Therapeutic Interventions in Upper Limb Prosthetic Rehabilitation
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Basics of amputation & prosthetics
Losing a limb because of accidental trauma, injury, or disease profoundly impacts a person’s overall health, mental state, relationships, and thereby he starts losing stability in his way of life. The loss or removal of a body part such as a finger, toe, hand, foot, arm, or leg is medically termed as “Amputation”.
A person can experience a traumatic amputation from a serious accident. In traumatic amputation, an upper limb or lower limb gets cut off or torn away, or in some cases, gets badly damaged due to crush injury or severe burning.
On the other hand, some degree of infection or tissue distraction affects a body part in such a way that makes it literally impossible to repair, even endangers the person’s life. In these cases, doctors perform a surgical amputation. (1)
Prosthetics are done after amputation. However, not everyone who has an amputation requires prosthetics (an artificial device to replace the lost limb). Before considering prosthetics, the physical medicine and rehabilitative care team considers plenty of aspects of the patient’s life, such as, the overall health, along with the amputation decision (Upper or lower extremity). Our upper limbs have complex structures; therefore, arm prosthetics are designed considering the complexity of the upper limb’s connective tissue, nerves, and muscles. Prosthetic experts make the latest models of upper limb prosthetics using cutting-edge technology, which can basically coordinate with the human nervous system and enables fine motor movement. (2)
How do prosthetics work?
Prosthetics or artificial limbs are specially designed for amputees to restore their functions from the loss or absence of a limb due to accidental trauma, injury, or disease. Prosthetic limbs are categorized based on the level of amputation, such as:
- Above the elbow
- Below the elbow
- Above the knee
- Below the Knee
Prosthetics are chosen based on functionality, aesthetics, and overall health concerns of the arm amputees. Considering the above factors, experts develop a wide range of prosthetic options to fulfill the diverse needs of amputees.
Different stages of upper limb prosthetic rehabilitation & associated care to restore functionality
Pre-surgery care: If a rehabilitative care therapist (Occupational therapist or hand therapist) is able to meet the patient before amputation, they can forecast the upcoming situation, and thereby educate the patient on one-handed tasks, and let them know about adaptive equipment options.
Post-surgery care: For post-surgery care, rehab care specialists usually develop a home exercise program that consists of maintaining an adequate range of motion. They also guide amputee patients with all the necessary tools to maintain decent independence with functional activities, which can actually help amputee patients to manage post-surgery depression and cope with the new life. In some cases, phantom limb treatment such as mirror therapy, augmented reality, and isometric exercises are also suggested after 5 to 7 days after surgery. (3)
Here the main objective of designing a home exercise program for amputee patients is to help them maintain an adequate range of motion (ROM), & strengthen joints of the residual limb.
In this phase certified prosthetist (CP) works with occupational or hand therapists to improve the therapeutic outcomes. They generally suggest patients to change the hand dominance, and ask them to use one-handed techniques, adaptive equipment, and assistive technology for better independence in daily activities.
Importance of grip strengthening exercises in the upper limb prosthetic movements
In the prosthetic rehabilitation program, hand therapists usually include exercises like joint movement in the short range, upper-limb muscle strengthening workout, isometric grip strengthening exercises, as well as stretching exercises in order to keep muscular structure in balance to perform daily activities smoothly. Isometric exercises have significant importance in upper limb prosthetic movements because it speeds up the recovery process. (4)
In prosthetic training, patients need to work on their grasping and releasing abilities. Here therapists include different types of grip strengthening exercises with different variations, repetitions, and combinations to boost the grasping ability of prosthetic hands. (5),(6)
When we are talking about grip strengthening isometric exercises in prosthetic rehabilitation, a device like Squegg can help prosthetic patients a lot. It is a blue-tooth enabled hand grip trainer that comes with a personalized application. The Squegg application supports various kinds of hand therapy exercises, isometric exercises, & also allows users to measure and track grip strength. Squegg is a smart device that makes isometric grip strengthening exercises interesting through engaging games.
References:
- Shores, J. (2019). Amputation. [online] Johns Hopkins Medicine Health Library. Available at: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/amputation.
- Gonzalez-Fernandez, M. (2021). Amputation: Recovery and Rehabilitation. [online] www.hopkinsmedicine.org. Available at: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/amputation/amputation-recovery-and-rehabilitation.
- Hermansson, L.N. and Turner, K. (2017). Occupational Therapy for Prosthetic Rehabilitation in Adults with Acquired Upper-Limb Loss. Journal of Prosthetics and Orthotics, 29, pp.P45–P50. doi:https://doi.org/10.1097/jpo.0000000000000154.
- www.oandplibrary.org. (n.d.). 11: Adult Upper Limb Prosthetic Training | O&P Virtual Library. [online] Available at: https://www.oandplibrary.org/alp/chap11-01.asp [Accessed 3 Dec. 2022].
- Soyer, K., Ünver, B., Tamer, S. and Ülger, Ö.G. (2016). The importance of rehabilitation concerning upper extremity amputees: A Systematic Review. Pakistan Journal of Medical Sciences, 32(5). doi:https://doi.org/10.12669/pjms.325.9922.
- Information for O&P professionals and therapists Therapy & Rehabilitation. (n.d.). Available at:https://media.ottobock.com/_web-site/prosthetics/upper-limb/body-powered/128516-en_gb-01-1704w_2514386.pdf.
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Grip Strength As A Biomarker
Grip strength has always been an overlooked area. Even the topmost fitness enthusiasts fail to put enough importance on this matter. Most people are concerned with the physical training of other body parts yet grip training is rarely included in that.
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