32. TYPES OF PROSTHESIS COSMETIC FUNCTIONAL Mostly passive or cosmetic types on one end to primarily functional types on the other. The purpose of most prosthesis falls somewhere in between. 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.
39. MYO-ELECTRICAL CONTROL SYSTEMS: 2-site/2-function (Dual Site) System: Separate electrodes for paired prosthetic activity. FLEXTION/EXTENSION, SUPINATION/PRONATION. It is more physiological and easier to control. 2. 1-site/2-function (Single Site) System: 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).
40. SWITCH CONTROL SYSTEMS: Switch controlled externally powered prosthesis utilize small switches, rather than muscle signals, to operate the elecric motors. 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) 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.
42. TYPICAL COMPONENTS OF AN UPPER-LIMB BODY-POWERED PROSTHESIS: All conventional body-powered prosthesis have following components: SOCKET SUSPENSION CONTROL-CABLE SYSTEM TERMINAL DEVICE COMPONENTS FOR ANY INTERPOSING JOINTS AS NEEDED ACCORDING TO THE LEVEL OF AMPUTATION.
43.
44. Outer wall designed to be of same length and contour as that of opposite limb.
50. SUCTION SOCKETS. 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.
51. The patient with a transradial amputation demonstrates 2 types of harnessing: The figure-8 harness; The shoulder saddle with chest-strap suspension C & D: For the patient with a transhumeral amputation
52.
53. Dual Control Cable System (Fair-lead Cable System).BODY MOVEMENTS CAPTURED FOR PROSTHETIC CONTROL: Gleno-Humeral Forward Flexion. Gleno-Humeral Depression/Elevation, Extension, Abduction Nudge Control (for more complex cases neeeding many control functions).
54. 4. TERMINAL DEVICE The major function of a hand that a terminal device tries to replicate is GRIP (PREHENSION). There are 5 types of grip; Precision Grip (Pincher Grip) Lateral Grip (Key Pinch) Tripod Grip (Palmer Grip/3-Jaw Chuk Pinch) Hook-Power Grip Spherical Grip
61. 5. COMPONENTS FOR ANY INTERPOSING JOINTS AS NEEDED ACCORDING TO THE LEVEL OF AMPUTATION WRIST UNITS ELBOW UNITS SHOULDER AND FOREQUARTER UNITS
62. A. WRIST UNITS: 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. Quick-Disconnect Wrist Unit Easy swapping of terminal devices that have special functions. Locking Wrist Unit To prevent rotation during grasping and lifting. Wrist Flexion Unit Improved function of midline activities e.g; shaving, buttoning, perineal care.
64. B. ELBOW UNITS: 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. Flexible Elbow Hinge Medium and Long TransRadial Amputations Wrist Disarticulations Rigid Elbow Hinge Short Transradial Amputation Internal Locking Elbow Joint Transhumeral Amputation. Internal Elbow allows 135 degree flexion and can be locked into different flextion positions
66. C. SHOULDER AND FOREQUARTER UNITS FOR AMPUTATIONS AT SHOULDER AND FOREQUARTER LEVELS. In cases of amputations at these levels, function is very difficult to restore due to; Weight of the prosthetic component Diminished overall function when combining multiple prosthesis. Increased energy expenditure required to operate the prosthesis. Thus, patients mostly choose either; A purely cosmetic prosthesis to improve body image and fit of their cloths. No prosthesis at all.
68. OVERALL TIMELINES FOR AN AMPUTATION & PROSTHESIS FITTING: FOUR STAGES; PRE-AMPUTATION SURGICAL PROCEEDURE ACUTE POST SURGICAL AMPUTATION PROSTHESIS FITTING AND TESTING
78. Psycology should be involved at this stage if possible. This addresses; Survival Recovery Integration 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.
79. 4. PROSTHESIS FITTING AND TESTING: In young patients with traumatic amputation IPOP (Immediate Post Operative Prosthesis) which is a temporary prosthesis, can be fitted during surgery. In older patients or in those with vascular disease, a prosthesis is not fitted until the suture line has completey healed. Prosthesis are either Preparatory or Definitive (Permanent). FITTING AN UPPER LIMB AMPUTEE WITH A BODY-POWERED PREPARATORY PROSTHESIS WITHIN 7-30 DAYS IS ADVISABLE. THIS IS CALLED AS THE “GOLDEN PERIOD”.
