Upper Extremity Prosthetic Technology and Care

Abstract

Significant advances in upper extremity prosthetic care and technology over the last decade have provided clinicians and their patients increased options for treatment and the potential for greater overall functionality. There has been unprecedented focus to the care, research, and technology of the upper extremity amputee in a relative short period of time. Service members injured in OIF/OEF receiving care for complicated upper extremity amputations have intensified the efforts to improve socket design, interfaces, suspension, and myoelectric function with multiple degrees of freedom as surgical advancement that optimize the intuitive function of the higher level upper extremity amputee. Academic and Government based research groups such as RIC under Dr. Todd Kuiken as well as DARPA and others have generated great interest in the area of surgical advancements coupled with advanced technology. These advanced technologies and unique surgical interventions are intended to provide patients with more intuitive function with myoelectric prostheses along with various advancing technologies of elbow, wrist and shoulder systems. Pattern grasp recognition using and array emg systems for more consistent operation of these advanced robotic technologies is one example that was directly generated from these efforts (Kuiken, Targeted muscle reinnervation a neural interface for artificial limbs, 2014; Dhillon, IEEE Trans Neural Syst Rehabil Eng 13:468–72, 2005). The increased availability of terminal devices with increased functional grasp patterns and conforming grips have provided patients options for more natural functionality of the myoelectric prosthesis for all levels. With all of these advancing technologies the understanding of optimized upper extremity amputee patient care is more important than ever before. Prior to utilization of these advanced technologies each respective clinician involved in the process must have a firm grasp of the protocols for a well-developed upper extremity plan of care for any patient. A well-educated and experienced clinical understanding for this particular patient group is vital to future success of the patient. Appropriate incorporation of optimized prosthetic design, patient education with a comprehensive team approach coupled these advanced technologies can prove challenging and require a well-designed and intentional method of patient care.