Dear List,
Thank-you very much for a great response to my question. I have compiled your answers and will meet soon with my client to present them to her. I appreciate all the time and effort you all took to reply.
Sincerely,
Andy d’Entremont C.P.(c)
Wascana Rehab Centre
Regina, SK
Canada
Replies:
Sounds like options are limited: has osseointegration ever come up? Or pin suspension with custom length matrix if need be.
Good luck,
One idea would be to give her a harness for when she is doing her heavier duty activities, such as horseback riding. I have had a lot of success with the Otto Bock 5055=X (X is the size) AcroComfort orthotic brace. It is big/bulky and black (so definitely NOT transparent!), but the best thing about it for you is that it is removable. If she started wearing the harness for some activities she might see how it is valuable and then you could explore more permanent, cosmetic options down the line if she was interested. If the chest strap is uncomfortable under the axilla (their pad is small), I’ve found that the silipos pediatric suspension sleeves (6/pk) fit great over it. Cheers, Laura
I have been wanting to try a DMO in place of a conventional harness for a transhumeral patient for quite some time now. If you are not familiar with DMOs then check out DMorthotics.com they have a lot of custom lycra garments that would be custom to the patient for a very intimate fit. I am thinking somehting like this to go around the patients sound side:
http://dmorthotics.com/sport/products/reps-pro-single-shoulder-support
DMO should then be able to provide custom slits where dacron could run off of the device to control cabling and suspention by attaching onto this mock ‘harness’. This would be so thin that she could wear it under anything and not have it show through. When it is seen it has an athletic look to it and she could choose colors to match her favorite sports team or go with a flesh tone. Sounds like a tough case and I think your assessment is dead on. Let me know what you end up doing for her and how it turns out.
Perhaps a pin might get her into a socket and once her volume is stable transition to suction or stick with the pin.
Just a thought, best to you and your client.
Hi Andre,
Since she is mid length and you have the room, I recommend trying to fit her with an Ossur Upper-x pin locking liner with a 700 series ossur locking mechanism or a Fillauer shuttle lock. If she needs additional suspension during horseback riding, you could try a shoulder saddle that connects to the socket. Good luck!
Have you considered using revo limb technology?? If the patients residuum is long enough, might be a possibility and solve some of Your issues. Good luck!
I just finished making a trans humeral prosthesis for a woman. She also did not want a harness. She was mid length and I casted up over the shoulder and most of the weight of the prosthesis is carried on the top of the shoulder so it’s not just hanging off the arm. That might be a possibility. Suspension was a silicone liner with a pin lock. For the liner I used the aegis thin liner with the bent knee and the bent part goes over the shoulder. I used the Ossur pin lock with the button under the axilla. This was also Endoskeletal. The shaped cover was difficult because I used a one piece foam so there would not be a gap at the elbow. Hope that helps.
No harness, no service
Osseointegration. 🙂
I have done an elbow disarticulation with an elevated vacuum system. maybe something like that with flesh-toned harness material? Maybe you could get Otto Bock to do an ultra-spray on the outside of the harness to match her skin tone…just some initial thoughts.
She needs a harness or a shoulder saddle. Likes it or not.
Now, you could have made her a shoulder saddle out of say translucent
soft polyethylene. Let me stretch it a bit for you. I have seen quite a
few females out there, exposing CLEAR bra straps. Small expense at say
walmart, buying two bras of that nature, could provide you with enough
material for “transparent” straps. Same soft poly may be cut into strips
and used as straps.
But she does need auxiliary suspension. Momentum and force of gravity
are very powerful.
Possible solution may be an ossur icelock (very low profile) locking mechanism in conjunction with an ossur upper-x locking liner.
My limited experience with trying to use suction systems on passive arms is that, as you mention, it causes a continuous draw on the arm, producing blood pooling below the surface of the skin and distal swelling and resultant tenderness. It’s not analogous to a suction lower limb prosthesis where there is constant loading and unloading of weight creating vacuum and pressure on the tissues cyclically. My recommendation is to avoid a suction liner on trans-humeral prostheses especially cosmetic ones.
A simple figure of 8 harness without suction should work well. Now convince her!
The only solution I know of is to have a HiFi Socket Interface provided. You can contact Randy Alley.http://www.biodesigns.com/interface_socket_design.html
Toughwareprx.com if she doesn’t mind the esthetics. You can put a hand on it. No harness!
Hi Andy
Do you think she would go for an Otto Bock Omo Neurexa to take some of the weight of the arm? Does she have a skin on her current prosthesis as the Omo Neurexa grabs skin on the forearm quite well?
She is SOL
I recommend psychotherapy for the patient to become more comfortable with the idea of having this change in body image
You may want to discuss the Cutaneous Anchor system with this patient. She may reject this too, but it is another option with no contralateral harness. Of course, there is the risk of skin irritation, but we used this with moderate success on one patient & I was surprised that it worked. Though it is shown here as a functional anchor for the control-attachment-strap, I don’t see why it couldn’t be utilized as a suspension method.
Since we often use elevated vacuum on lower-extremities, with the effect of perceived weight reduction, I would also consider elevated vacuum for this patient. Unfortunately, it doesn’t sound like you have much limb length to work with.
Good luck!
Original question: I have a new client that has come to me from out of province. She has a mid-length trans-humeral amputation due to vehicular accident. She has tried two styles of prostheses with no success due to discomfort and weight of prosthesis issues. It seems the first one she tried is a standard pull in suction socket with and endoskeletal light-weight system with no harness. She felt the weight of the prosthesis uncomfortable. It seems she also tried a seal-in liner system again with no harness and endoskeletal componentry. She also felt this was too heavy and uncomfortable. Her residuim is not tender, painful or scarred.
I have tried to convince her that she will NEED a harness to make this a workable prosthesis. She wants it mainly for cosmesis and a passive hand with spring to hold some objects. She also rides horses and would like to wear this while riding. I explained that the up and down motion of riding would put a lot of tension or draw on the residuim and that is likely why the past systems have not worked for her.
Some of my concerns are: She lives 2 ½ hours from our facility. If I were to try standard pull-in suction, I would believe she would shrink out of it in a short time. This is because she has not been wearing any device for 2 years and shrinkage is likely. The same applies to a seal-in liner as I believe it would become loose and the jarring of horse-riding would be uncomfortable. A lanyard system was brought up but she did not want a string showing. This would negate a coyote like system as well.
She asked if there was a transparent harness material, which I told her I was unaware of anything like that.
Would any-one have any comments or suggestions I could propose to this client? It would be much appreciated.
