Upper Extremity

Prosthesis
Prosthetic Fitting & Training
 Terminal Devices
 Prosthetic Wrists
 Prosthetic Elbows
 Prosthetic Sockets
 Suspension Systems
 Control Mechanisms
 Activity Specific Devices
Terminal Devices
 Nonprehension  Prehension
 Touching  PRECISION GRIP
 Feeling  Three jaw chuck
 Lateral or key grip
 Pressing
  POWER GRIP
Tapping
 Hook grip
 Vibrating  Spherical grip
 Lifting and pushing
with the hand
 Human hand is a complex anatomical and
physiological structure
 All the prosthetic terminal devices lack sensory
feedback and have limited mobility and
dexterity
 Types:
 Passive
 Body-powered
 Externally powered
Classification of Terminal Device
Body-powered TD
 Voluntary Closing
 Most physiological
 To close the device by “pulling” with the cable on
the harness system to grasp the object
 To release  patient releases the pull on the
harness
 Maximum prehensile force is determined by the
strength of the individual
 Disadvantage  prolonged prehension requires
constant pull of the harness
 BODY POWERED TERMINAL DEVICE
 Voluntary opening
 Most common and practical
 Maintained in a close position by rubber bands or
tension grips
 Open by “pulling” with the cable on the harness
system in preparation to grasp
 Grasp  releases the opened terminal device
 Rubber bands and spring provides the prehensile
force
VO/VC
Canted hook
Muenster socket
Myoelectric
Prehensors VS Hook
Transradial
Transradial Prosthesis
 EXTERNALLY POWERED DEVICE
 Control
 Digital
 On and off
 Proportional
 Stronger signal =faster action
 Slip control system
 Uses a sensor that maintains a constant pressure to
prevent object slippage
 Otto Bock Company
Externally-
powered
UE Prosthesis
Prosthetic Wrists
 MECHANICAL
 Pronosupination
 FRICTION CONTROLLED
 Permits ease of positioning but rotates when lifting heavy
objects
 QUICK-DISCONNECT WRISTS
 Permit rapid interchange of different terminal device
 If locked  secure control for wrist rotation
 SPRING ASSISTED
 For bilateral amputee
 Flexion
 SPRING ASSISTED
 Permits the patient to reach the body’s midline
Quick disconnect
 EXTERNALLY POWERED
 Pronosupination
 MYOELECTRIC
 For bilateral transhumeral or higher level amputation
 SWITCH CONTROL
Transhumeral
Prosthetic Elbows
 Can have internal or external joint
 Types
 Passive
 Body empowered
 Externally powered
 Controls
 Mechanical cables
 Electrical switches
 Myoelectric signals
Classification of
Prosthetic Elbows
 MECHANICAL ELBOW
 Locking mechanisms that is manually applied using
 Contralateral hand
 Chin
 Ipsilateral shoulder via a cable system
 Flexion force is dependent on:
 Wearer’s strength
 Comfort of socket’s fit
 Efficient transfer of power from residual limb to the
prosthesis
 ELECTRIC ELBOWS
 With electromechanical brake or switch
controlled lock mechanism
 Rotation function is provided through the use
of turntable
 Reach the body midline
 Limited active flexion force
 ELBOW DISARTICULATION
 External elbow joint to maintain the optimal
length of the arm
 Larger and protrudes in the medial aspect
 Limited flexion strength