Randall Alley, BSc, CP, FAAOP, is the head of
Clinical Research and Business Development for Hanger’s Upper
Extremity Prosthetic Program. He is the Academy’s Upper Limb
Prosthetic Society Chair and an international lecturer and
Diane Atkins, OTR, is A clinical assistant
professor in Physical Medicine and Rehabilitation at the Baylor
College of Medicine, Houston, Texas. Atkins is an occupational
therapist who has specialized in amputee rehabilitation for more
than 25 years-with special focus on rehabilitation of the upper
John Billock, CPO/L, FAAOP, and past president
of the AAOP, is the clinical/executive director of the Orthotics
& Prosthetics Rehabilitation Engineering Centre, Warren,
Carl Brenner, CPO, is the director of
prosthetic research at the Michigan Institute for Electronic Limb
Development, Livonia, Michigan.
John M. Miguelez, CP, FAAOP, president of
Advanced Arm Dynamics, Rolling Hills Estates, California, serves as
a clinical consultant worldwide on issues regarding upper-extremity
Robert H. Meier III, MD, is founder of Amputee
Services of America, Thornton, Colorado, a comprehensive center of
excellence that addresses issues related to limb amputation.
Meier’s experience in rehabilitating persons with amputation
encompasses about 2,700 amputees, 45 percent of whom are upper-limb
What are your own personal visions, goals, and desires
for the upper-extremity field?
Alley: My ultimate goal is patient empowerment
and industry advancement. I have tried to achieve this by helping
to create and develop the Upper Extremity Prosthetic Program, whose
chief mission was and is to improve patient care; by utilizing the
principles of kinesiology in designing more effective, efficient
and comfortable prosthetic interfaces; by writing articles that
attempt to bring to light relevant and timely topics for patients
and health professionals; by driving education and innovation
through my development and research role at Hanger, and finally by
introducing initiatives into the charter for the Upper Limb
Prosthetic Society that will attempt to refine the overall
My ultimate hope is to work together with the dedicated members
of this field to coalesce the building blocks of an enhanced care
delivery process, improved outcomes, and a more comprehensive
educational and support system into a brighter future for patients
and the individuals who care for them.
Atkins: My goals for the UE field are
(1) To establish a National Directory of experienced
occupational therapists in UE prosthetics;
(2) To promote education and an ongoing awareness in UE amputee
rehabilitation-particularly its technological advances-to doctors
(rehabilitation, orthopedic, and plastic), OTs, and rehabilitation
(3) To enhance opportunities for UE amputees to network with
each other, particularly those with bilateral UE amputations;
(4) To reinforce the importance of the experienced team approach
in all aspects of treatment for the UE amputee.
Billock: There really need to be more OTs
trained to work with patients to provide comprehensive functional
use training after they’re provided with an upper-limb prosthesis.
They never seem to get the vocational rehabilitation training they
need. There are vocational counselors available, yes-but no
occupational therapists skilled at providing the functional use
And with an upper-limb issue, the functional need is much
greater than with a lower limb.
I’d like more component options to be available to answer
patient demands: I recently saw a young woman who lost her arm in a
lion attack and was seen elsewhere, where it was recommended that
she be fitted with an electric elbow that was unacceptable to her
because it was too large, too heavy, and too noisy. Because of the
aesthetic importance to her and its overall weight, we developed a
dramatically modified prosthesis for her, which will have
custom-sculptured foam and Livingskin® restoration cover to
better address her needs-until a more acceptable functional elbow
As per her request, the prosthesis was also self-suspended,
without straps or harnessing, and had a dramatically modified
myoelectrically controlled hand with lightweight lithium polymer
batteries for power. Until faster hands with more grip force are
developed, along with better controls and lighter elbows, we won’t
be able to provide patients with what they want, need, and
Some manufacturers like Otto Bock have made a significant
investment in this area-but it is in manufacturers’ best interests
to use of all their existing inventories before moving on and
making more sophisticated prosthetic solutions widely available to
The rapid escalation of technology keeps pushing us all along.
It’s moving at a faster and faster pace. If we don’t stay ahead,
we’ll get run over. Providing prostheses with components that
rapidly become obsolete and eventually impossible to replace or
repair will increasingly challenge the delivery of upper- limb
prosthetic care in the future!
Brenner: There are a couple of things I would
like to see: Cosmetic gloves for powered prostheses that are more
durable, stain-resistant, and not only more cosmetic, but also more
cost-effective and affordable as well.
Another area that I think severely limits the effectiveness of
any upper-limb prosthesis is the lack of truly effective feedback.
If anything were to be developed at my choice, I would like to see
realistic and practical tactile feedback systems for upper-limb
prostheses, so the user doesn’t have to rely primarily on visual
observation as a substitute for a real sense of touch.
Miguelez: Personally, my goal is to help
patients know that despite their terrible loss, they don’t need to
worry about the rehab process. All they have to focus on is their
rehab, not all those ancillary issues.
I’d like to improve the success rate with upper-extremity
prosthetics: the number that’s cited most often is 50 percent-and
that is just terrible. My goal is to educate referral sources and
reimbursement agencies that, given the right approach and the right
resources, the success rate should be expected to be very high.
Meier: Our largest goal-almost complete at this
moment-is a current textbook designed for use by UE amputees,
practitioners, physicians, and therapists.
*Note: “Functional Restoration of Adults and Children with Upper
Extremity Amputation” is scheduled to be available in July 2003,
according to the publisher, Demos Medical Publishing, Inc. For more
information, call 212.683.0072 or e-mail [email protected].