  35. 35. SWITCH-CONTROLLED PROSTHESIS.</li></li></ul><li>BODY-POWERED PROSTHESIS:<br />
  36. 36.
  37. 37. PATIENT CONTROLLED BATTERY-POWERED (MYO-ELECTRIC/SWITCH CONTROLLED)<br />
  38. 38.
  39. 39. MYO-ELECTRICAL CONTROL SYSTEMS:<br />2-site/2-function (Dual Site) System:<br /> Separate electrodes for paired prosthetic activity. FLEXTION/EXTENSION, SUPINATION/PRONATION.<br /> It is more physiological and easier to control.<br />2. 1-site/2-function (Single Site) System:<br /> Used when limited control sites (MUSCLES) are available in a residual limb. This system uses 1 electrode to control both funtions of a paired activity (Flextion/Extension), (Supination/Pronation).<br />
  40. 40. SWITCH CONTROL SYSTEMS:<br />Switch controlled externally powered prosthesis utilize small switches, rather than muscle signals, to operate the elecric motors.<br /> A switch can be activated by movement of a remanant digit or part of a bony prominance against the swithch or by a pull on a suspension harness (similar to movement a patient makes, when operating a body-powered prosthesis)<br /> This can be a good option to provide contol for external power when myoelectric control sites are not available or when the patient can not master myoelectric control.<br />
  41. 41. Switch control battery powered <br />
  42. 42. TYPICAL COMPONENTS OF AN UPPER-LIMB BODY-POWERED PROSTHESIS:<br />All conventional body-powered prosthesis have following components:<br />SOCKET<br />SUSPENSION<br />CONTROL-CABLE SYSTEM<br />TERMINAL DEVICE<br />COMPONENTS FOR ANY INTERPOSING JOINTS AS NEEDED ACCORDING TO THE LEVEL OF AMPUTATION.<br />
  43. 43. 1. SOCKET:<br />It has a Dual-wall design<br /><ul><li> Rigid inner socket to fit patient’s residual limb
  44. 44. Outer wall designed to be of same length and </li></ul> contour as that of opposite limb.<br />
  45. 45. 2. SUSPENSION:<br /><ul><li>HARNESS BASED SYSTEMS
  46. 46. Figure of 8
  47. 47. Shoulder saddle with chest strap
  48. 48. Figure of 9.
  49. 49. SELF SUSPENDING SOCKETS
  50. 50. SUCTION SOCKETS.</li></ul> The suspension system must hold the prosthesis securely to limb as well as accommodate and distribute forces associated with weight of the prosthesis and any super-imposed fitting devices.<br />
  51. 51. The patient with a transradial amputation demonstrates 2 types of harnessing: <br />The figure-8 harness; <br /> The shoulder saddle with chest-strap suspension <br />C & D: For the patient with a transhumeral amputation<br />
  52. 52. 3. CABLE –CONTROL SYSTEM<br /><ul><li>Single Control Cable (Bowden Cable System)
  53. 53. Dual Control Cable System (Fair-lead Cable System).</li></ul>BODY MOVEMENTS CAPTURED FOR PROSTHETIC CONTROL:<br />Gleno-Humeral Forward Flexion.<br />Gleno-Humeral Depression/Elevation, Extension, Abduction<br />Nudge Control (for more complex cases neeeding many control functions).<br />
  54. 54. 4. TERMINAL DEVICE<br />The major function of a hand that a terminal device tries to replicate is GRIP (PREHENSION).<br />There are 5 types of grip;<br />Precision Grip (Pincher Grip)<br />Lateral Grip (Key Pinch)<br />Tripod Grip (Palmer Grip/3-Jaw Chuk Pinch)<br />Hook-Power Grip<br />Spherical Grip<br />
  55. 55. Types of Terminal Devices:<br />Passive Terminal Devices (More Cosmetic than Functional)<br /><ul><li>Functional e.g Child Mitt used on infant’s first prosthesis to assist in crawling.
  56. 56. Cosmetic.</li></ul>Active Terminal Devices (More Function than Cosmetics)<br /><ul><li>Can be both
  57. 57. Body Powered (Cable controlled)
  58. 58. Externally Powered (Electrically controlled).</li></ul> Cable controlled Active terminal devices can be<br />Voluntary opening devices<br />Voluntary closing devices<br />
  59. 59. Active terminal devices can be either prosthetic hands or Hooks<br /> .<br />
  60. 60. PROSTHETIC HAND<br />PROSTHETIC HOOK<br />
  61. 61. 5. COMPONENTS FOR ANY INTERPOSING JOINTS AS NEEDED ACCORDING TO THE LEVEL OF AMPUTATION<br />WRIST UNITS<br />ELBOW UNITS<br />SHOULDER AND FOREQUARTER UNITS<br />
  62. 62. A. WRIST UNITS:<br /> The wrist unit provides orientation of the terminal device in space. Once positioned, the wrist unit is held in place by a friction lock or a Mechanical lock.<br />Quick-Disconnect Wrist Unit<br /> Easy swapping of terminal devices that have special functions.<br />Locking Wrist Unit<br />To prevent rotation during grasping and lifting.<br />Wrist Flexion Unit<br /> Improved function of midline activities e.g; shaving, buttoning, perineal care.<br />
  63. 63. WRIST UNIT<br />
  64. 64. B. ELBOW UNITS:<br /> Elbow units are chosen based on te level of amputation and the amount of residual limb. It is helpful to remember that supination and pronation of the forearm decreases as the site of amputatin becomes more proximal.<br />Flexible Elbow Hinge<br />Medium and Long TransRadial Amputations<br />Wrist Disarticulations<br />Rigid Elbow Hinge Short Transradial Amputation<br />Internal Locking Elbow Joint Transhumeral Amputation.<br />Internal Elbow allows 135 degree flexion and can be locked into different flextion positions<br />
  65. 65. ELBOW UNIT<br />
  66. 66. C. SHOULDER AND FOREQUARTER UNITS<br />FOR AMPUTATIONS AT SHOULDER AND FOREQUARTER LEVELS.<br /> In cases of amputations at these levels, function is very difficult to restore due to;<br />Weight of the prosthetic component<br />Diminished overall function when combining multiple prosthesis.<br />Increased energy expenditure required to operate the prosthesis.<br />Thus, patients mostly choose either;<br />A purely cosmetic prosthesis to improve body image and fit of their cloths.<br />No prosthesis at all.<br />
  67. 67. SHOULDER UNIT<br />
  68. 68. OVERALL TIMELINES FOR AN AMPUTATION & PROSTHESIS FITTING:<br />FOUR STAGES;<br />PRE-AMPUTATION<br />SURGICAL PROCEEDURE<br />ACUTE POST SURGICAL AMPUTATION<br />PROSTHESIS FITTING AND TESTING<br />
  69. 69. 1. PRE-AMPUTATION<br /> Patient must be seen by Re-habilitation team pror to the surgery to;<br /><ul><li>Evaluate post operative needs and desires
  70. 70. Discuss Prosthetic Restroration
  71. 71. Begin any range of motion exercises (ROM)
  72. 72. Strengthening and training in Activities of Daily Livings (ADLs)
  73. 73. Provide peer support of another successful amputee.</li></li></ul><li>2. SURGICAL PROCEDURE<br />Several actions can be taken to maximize the function of residual limb.<br /><ul><li>Bevelling the Bone End (Helps to minimize soft tissue trauma by sharp/irregular bones)
  74. 74. Gentle traction while severing a nerve (Resulting Neuroma forms in soft tissue with less post surgical pain)
  75. 75. Myoplasty (Agonist-antagonist muscles are stitched to each other)
  76. 76. Myodesis (Residual muscles are stiched to the bone).
  77. 77. Ensuring proper length so that specific prosthetic components can be used that may look cosmetically more pleasing and achieve functional goals.</li></li></ul><li>3. ACUTE POST SURGICAL PERIOD:<br />The major physical issues in this phase are;<br />Adequate wound healing<br />Pain Management<br />Instructions in performance of ADLs<br />Mobility<br />ROM<br />Strength<br /> During this phase a programe to prepare the residual limb for prosthesis should be initiated.<br /> Skin desensitization should be done;<br />Gentle tapping on distal portion to mature site<br />Massage to prevent excessive scar formation<br />Edema control<br />
  78. 78. Psycology should be involved at this stage if possible. This addresses;<br />Survival<br />Recovery<br />Integration<br />The patient will need to be followed through out the course of immediate Post-amputation, prosthetic fitting and functional re-integration back into his/her social life routine.<br />
  79. 79. 4. PROSTHESIS FITTING AND TESTING:<br />In young patients with traumatic amputation IPOP (Immediate Post Operative Prosthesis) which is a temporary prosthesis, can be fitted during surgery.<br />In older patients or in those with vascular disease, a prosthesis is not fitted until the suture line has completey healed.<br />Prosthesis are either Preparatory or Definitive (Permanent).<br /> FITTING AN UPPER LIMB AMPUTEE WITH A BODY-POWERED PREPARATORY PROSTHESIS WITHIN 7-30 DAYS IS ADVISABLE. THIS IS CALLED AS THE “GOLDEN PERIOD”.<br />
  80. 80. THANKYOU!<br />

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