The unique preparation of occupational therapists enables them to strongly influence an individual with upper limb absence. Understanding the phases of prosthetic rehabilitation with patient-centered protocols is required to meet the functional needs of individuals fit with diverse prostheses, including presurgery and postsurgery, preprosthetic fitting, and prosthetic training interventions to facilitate optimal functional outcomes. These protocols support independence and are adapted dependent on the individual client factors and the prosthetic device used. A collaborative interprofessional dynamic that engages the team is crucial to prepare each patient to reach their maximum potential and to enjoy wellness, well-being, and quality of life.
Socket-based prosthetics are associated with several problems in the context of upper extremity amputation. These negatively affect comfort and functionality and result in high prosthetic abandonment rates. The concept of osseointegration seeks to circumnavigate these issues by providing a stable interface and avoiding the need for a socket. In this article, we discuss the different osteointegration strategies for each upper extremity amputation level and briefly explore the reported clinical experience for each strategy. Finally, we discuss how progress in this field may help us get closer to the intuitive control of the native hand in the near future.
Sensing is the crucial undercurrent of life, enabling not just grasping a loved one's hand or tying laces, but expressing emotions or creating art. Having evolved since bacterial chemotaxis-a driving force of motility-it's profoundly underrated in movement, often seen as mere byproduct. This article glimpses the evolution of sensing across species, its convergence with motor commands, and deep interdependence. In bionic reconstruction, sensory restoration lags motor advances; we highlight the challenge of translating binary machine signals into the homunculus's stereognostic language, while spotlighting promising biological interfaces pivotal for embodiment of bionic hands.
Meticulous bony and soft tissue handling is paramount in optimizing prosthesis wear and minimizing neuropathic and phantom limb pain in patients with transradial amputations. Resection of 7 to 8 cm of radius and ulna proximal to the wrist joint preserves the majority of native forearm rotation. A pedicled pronator quadratus is a useful target for targeted muscle reinnervation and can provide additional distal soft tissue padding over the bone ends. Targeted muscle reinnervation or regenerative peripheral nerve interface techniques that place neurorrhaphy sites deep and distal within the forearm are preferred to minimize painful compressive sites with prosthesis wear.
The upper extremity is a structure of incredible complexity able to perform unique tasks that span from the most delicate and intricate to highly strenuous and forceful. Fully functional and aesthetic replacement of the upper extremity after loss remains a medical and technological aspiration. Meaningful advancements continue to be made in all areas of upper extremity limb loss, specifically in traditional surgical reconstruction and prosthetics. This has generated a new field of treatment that is most accurately titled Bionic Reconstruction. Essentially, successful bionic reconstruction allows for the human body to effectively communicate and work in concert with the man-made technology.
This article explores the regenerative peripheral nerve interface (RPNI) as an innovative solution for intuitive prosthetic control. Traditional control methods (myoelectric, brain-computer interfaces, and peripheral nerve interfaces) each have their own unique limitations. RPNI surgery involves implanting severed peripheral nerves into free skeletal muscle grafts to amplify action potentials and provide long-term signal stability. Preclinical studies in rats and nonhuman primates demonstrated the effectiveness of the RPNI in neural signal transduction, neuroma prevention, and long-term stability. Early human trials confirm its viability for volitional prosthetic control.
While partial hand amputations are life-altering events, advances in prosthetic technologies have allowed for great strides in optimizing function of the residual hand. The Starfish procedure has further enhanced the capabilities of myoelectric prosthetics by enabling independent digital manipulation. When coupled with thoughtful nerve and soft tissue management, patients can regain meaningful use in an otherwise devastating injury.
Over the course of history, humanity has continuously pursued ways to restore the upper extremity after amputation. Both technology and new techniques have helped bring surgeons closer to recreating the biological upper extremity than ever before. Surgical innovations such as vessel ligation, proximal osteotomies, muscle flap closures, and infection control have their basis in historical accounts of amputation care. The 21st century has seen advances in surgical pain control after amputation, improved myoelectric prosthetic control, and the potential for sensory feedback. The combination and interplay of technology and surgical innovation will continue to drive the field of prosthetics forward.
