The effect of prefabricated wrist-hand orthoses on performing activities of daily living

Wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit associated with the wrist as a result of rheumatoid changes. The common presentation of the wrist is one of flexion and radial deviation with ulnar deviation of the fingers. This wrist position Results in altered biomechanics compromising hand function during activities of daily living (ADL). A paucity of evidence exists which suggests that improvements in ADL with WHO use are very task specific. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on performing five ADLs tasks was investigated. The tasks were selected to represent common grip patterns and tests were performed with and without WHOs by right-handed, females, aged 20-50 years over a ten week period. The time taken to complete each task was recorded and a wrist goniometer, elbow goniometer and a forearm torsiometer were used to measure joint motion. Results show that, although orthoses may restrict the motion required to perform a task, participants do not use the full range of motion which the orthoses permit. The altered wrist position measured may be attributable to a modified method of performing the task or to a necessary change in grip pattern, resulting in an increased time in task performance. The effect of WHO use on ADL is task specific and may initially impede function. This could have an effect on WHO compliance if there appears to be no immediate benefits. This orthotic effect may be related to restriction of wrist motion or an inability to achieve the necessary grip patterns due to the designs of the orthoses

Ideas and networks: The rise and fall of research bodies for powered artificial arms in America and Canada, 1945-1977

This paper examines the rise and fall of research and development funding programs for upper-limb myoelectric prosthetics in America and Canada from 1945 to 1977. Despite similarities in overall technological goals—to produce electronic arms and hands for veterans in the US and children with phocomelic limbs in Canada—we argue that the reasons for starting and ending the programs reflected different national preoccupations. In the US the reasons for the creation in 1945 and termination in 1977 of funding programs focused on the lack of fundamental research in the field, and role that science could have in the development and design in prosthetics. In Canada, by contrast, there was little discussion about science and its relationship to technology in knowledge creation when the prosthetics research and training unit (PRTU) funding program was founded in 1963 and wound up in 1975. Instead, the policy discussion focused on the importance of regional representation and relationships among different professional groups and sectors of society

A case study of technology transfer: Rehabilitative engineering at Rancho Los Amigos Hospital

The transfer of NASA technolgy to rehabilitative applications of artificial limbs is studied. Human factors engineering activities range from orthotic manipulators to tiny dc motors and transducers to detect and transmit voluntary control signals. It is found that bicarbon implant devices are suitable for medical equipment and artificial limbs because of their biological compatibility with human body fluids and tissues

Use of stance control knee-ankle-foot orthoses : a review of the literature

The use of stance control orthotic knee joints are becoming increasingly popular as unlike locked knee-ankle-foot orthoses, these joints allow the limb to swing freely in swing phase while providing stance phase stability, thus aiming to promote a more physiological and energy efficient gait. It is of paramount importance that all aspects of this technology is monitored and evaluated as the demand for evidence based practice and cost effective rehabilitation increases. A robust and thorough literature review was conducted to retrieve all articles which evaluated the use of stance control orthotic knee joints. All relevant databases were searched, including The Knowledge Network, ProQuest, Web of Knowledge, RECAL Legacy, PubMed and Engineering Village. Papers were selected for review if they addressed the use and effectiveness of commercially available stance control orthotic knee joints and included participant(s) trialling the SCKAFO. A total of 11 publications were reviewed and the following questions were developed and answered according to the best available evidence: 1. The effect SCKAFO (stance control knee-ankle-foot orthoses) systems have on kinetic and kinematic gait parameters 2. The effect SCKAFO systems have on the temporal and spatial parameters of gait 3. The effect SCKAFO systems have on the cardiopulmonary and metabolic cost of walking. 4. The effect SCKAFO systems have on muscle power/generation 5. Patient’s perceptions/ compliance of SCKAFO systems Although current research is limited and lacks in methodological quality the evidence available does, on a whole, indicate a positive benefit in the use of SCKAFOs. This is with respect to increased knee flexion during swing phase resulting in sufficient ground clearance, decreased compensatory movements to facilitate swing phase clearance and improved temporal and spatial gait parameters. With the right methodological approach, the benefits of using a SCKAFO system can be evidenced and the research more effectively converted into clinical practice

Treatments of proximal upper extremity amputations : utility of hand allotransplantation versus myoelectric prostheses

Les amputations d’un membre supérieur sont non seulement dévastatrices pour le bien-être physique, psychologique et social des patients, mais elles comportent également des répercussions financières importantes pour l’individu et le système de santé. Les allotransplantations de tissus composites vascularisés ont été proposées en tant que solution permettant de rétablir la forme et la fonction au détriment d’une immunosuppression à vie et d’un taux élevé de rejet chronique. Les prothèses myoélectriques combinent l’expertise chirurgicale avec les avancées technologiques pour réhabiliter les fonctions motrices d’un moignon amputé, mais elles demeurent limitées par un taux élevé d’abandon et des coûts importants. Dans les systèmes de santé avec des ressources limitées, les dirigeants ont la tâche complexe de partager équitablement l’allocation de ressources entre plusieurs maladies et interventions. Dans le domaine de l’économie de la santé, les analyses de type coût-bénéfice ont été développées pour répondre à ces questions. Les mesures d’utilité doivent incorporer l’impact que le traitement suscite sur l’espérance de vie et la qualité de vie. Ces utilités sont ensuite rapportées en fonction du coût, ce qui permet aux dirigeants de la santé de déterminer dans quels traitements il serait préférable d’investir les ressources. Dans cette thèse, nous proposons un modèle pour étudier les coûts-utilité des allotransplantations de la main et des prothèses myoélectriques. Pour commencer, une étude pilote a été effectuée sur les amputations du pouce traitées avec des lambeaux libres de l’orteil, ce qui nous a permis de confirmer la faisabilité des questionnaires d’utilité conçus. Par la suite, les utilités ont été mesurées dans une population d’amputés du membre supérieur, de patients réimplantés proximalement et de contrôles en santé. Les résultats démontrent que 1) les patients réimplantés rapportent la meilleure utilité avec les prothèses myoélectriques, 2) les amputés unilatéraux préfèrent significativement les prothèses myoélectriques également, et 3) aucune différence n’a été recelée entre les deux traitements chez les amputés bilatéraux. Au final, une analyse des coûts-bénéfices a été effectuée dans le contexte du système de santé canadien, démontrant que le traitement des patients amputés unilatéralement avec des prothèses myoélectriques permettrait de sauver davantage de coûts, alors que l’écart en épargnes monétaires se rétrécit pour les amputés bilatéraux traités avec une allotransplantation ou une prothèse. Avec les résultats rapportés dans cette thèse, nous pouvons proposer une mise à jour des indications de traitements pour les patients avec une amputation du membre supérieur. Basé sur l’analyse de type coût-utilité, nous concluons que les amputés unilatéraux sont de meilleurs candidats pour des prothèses myoélectriques, alors que les deux traitements sont encore adéquats pour les amputations bilatérales.Amputations of the upper extremity are not only devastating for the patient’s physical, psychological and social well-being, but they also yield significant financial repercussions to the individual and the healthcare system. Vascularized composite allotransplantations of the upper extremity were proposed as a solution to restore form and function, albeit to the detriment of lifelong immunosuppression and high rates of chronic rejection. New-generation myoelectric prostheses combine surgical prowess with technological refinements to rehabilitate motor functions of the amputated stump, but remain plagued by high rates of abandonment and significant costs. In healthcare systems wherein resources are limited, financial regulators have the difficult task of proposing an equitable divide of resource allocations between a multitude of diseases and interventions. In the field of health economics, cost-benefit analyses were developed to assist in this decision-making process. Utility outcome measures need to encompass the impact that a treatment elicits on life expectancy and quality of life. Comparison of utilities of different interventions as a function of cost further indicates which route healthcare regulators should partake. In this thesis, we propose a model to study cost-utilities of hand allotransplantation and myoelectric prostheses. To begin, a pilot study was performed on thumb amputations treated with free toe flaps, which allowed to confirm the feasibility of the utility questionnaires that we developed. Afterwards, utilities and quality adjusted life years were measured in a population of upper extremity amputees, proximally replanted patients and healthy controls. Findings demonstrated that 1) replanted patients reported the highest utility outcomes for myoelectric prostheses, 2) unilateral amputees significantly preferred myoelectric prostheses as well, and 3) no significant preference between both interventions was obtained in patients with bilateral amputations. Finally, a cost-benefit analysis was performed in the context of the Canadian healthcare system, demonstrating that significant savings can be achieved with treatment of unilateral amputations with myoelectric prostheses, whereas the gap in cost savings between both treatment groups becomes less significant in bilateral amputees. With the findings reported in this thesis, we can propose an update of the indications for treatment in patients with upper extremity amputations. From the perspective of cost-utility analyses, we conclude that unilateral amputees are better candidates for myoelectric prostheses, and that both treatments can still be offered in cases of bilateral amputations

The effect of prefabricated wrist-hand orthoses on grip strength

Prefabricated wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit and compromised grip strength as a result of rheumatoid changes. It is thought that an orthosis which improves wrist extension, reduces synovitis and increases the mechanical advantage of the flexor muscles will improve hand function. Previous studies report an initial reduction in grip strength with WHO use which may increase following prolonged use. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on grip strength was measured using a Jamar dynamometer. Tests were performed with and without WHOs by right-handed, female subjects, aged 20-50 years over a ten week period. During each test, a wrist goniometer and a forearm torsiometer were used to measure wrist joint position when maximum grip strength was achieved. The majority of participants achieved maximum grip strength with no orthosis at 30° extension. All the orthoses reduced initial grip strength but surprisingly the restriction of wrist extension did not appear to contribute in a significant way to this. Reduction in grip must therefore also be attributable to WHO design characteristics or the quality of fit. The authors recognize the need for research into the long term effect of WHOs on grip strength. However if grip is initially adversely affected, patients may be unlikely to persevere with treatment thereby negating all therapeutic benefits. In studies investigating patient opinions on WHO use, it was a stable wrist rather than a stronger grip reported to have facilitated task performance. This may explain why orthoses that interfere with maximum grip strength can improve functional task performance. Therefore while it is important to measure grip strength, it is only one factor to be considered when evaluating the efficacy of WHOs

Rehabilitation of lower limb amputees

Rehabilitation of amputees represents a complex process during the course of which an amputee receives professional aid and support, so as to adapt to the use of prosthesis, i.e. an artificial supplement for the lost body part. The process aims at achieving an independent performance of the amputee in all areas of everyday life and as high quality of life as possible. The rehabilitation encompasses not only the pre-amputation, postoperative, pre-prosthetic and prosthetic stage, within which an amputee is provided with a prosthetic aiding device, but also the subsequent long-term monitoring and follow-up. The implementation of the rehabilitation process runs in line with the biopsychosocial model and requires a multidisciplinary and an interdisciplinary approach, so as to achieve a successful reintegration of an amputee and allow for a lifestyle resembling the pre-amputation one as much as possible. The article brings the causes and types of amputation, the principles underpinning contemporary amputation surgery, prosthetics and rehabilitation during preoperative, postoperative, pre-prosthetic and prosthetic stages, as well as the stage goals and MOs of their attainment. Principles of evaluation of prosthetic rehabilitation outcomes in limb amputees, which make use of appraisal questionnaires, have been discussed as well

Obstacles to Prosthetic Care - Legal and Ethical Aspects of Access to Upper and Lower Limb Prosthetics in Germany and the Improvement of Prosthetic Care from a Social Perspective

This article belongs to the Special Issue Socio-technical Approaches for Assistive Technologies and People with Disabilitie

A Neuro-robotic Prosthetic Arm (Ruoko bot)

This paper focuses on the provision of an affordable and less weight prosthetic arm for the Zimbabwean population. The research concentrated on improving the amputees’ living standards by means of providing them with a useful artificial arm which can perform tasks as a normal human arm. The literature review was thoroughly done by investigating the latest prostatic arms available in the market. The V-model or evolutionary prototyping was used in the research project to account for every component of the prosthetic limb. The V-model is a type of software development life cycle (SDLC) paradigm where processes run sequentially in a V-shape. The Ruoko bot is flexible and affordable than the current artificial prosthetic available. The prosthetic limb has an Arduino board which allows the useof an artificial intelligence algorithm to determine which signal of the brain\u27s waves should be translated into bodily motion by an EEG headband

Functional and Psychosocial Outcomes of Hand Transplantation Compared with Prosthetic Fitting in Below-Elbow Amputees:A Multicenter Cohort Study

BACKGROUND:Hand-transplantation and improvements in the field of prostheses opened new frontiers in restoring hand function in below-elbow amputees. Both concepts aim at restoring reliable hand function, however, the indications, advantages and limitations for each treatment must be carefully considered depending on level and extent of amputation. Here we report our findings of a multi-center cohort study comparing hand function and quality-of-life of people with transplanted versus prosthetic hands. METHODS:Hand function in amputees with either transplant or prostheses was tested with Action Research Arm Test (ARAT), Southampton Hand Assessment Procedure (SHAP) and the Disabilities of the Arm, Shoulder and Hand measure (DASH). Quality-of-life was compared with the Short-Form 36 (SF-36). RESULTS:Transplanted patients (n = 5) achieved a mean ARAT score of 40.86 ± 8.07 and an average SHAP score of 75.00 ± 11.06. Prosthetic patients (n = 7) achieved a mean ARAT score of 39.00 ± 3.61 and an average SHAP score of 75.43 ± 10.81. There was no significant difference between transplanted and prosthetic hands in ARAT, SHAP or DASH. While quality-of-life metrics were equivocal for four scales of the SF-36, transplanted patients reported significantly higher scores in "role-physical" (p = 0.006), "vitality" (p = 0.008), "role-emotional" (p = 0.035) and "mental-health" (p = 0.003). CONCLUSIONS:The indications for hand transplantation or prosthetic fitting in below-elbow amputees require careful consideration. As functional outcomes were not significantly different between groups, patient's best interests and the route of least harm should guide treatment. Due to the immunosuppressive side-effects, the indication for allotransplantation must still be restrictive, the best being bilateral amputees