Indications/Contraindications
General:
Upper Extremity Terminal Devices-End Effectors:
Prosthetic devices are tools designed to provide or replicate certain aspects and
functions of the human hand including anatomical realism. All these devices have
benefits, limitations, ranges of function and liabilities that need to be understood
by the user-consumer. The basis for any reliable functional outcome in using these
devices is premised upon having a well-designed, reliably suspended, comfortable,
functional prosthetic limb, which optimizes the user's remaining physical capabilities,
including range of limb motion and strength. The remaining limb itself, is a basic
limiter of function and performance. Typically, the longer the limb the more functional
capacity over a prosthesis will be achieved, assuming the limb's muscular and skeletal
framework are not compromised beyond simply hand absence. Loss of muscle
tissue, permanent nerve damage and phantom limb sensations-pain can all impact
the user's ability to perform with a prosthesis. In general, a user with a limb absence
where less than 25% of the humerus remains, will not be a good candidate for using
upper extremity prosthetic technology successfully . Additionally, the user's cognitive
acuity and capability are important in understanding the ranges of function and the
specific limits of function, while controlling such prosthetic tools, to optimize their
performance and avoid injury.
Finally, all prosthetic terminal devices, have inherent dangers of entanglement or
engagement where release can be compromised because of their physical exterior
design, unique unforgiving materials, and inanimate lack of "feel." Wearing an upper
extremity prosthesis does involve risk! Training and therapy are always recommended
when using a prosthesis, especially when using new or unique technology or changing
prosthetic system operative controls.
Specific:
Body Powered Devices: Prehensor TDs.
Body powered prosthetic devices using a shoulder harness and cable for operation
require a certain level of physical coordination and strength. Additionally, use of such
devices requires a sound cognitive basis that provides the user with the understanding
of the values of the technology, how it operates and its limitations and the potential for
both performance and self-injury. Body powered prosthetic devices require practice.
More practice will provide better functional outcomes in performance. Certain devices
have capabilities beyond that of the human hand regarding their ability to withstand
impact, withstand load and resist environmental elements such as severe heat,
fire, freezing cold temperatures and caustic chemicals. Other devices are inferior
to the human hand regarding such exposures. The user must understand and take
advantage of the aspects of each type of technology they choose to use.
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