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Diane W. Braza MD, Jennifer N. Upper limb amputations are devastating occurrences for individuals, with profound functional and vocational consequences. In the United States, overall, there are approximately 1. The primary reason for upper limb loss in adults is trauma; cancer is the next most common cause.
Dysvascular disease, a frequent cause of lower limb amputations, is primarily related to diabetes and peripheral arterial diseases; lower extremity dysvacular amputations occur in 45 perindividuals and disproportionately affect minority individuals.
The rates for traumatic amputations have declined over the last four decades, 3 probably because of changing work force patterns and greater concerns for industrial occupational safety. Finger amputations are the most common of upper limb amputations and mostly involve single digits. Upper limb amputations from trauma occur at a rate of 3. Hand amputations from trauma occur at a rate of 0. In an analysis of the National Trauma database between the years andupper limb amputations were more likely to be seen than lower limb amputations in motor vehicle crashes.
Motorcyclists and pedestrians were more likely to sustain a lower limb amputation. As a result of wars in Afghanistan and Iraq, the of catastrophic injuries due to explosive devices has increased. Heating causes coagulative necrosis, and the passage of the Male arm amputee current through the tissues causes disruption of cell membranes.
As of Septemberthere were major limb and partial limb amputations. Rates of prosthetic rejection are high among upper limb amputees. Proper rehabilitation and a comfortable and functional prosthesis will facilitate functional restoration. Vocational counseling and vocational retraining are vital aspects of any program, as this condition often afflicts young, vocationally productive persons, primarily men.
A continuum of care is vital to successful rehabilitation. Patients must be transitioned effectively from the inpatient postsurgical unit, sometimes to an inpatient rehabilitation unit, and always to a long-term outpatient rehabilitation and prosthetic program.
Contreras-Vidal, in Progress in Brain Research Upper limb amputation in a severe reduction in the quality of life of affected individuals due to their inability to easily perform activities of daily living. Brain—machine interfaces BMIs that translate grasping intent from the brain's neural activity into prosthetic control may increase the level of natural control currently available in myoelectric prostheses. Current BMI techniques demonstrate accurate arm position and single degree-of-freedom grasp control but are invasive and require daily recalibration.
In this study we tested if transradial amputees A1 and A2 could control grasp preshaping in a prosthetic device using a noninvasive electroencephalography EEG -based closed-loop BMI system. Participants attempted to grasp presented objects by controlling two grasping synergies, in 12 sessions performed over 5 weeks. Prior to closed-loop control, the first six sessions included a decoder calibration phase using action observation by the participants; thereafter, the decoder was fixed to examine neuroprosthetic performance in the absence of decoder recalibration. Ability of participants to control the prosthetic was measured by the success rate of grasping; ie, the percentage of trials within a session in which presented objects were successfully grasped.
EEG al quality was stable across sessions, but the decoders created during the first six sessions showed variation, indicating EEG features relevant to decoding at a smaller timescale ms may not be stable. Overall, our show that a an EEG-based BMI for grasping is a feasible strategy for further investigation of prosthetic control by amputees, and b factors that may affect brain activity such as medication need further examination to improve accuracy and stability of BMI performance.
Joan E. Edelstein, in Physical Rehabilitation Partial hand amputation or removal of any portion of the hand is a minor upper extremity amputation. Wrist disarticulation separation of the radius from the proximal carpals or separation between the proximal and distal row of carpals. Transradial amputation through the radius and ulnaly known as below-elbow. Elbow disarticulation separation of the humerus from the ulna or amputation through the most distal portion of the humerus. Transhumeral amputation through the humerusly known as above-elbow.
Shoulder disarticulation separation of the humerus from the scapula. Forequarter removal of any portion of the thorax, together with any portion of the shoulder girdle and all distal parts. Transradial and transhumeral amputations are classified according to the relative lengths of the residual limb and the sound extremity Fig. For transradial amputations, Male arm amputee length of the sound side is measured from the medial humeral epicondyle to the ulnar styloid. On the amputated side the length is measured from the medial humeral epicondyle to the bony end of the residual limb.
Classification is as follows:. For transhumeral amputations the length of the sound side is measured from the scapular acromion to the lateral humeral epicondyle Fig. On the amputated side the length is measured from the acromion to the bony end of the residual limb. Craig W. Heckathorne, in Clinician's Guide to Assistive Technology Because most arm amputations occur in early or middle adulthood and result from trauma rather than disease, a person is likely Male arm amputee be in good health at the time of the amputation. This contrasts with persons who have lower limb amputations.
These are generally people more than age 50 at the time of amputation who have had the amputation because of the effects of a prolonged systemic disease.
A person with an arm amputation may also be ambulatory, with an intact arm and hand. Consequently, this person is able to move about and perform many one-handed activities. Such a person has retained many abilities and is not hampered in the rehabilitation process by the debilitating effects of disease.
However, the specialists involved should not assume that a person is in good health after the amputation and therefore retains the functional capabilities typical of a person of similar age and physical build. Associated injuries are likely in motor vehicle accidents and encounters with powerful equipment such as farm machinery. The presence of coincident musculoskeletal injuries compound and sometimes overshadow functional limitations resulting from the amputation. Sensory deficits before or resulting from the trauma, especially those involving vision, touch, or kinesthesia, also affect the level at which a person can function and the options for prosthetic restoration.
Persons with bilateral arm amputations, especially proximal to the elbow or with upper and lower limb amputations, have lost a ificant amount of body surface area. These people generally cannot give off heat as readily as people without amputations. Therefore they may be susceptible to overheating and have limited tolerance for sustained activity, particularly in warm environments. The etiology of upper extremity amputations varies widely. The earliest recorded use of limb prostheses was that of a soldier who reportedly amputated his own limb around BC.
Ambrose Pare —whom many consider the father of modern orthopedic surgery, contributed ificantly to the advancement of amputation surgery. The incidence and prevalence of upper extremity amputation over the past several centuries is attributed to advances in the pharmacologic and surgical management of disease and trauma.
Furthermore, in the area of externally powered prosthetics, fewer still have the additional education and certifications to work with these complex systems. Upper limb loss occurs due to trauma, dysvascular conditions, cancer, and congenital limb deficiency. More than 29 million Americans are living with diabetes. Mark Hallett, in Botulinum Toxin All patients experienced a reduction in stump pain, which lasted for many weeks. There was also a decreased occurrence of involuntary stump movements.
Matthew Trovato, Ramazi O. This approach to classification serves both academic and clinical purposes and presents a foundation upon which the indications for replantation are predicated and functional outcomes assessed and compared. Types of amputations are classified by anatomic criteria.
The complete type is clearly defined by its term, that is, an amputation without any tissue connection between amputated and proximal parts of the extremity. An incomplete, or partial amputation is where most of vital anatomic structures are disrupted, and blood circulation in the amputated part of the extremity is absent; without replantation the amputated segment will neither survive nor be functional Figure 1. The level of traumatic amputation of the extremities is defined by the level of the skeletal rather than soft-tissue disruption.
Based on these criteria, we divide all traumatic amputations replantations of the extremities into two main groups: major and minor amputations replantations. The necessity of differentiating the extremity amputations and replantations has been stressed by many authors for important clinical reasons, especially for indications and timing of surgery. This is due to the fact that major segments of the extremities contain large muscle mass, and anoxia of the muscles largely determines successful outcome of, and therefore indications for, replantation. Minor segments are those amputated distal to the wrist or ankle level, and major segments are those amputated at and proximal to the level of Male arm amputee respective ts.
Zone I—distal to the insertion of the flexor digitorum superficialis FDS tendons. Zone II—at the level of the fibro-osseous canals of the flexor tendons, between anterior interosseous AI pulley and FDS tendon insertion. Based on the mechanism of trauma, we differentiate the following types of injury and various combinations of these in the same patient:. Guillotine: a very sharp wound with minimal skin and soft-tissue damage.
Cutting: for instance, a guillotine with some zone of contusion. Crushing: the skin and soft-tissue injury zone is ificant, often associated with comminuted fractures. Avulsion : dissociation in levels of amputation of bone and soft tissues, almost always requiring vessel grafts Figure 3. Patients with traumatic amputation of an extremity and associated ificant injury to other organs, such as the head, chest or abdomen, usually represent a special challenge. These combined injuries are usually life-threatening and Male arm amputee preclude replantation.
Annemarie E. The Male arm amputee for levels of upper extremity amputation are described anatomically and are illustrated in Fig. The term disarticulation describes an amputation through the t. From proximal to distal, the term intrascapular thoracic describes an amputation of the entire upper extremity, scapula, and clavicle.
Transhumeral describes an amputation through the humerus, also known as an above-elbow amputation. The term transradial Male arm amputee an amputation through the radius and ulna, also known as a below-elbow amputation see Fig. Functionally speaking, with more proximal levels of amputation, fewer ts and muscles are available to control the prosthetic device.
Although a longer residual limb provides better mechanical advantage for prosthetic use, limb length does not always correspond to an increase in prosthetic function. For example, the length of the residual limb in an elbow disarticulation or long transhumeral amputation limits the space available for an elbow unit and affects both cosmesis and function of the prosthesis. Outcomes research in patients with upper extremity amputation is elusive. Few articles have been written about the outcomes after amputation and fitting of upper extremity prosthetics.
Experts cite the uniqueness of each case, the limited measurements available to assess function, and the relatively small population of patients. Some of the research available investigates the ability Male arm amputee health care providers to return the patient to his or her prior level of function.
Patients may discover methods to perform particular activities that may or may not involve the use of a prosthesis. Datta and colleagues 7 reported that Gaine and associates 8 described the satisfaction rate of prosthetic use in patients suffering a traumatic upper extremity amputation and in those with congenital deformities.
They reported that early prosthetic fitting, rehabilitation, and posttraumatic counseling lead to the optimum functional state of the patient. Overall satisfaction of upper limb amputees with their prosthesis was also investigated by Davidson. Successful rehabilitation programs address all of these areas. Jonathon W. Michelle Sybring, in Encyclopedia of Biomedical Engineering The clear majority of people with an upper-limb amputation have only a partial hand amputation in which they are missing one or more fingers. It is difficult to fit a device to these patients because so little space remains for the mechanism itself.
Devices have conventionally only been body-powered. Recently, several companies have developed externally powered devices in which the motors are housed in the fingers themselves. These devices may be fitted to people when enough of the finger or hand is missing to allow for enough space for them to be fitted.
Set alert. About this. Upper Limb Amputations Diane W. Yacub Martin MD, in Essentials of Physical Medicine and Rehabilitation Fourth EditionDefinition Upper limb amputations are devastating occurrences for individuals, with profound functional and vocational consequences. View chapter Purchase book. Contreras-Vidal, in Progress in Brain ResearchAbstract Upper limb amputation in a severe reduction in the quality of life of affected individuals due to their inability to easily perform activities of daily living. Amputations and Prostheses Joan E.
Major Upper Extremity Amputations. Major upper extremity amputations are classified as follows Fig. Upper-Limb Prosthetics Craig W. Heckathorne, in Clinician's Guide to Assistive TechnologyFunctional Limitations Because most arm amputations occur in early or middle adulthood and result from trauma rather than disease, a person is likely to be in good health at the time of the amputation.Male arm amputee
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