Upper extremity prosthetics

INTRODUCTION/BACKGROUND: Despite inspiring improvements in postamputation pain and prosthetic control, targeted muscle reinnervation (TMR) continues to be underused. With some consistency for recommended nerve transfers developing in the literature, it is necessary to systematize these techniques and simplify their incorporation into routine amputation and neuroma care. This systematic review explores the coaptations reported in the literature to date. METHODS: A systematic review of the literature was performed to collect all reports describing nerve transfers in the upper extremity...

Cervical spinal cord injury (SCI) can significantly impair an individual's hand functionality due to the disruption of nerve signals from the brain to the upper extremity. Robotic assistive hand exoskeletons have been proposed as a potential technology to facilitate improved patient rehabilitation outcomes, but few exoskeleton studies utilize standardized hand function tests and questionnaires to produce quantitative data regarding exoskeleton performance. This work presents the human subject case study evaluation of the FLEXotendon Glove-III, a 5 degree-of-freedom voice-controlled, tendon-driven soft robotic assistive hand exoskeleton for individuals with SCI...

PURPOSE: The aim of this study was to describe the demographic and clinical characteristics of children with limb loss in Saudi Arabia. METHODS: This is a retrospective study on children attending a limb loss clinic in a tertiary hospital in Riyadh, Saudi Arabia, between July 2012 and June 2020. Descriptive statistics were computed to describe the sample characteristics. A Chi-Squared test was conducted to explore the relationship between a child's sex with the type of limb loss (congenital or acquired) and extent of limb loss (major and minor) and the association between child's age and the mechanism of injury in traumatic limb loss...

OBJECTIVE: Extracting signals directly from the motor system poses challenges in obtaining both high amplitude and sustainable signals for upper-limb neuroprosthetic control. To translate neural interfaces into the clinical space, these interfaces must provide consistent signals and prosthetic performance. APPROACH: Previously, we have demonstrated that the Regenerative Peripheral Nerve Interface (RPNI) is a biologically stable, bioamplifier of efferent motor action potentials...

Trials for therapies after an upper limb amputation (ULA) require a focus on the real-world use of the upper limb prosthesis. In this paper, we extend a novel method for identifying upper extremity functional and nonfunctional use to a new patient population: upper limb amputees. We videotaped five amputees and 10 controls performing a series of minimally structured activities while wearing sensors on both wrists that measured linear acceleration and angular velocity. The video data was annotated to provide ground truth for annotating the sensor data...

Lower limb vascular access (LLVA) should be considered for patients in whom upper extremity access has been exhausted. The decisional process around vascular access (VA) site selection should incorporate a patient centered approach that aligns with End Stage Kidney Disease life-plan as recently described in proffered in 2019 Vascular Access Guidelines. The current surgical approaches to LLVA can be divided into two main groups: (A) autologous arteriovenous fistulas (AVFs); (B) synthetic arteriovenous grafts (AVGs)...

BACKGROUND AND OBJECTIVE: Surgical creation of arteriovenous fistulas (AVF) and grafts (AVG) continues to be the mainstay access for hemodialysis (HD). Avoidance of dependence on dialysis catheters continues to be a worldwide mission in dialysis access. Importantly, there is no one-size-fits-all approach to hemodialysis access and each patient should undergo access creation that is patient-centered. The aim of this paper is to review the literature, current guidelines, and discuss the common types of upper extremity hemodialysis access and their reported outcomes...

Facioscapulohumeral dystrophy is an autosomal dominant disorder that results in progressive muscle weakness. Patients most commonly present with facial and periscapular muscle weakness, which progresses to involve their upper and lower extremities as well as truncal muscles. We present a patient with facioscapulohumeral dystrophy who underwent staged bilateral total hip arthroplasties but developed late prosthetic joint infection. This case also reports the management of periprosthetic joint infection after total hip arthroplasties through explant and placement of an articulating spacer as well as both neuraxial and general anesthetic management for this uncommon neuromuscular disorder...

BACKGROUND: Multi-grip myoelectric hand prostheses (MHPs), with five movable and jointed fingers, have been developed to increase functionality. However, literature comparing MHPs with standard myoelectric hand prostheses (SHPs) is limited and inconclusive. To establish whether MHPs increase functionality, we compared MHPs with SHPs on all categories of the International Classification of Functioning, Disability, and Health-model (ICF-model). METHODS: MHP users (N = 14, 64...

OBJECTIVES: When an adequate cephalic vein is not available for fistula construction, surgeons often turn to basilic vein or prosthetic constructions. Single stage forearm prosthetic hemodialysis accesses are associated with poor durability, and upper arm non-autogenous access options are often limited by axillary outflow failure which inevitably drives transition to the contralateral arm or lower extremity. We hypothesized that initial creation of a modest flow proximal forearm arterial-venous anastomosis to dilate ("develop") inflow and outflow vessels, followed by a planned second stage procedure to create a cannulation zone with a prosthetic graft in the forearm, would result in reliable and durable hemodialysis access in patients with limited options...

BACKGROUND: Vascularized fibula epiphyseal flap was first described in 1998 for proximal humeral reconstruction in children/infants. The authors aim to review their international, multi-institutional, long-term outcomes. METHODS: An international, multi-institutional review (2004 to 2020) was conducted of patients younger than 18 years undergoing free vascularized fibula epiphyseal transfer for proximal humeral reconstruction. Donor- and recipient-site complications, pain, and final ambulatory status were reviewed...

UNLABELLED: Complex regional pain syndrome (CRPS) is a debilitating condition, characterized by severe pain with vascular, motor, or trophic changes. Varied presentations make this a diagnostic and therapeutic challenge. There is a lack of high-quality evidence demonstrating efficacy for most existing therapies, particularly with surgical intervention for type II CRPS (CRPS-II). Targeted muscle reinnervation (TMR) is a surgical technique to transfer the terminal end of a divided nerve to a recipient motor nerve, shown to limit phantom limb pain, residual limb pain, and postamputation neuroma pain...

Understanding and quantifying inter-joint coordination is valuable in several domains such as neurorehabilitation, robot-assisted therapy, robotic prosthetic arms, and control of supernumerary arms. Inter-joint coordination is often understood as a consistent spatiotemporal relation among kinematically redundant joints performing functional and goal-oriented movements. However, most approaches in the literature to investigate inter-joint coordination are limited to analysis of the end-point trajectory or correlation analysis of the joint rotations without considering the underlying task; e...

BACKGROUND: Given the existence of multiple low-temperature thermoplastics, clinicians fabricating can readily modify an orthoses' thickness, weight and flexibility, among other properties. However, there is limited evidence on the impact of such different materials on upper extremities' biomechanics. OBJECTIVE: Our study aimed to investigate differences in joint stabilization and movement coordination provided by upper extremity orthotics fabricated with low-temperature thermoplastics of different thicknesses...

BACKGROUND: Restoring touch perception for individuals with upper extremity limb loss is an ambitious task. It is important to understand how persons with upper limb loss think this would be best achieved. METHODS: An anonymous online survey was developed to obtain data from prosthetic users. Participants ranked the perceived acceptability and effectiveness of noninvasive sensory feedback to areas of intact sensation not typically involved in sensory feedback (i...

INTRODUCTION AND PURPOSE: The purpose of this study was to evaluate the outcomes of utilizing a 3D prosthetic device with a home exercise program. This case study was intended to see if the application of a home exercise program utilizing a 3D printed prosthetic hand resulted in increased range of motion, strength, coordination, sensory integration, and perceived function of the upper extremity. STUDY DESIGN: Case Study METHODS: This study outlines one rehabilitation protocol for a 6-year-old boy with right congenital upper limb deficiency...

PURPOSE: To develop a self-report measure of activity performance for upper limb prosthesis users that quantifies outcomes by level of amputation and prosthesis type. MATERIALS AND METHODS: Telephone survey of 423 adults with major upper limb amputation (ULA) who used a prosthesis. Item generation, cognitive, and pilot testing were followed by field testing. Items were categorized as one- or two-handed. Factor and Rasch analyses evaluated unidimensionality, monotonicity, item fit, differential item functioning (DIF), and reliability...

Phantom limb pain after amputation is a debilitating condition that negatively affects activities of daily life and the quality of life of amputees. Most amputees are able to control the movement of the missing limb, which is called the phantom limb movement. Recognition of these movements is crucial for both technology-based amputee rehabilitation and prosthetic control. The aim of the current study is to classify and recognize the phantom movements in four different amputation levels of the upper and lower extremities...

Management of partial hand amputations is a notable clinical challenge. Historically, myoelectric prostheses have not allowed for independent digital control, resulting in unsatisfactory function and high rejection rates among upper extremity amputees. The Starfish Procedure was developed for patients who sustained loss of multiple digits through the level of the base of the proximal phalanx or distal metacarpal. The procedure involves the pedicled transfer of 1 or more dorsal interosseous muscles to a subcutaneous location...

Objective: To develop and test an assessment measuring extended physiological proprioception (EPP). EPP is a learned skill that allows one to extend proprioception to an external tool, which is important for controlling prosthetic devices. The current study examines the ability of this assessment to measure EPP in a nonamputee population for translation into the affected population. Design: Measuring precision and accuracy of an upper extremity (UE) proprioceptive targeting task assessment...