Special communicationAdvanced Upper Limb Prosthetic Devices: Implications for Upper Limb Prosthetic Rehabilitation
Section snippets
Why is New Technology Needed? Upper Limb Prosthetic Use and Rejection
Many studies show that upper limb amputees are not satisfied with available technology. Many abandon their prostheses or reject using a prosthesis altogether.3, 4 Numerous factors are related to rejection and abandonment such as proximal level of amputation, type of device, poor training, late fitting, limited usefulness of devices, and cost of repairs.4, 5, 6, 7, 8, 9, 10 Rates of abandonment are higher for those with more proximal levels of limb loss.3 Transradial users are reported to have
Role of Rehabilitation
Several studies18, 19 suggest that prosthetic training, early fitting and functional training, an experienced team, and patient education are critical in increasing the likelihood of prosthetic acceptance. Prosthetic training may double the likelihood of long-term, full-time use,13 and receipt of early (within 3mo of amputation) and specialized prosthetic training appears to be more effective than nonspecialized or delayed specialized prosthetic training.20 There is some evidence that persons
The Rehabilitation Process
Rehabilitation after traumatic limb amputation can be separated into 4 phases: acute postsurgical, subacute preprosthetic training, basic prosthetic training, and advanced long-term rehabilitation.18, 24 The length of basic prosthetic training depends on amputation level, prosthesis complexity, functional needs, learning ability, and motivation.7, 20 There is no clear consensus on the amount of prosthetic training upper limb amputees should have. The VA and Department of Defense (DoD) share
The Rehabilitation Team
A well-coordinated, multidisciplinary approach to improving functional outcomes and enhancing emotional adjustment of patients with amputations is well recognized.7, 8, 9, 11, 13, 20, 23, 24, 27, 28, 29, 30, 31 Ideally, the team approach centers on the patient who is engaged in development of treatment goals and care decisions. If possible, the rehabilitation team, including the prosthetist, are included in determining the type of surgery and the overall length of the residual limb, and
Who Pays for Prosthetic Rehabilitation?
The VA has developed a unique Amputation System of Care (ASoC) to provide consistent and specialized care for veterans with amputations. The ASoC classifies each facility in the VA system into 1 of 4 designations based on the level of services provided at the facility. The facility classification levels are as follows: level I, Regional Amputation Centers (RACs); level II, Polytrauma/Amputation Network Site (PANS); level III, Amputation Care Teams (ACTs); and level IV, Amputation Points of
Prosthetic Rehabilitation Using the DEKA Arm
Our experience with the VA Study to Optimize the DEKA Arm affirmed the need for close therapist-prosthetist collaboration. It also pointed to the need for expansion of clinical roles and receipt of specialized clinical training in the use of advanced technology. The Gen 2 DEKA Arm system that we tested incorporated multiple degrees of powered movement and endpoint control of movement (at the shoulder configuration level), and was set up via a sophisticated computer interface.
The Gen 2 system
Need for Future Research
Our experience highlights the need for future research to ensure that this technology is deployed appropriately. As new prosthetic technologies are introduced, it is crucial to conduct comparative effectiveness studies to support clinical deployment and reimbursement. Such studies should examine rates of abandonment, as well as functional benefits and impact on the user's quality of life. This research is needed to aid in the development of policy decisions that promote consistent coverage of
Conclusions
The U.S. government has made a major investment in developing technologically advanced upper limb prosthetic devices through the Revolutionizing Prosthetics program. Much work is needed to ensure that this investment will benefit persons with amputations. Implementation of advanced prosthetic technology requires a coordinated approach offered by a specialized, colocated rehabilitation team. Integrated health systems, such as the VA and military treatment facilities, are ideally suited to offer
References (48)
- et al.
Estimating the prevalence of limb loss in the United States: 2005 to 2050
Arch Phys Med Rehabil
(2008) - et al.
Prosthetic usage in major upper extremity amputations
J Hand Surg [Am]
(1995) - et al.
Prosthetic management and training of adult upper limb amputees
Curr Orthop
(1997) - et al.
Progressive upper limb prosthetics
Phys Med Rehabil Clin N Am
(2006) - et al.
Upper limb traumatic amputeesReview of prosthetic use
J Hand Surg [Br]
(1997) - et al.
Incidence, acute care length of stay, and discharge to rehabilitation of traumatic amputee patients: an epidemiologic study
Arch Phys Med Rehabil
(1998) - et al.
Rehabilitation of the lower-extremity war-injured at the center for the intrepid
Foot Ankle Clin
(2010) General considerations in managing upper limb amputations
Orthop Clin North Am
(1981)- et al.
Use and satisfaction with prosthetic limb devices and related services
Arch Phys Med Rehabil
(2004) Amputation statistics by cause. Limb loss in the United States. NLLIC fact sheet
Upper limb prosthesis use and abandonment: a survey of the last 25 years
Prosthet Orthot Int
Consumer design priorities for upper limb prosthetics
Disabil Rehabil Assist Technol
Epidemiologic overview of individuals with upper-limb loss and their reported research priorities
J Prosthet Orthot
A method of early prosthetics training for upper-extremity amputees
Artif Limbs
Prosthetic rehabilitation in traumatic upper limb amputees (an Indian perspective)
Arch Orthop Trauma Surg
Empowering prosthetics: a team approach to prosthetics and limb loss
Rehab management
Upper-limb prosthetics: critical factors in device abandonment
Am J Phys Med Rehabil
Rehabilitation of unilateral below-elbow amputees with myoelectric prostheses
Scand J Rehabil Med
The reimbursement challenge for advanced prosthetics
Consumer concerns and the functional value of prostheses to upper limb amputees
Prosthet Orthot Int
Chronic pain associated with upper-limb loss
Am J Phys Med Rehabil
Overuse syndrome and the unilateral upper limb amputee: consequences and prevention
J Prosthet Orthot
Adult upper limb prosthetic training
Returning upper-extremity amputees to work
The O&P Edge
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Supported by Veterans Administration Rehabilitation Research and Development (VA RR&D), VA RR&D A6780, and VA RR&D A6780I. DEKA's support of the VA optimization studies was sponsored by the Defense Advanced Research Projects Agency and the U.S. Army Research Office. The information in this manuscript does not necessarily reflect the position or policy of the government; no official endorsement should be inferred.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.