Reprinted with permission
- O & P Business World, Winter 1
Fifty percent of all upper
extremity amputees fit with a prosthesis stop wearing it within
one year. One contributor to this problem is the common protocol
followed by most physicians and prosthetists which requires
the initial use of a body-powered prosthesis before considering
a myoelectric prosthesis. While the rugged design of a body-powered
prosthesis serves many patients well, those whose needs are
not met and did not receive alternative options from the onset
of amputation frequently choose to discontinue use altogether.
Until recently, this conservative approach addressed three
main challenges faced by amputees:
1) the frequent breakdown of first-generation electric prostheses
required a more dependable body-
powered backup prosthesis,
2) the intimate fit required to keep the electrodes in contact
with the skin for a myoelectric prosthesis was problematic
for new amputees undergoing residual limb volumetric fluctuation,
and 3) many practitioners lacked experience with myoelectric
technology and techniques. Fortunately, advancements in the
field of upper extremity prosthetics now enable practitioners
to exercise a more dynamic prescriptive approach.
More dependable and sophisticated
second- and third-generation electronics eliminate the need for backup
body-powered prostheses. This is an exciting time for prosthetists
and amputees as many manufacturers of upper extremity components are
releasing innovative products. For example, Liberty Technology has
introduced a new microprocessor myoelectric system that uses a personal
computer to perform adjustments allowing for multiple control schemes
using a single controller. The ability to transition patients from
single site myoelectric control to dual site myoelectric control,
and later, proportional control, by simply reprogramming the onboard
microprocessor results in enhanced function and cost efficiency. This
is especially useful as a child develops or as an adult progresses
in his rehabilitation, as the same myoelectric controller can be used
throughout the rehabilitation process.
Motion
Control's new Utah Arm 2 features more reliable circuitry and a
longer-life battery. The new battery charging system reduces charging
time from 18 hours to a mere two and a half hours. Otto Bock has
released the Sensor Electronic Hand that automatically detects and
adjusts for slippage through tiny sensors mounted in the fingers,
so the wearer no longer needs to concentrate on increasing grip
force as an object becomes heavier or starts to slip from his grasp.
The greater function and
reliability provided by state-of-the-art electronics are further supported
by new materials and interface designs which increase comfort and
longevity. Thermoplastic materials permit easy interface adjustments
for residual limb volumetric fluctuation without the need to replace
the inner socket. New flexible materials combined with advanced socket
designs produce lighter weight prostheses that increase range of motion
while enhancing comfort. Advanced socket designs perhaps are best
demonstrated by the MicroFrame design of shoulder and interscapular
thoracic level prostheses that reduce socket to skin surface area
by as much as 65% from traditional interface designs, dramatically
deminishing weight and heat buildup. Cosmetic restoration materials
also have improved to resist staining while closely duplicating the
contralateral limb. Several manufacturers, including Life Like Laboratories
and Aesthetic Concerns, provide custom shaped and painted silicone
materials which can now be applied to myoelectric prostheses. For
the first time, one prosthesis can meet an amputee's functional and
cosmetic requirements.
Exciting developments in technology and materials
are only part
of the equation
in improving patient success rates; practitioner experience is equally
as important. Until recently, obtaining experience was challenging
because the average practitioner sees so few upper extremity patients
per year. Furthermore, the limited availability of advanced practitioner
training (often a prerequisite for the purchase of upper extremity
components) required practitioners to leave their busy practices and
sometimes their countries. Cutting-edge consultation services have
emerged to address these needs. For example, Advanced Arm Dynamics,
Inc., provides direct patient care, on-site practitioner training,
manufacturer component certification, and insurance justification
and authorization assistance worldwide. These services allow any facility
in the world to provide state-of-the-art technology and techniques
to its patients.
Now that the barriers
to fitting a patient initially with a myoelectric prosthesis have
been removed, patient success and satisfaction can be significantly
improved by dispensing with the old lexicon (fitting an upper extremity
patient with a bodypowered prosthesis first) and providing the most
appropriate prosthesis from the very beginning. While not all amputees
are candidates for a myoelectric prosthesis, new technology, techniques,
and expert upper extremity prosthetic practitioner resources can
increase the success rate of upper extremity amputees. Critical
to this approach is a comprehensive initial patient assessment which
focuses on the patient's goals, family life, return to work requirements,
and the condition of the residual limb. With detailed information
and the flexibility to apply it creatively, an experienced practitioner
can expedite his patients' rehabilitation and enhance their quality
of life.
John Miguelez, C.P., has recently launched a new
company, Advanced Arm Dynamics, Inc. Previously he was Vice President
and Senior Clinical Director for the National Upper Extremity Prosthetic
Program at NovaCare, Inc. Contact him at Advanced Arm Dynamics,
Inc., 50-B Peninsula Center Drive, Suite 172, Rolling Hills Estates,
California 90274-3506 USA. Telephone: 310-378-5885; Fax: -310-378-8116;
E-mail: jmiguelez@armdynamics.com;
Web site: www.arrndynamics.com.
