Advancing Care for Upper-limb Loss

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By Andrea Spridgen

Providing upper-limb prosthetic care is often viewed as particularly difficult because of the complexity of trying to replicate the function of the human hand. Additionally, upper-limb prosthetic rehabilitation has been fraught with high rejection levels, attributed to users' perceptions of inadequate functionality, wear temperature, weight, and, depending on the type of prosthesis, unappealing cosmesis or burdensome maintenance. This issue of The O&P EDGE  explores advances in upper-limb technology and treatment approaches that are improving the options and outcomes for those with upper-limb loss.

While pattern recognition (PR) technology is not new, it was only recently that commercially available systems made it viable for use outside the lab. "Upper-limb Prosthetics: Pattern Recognition Shows Practical Promise" examines advances in PR for upper-limb prosthetic clinical use and reviews research efforts to compare it to traditional direct control for myoelectric prostheses. Additionally, targeted muscle reinnervation, which can enhance PR control is discussed in this article and in Today's Consumer, featuring Tiffany Johnson who would have been limited in prosthetic function without the surgery.

An upper-limb amputation is generally more visible than a lower-limb amputation that can be more easily disguised by clothing as desired. As such, issues surrounding cosmesis are an integral part of discussions about upper-limb prostheses. "Climbing to Westworld: Realism in Prosthetic Design" tackles the concept of whether societally we become more or less comfortable as prostheses more closely replicate the appearance of biological arms and hands, and what impact that perception may have on a patient's experience of prosthetic acceptance. This article also raises questions about whether recent changes in attitudes have led away from realism toward an affinity for the appearance of high-tech limbs whether or not their function reflects the perception.

Historically, one of the least served populations of people with upper-limb amputations were represented by the greatest number of individuals—those who have partial hand amputations. Fortunately, as described in "Updates on Prosthetic Rehabilitation Following Partial Hand Amputation," options for partial hand prostheses have increased and their functionality has improved. Although the article stresses the need for further research, the advances demonstrate improvement in meeting the needs of this traditionally underserved population.

I want to thank Nicole Van Kuilen for sharing a firsthand reflection on her experience as the inaugural fellow for the National Association for the Advancement of Orthotics and Prosthetics and providing her perspective on patient advocacy.

Finally, I'd like to congratulate my team members here at The O&P EDGE:  For the fourth consecutive year, the magazine has been awarded an Editorial TABBIE award, an awards program sponsored by Trade, Association and Business Publications International. And, if you are attending the American Orthotic & Prosthetic Association's National Assembly, stop by booth #941 and say hello to some of our EDGE staff members.

Happy reading.