Prosthetic Lab for OT Students
We had a man with bilateral above-elbow amputations come in. He used a body-powered prosthesis. We also had a vendor come in from CFI to tell us about electrically powered prostheses.
There are three main prosthetic options
1. Passive, cosmetic arm/hand
2. Body-powered (through cable/harness)
3. Electrical prosthesis…maybe controlled by myoelectric sensors! (see video for example)
A lot of people have unrealistic expectations of how a prosthesis will help them. The truth is that the prosthesis will always be the assistant – it is not a fully functional hand. The ones that look like real hands are really not that functional – the hook is still the best option. Occupational therapists can help with education of this fact. It’s also important that the person with the amputation (it’s easiest to say amputee, but that isn’t person-first language!) understand the importance of checking their skin daily for irritation, how to keep a proper wear schedule, and how to take care of the residual limb/prosthesis.
The OT also needs to work on helping the person review the motions that will be necessary for using the cable-controlled body-powered device. Such as scapular abduction, elbow flexion, shoulder extension, etc.
The OT can also work on body positioning. A person who has had good training will be able to make their hook arm look so natural that you don’t even notice it. If the person does not have good training, it will be immediately obvious due to the awkward and uncomfortable position the person will be in.
Even bilateral amputees can put their own prostheses on, and can be independent in things like toileting, dressing, eating, etc. The toileting thing was the most fascinating thing to learn about. A below-elbow amputee can probably do it more or less the normal way, but if it is an above-elbow amputation, it may need to be done using a heel method or seat method, that allows them to wipe themselves by moving themselves against something stationary like the bathtub edge (with toilet paper put down first). I thought that was pretty creative.
The OT can assist the amputee in learning all the different ways he/she can be independent in their activities of daily life (ADLs). The OT can also educate the person their recreational options, the importance of follow-up visits, resources, assistive devices, and more.
Most of this information was paraphrased from a packet entitled “Adult Upper-Limb Prosthetic Training” by Diane J. Atkins
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