Upper Limb Prosthetics

The main objectives in upper limb prosthetics are to meet the vocational, recreational and lifestyle needs of each amputee and to achieve an aesthetically pleasing outcome. Upper limb prosthetics management is a highly customised process.

Significant technological advancements in recent decades, especially the use of myo-electric units and targeted muscle reinnervation (TMR) have vastly increased the possibilities and capabilities of many Upper limb prosthetics users.

The basic components of Upper Limb Prosthesis are:

  • Terminal device – attached to the distal end of the prosthesis to provide function. This may include hands, hooks, other activity specific devices.
  • Socket – envelopes the residual limb and provides the foundation of the prosthesis
  • Harness – provides stability and suspension of the prosthesis and combines with the control system to provide function; &
  • may also include a wrist, elbow and shoulder joint.

There are several different types of prostheses for upper extremities. Your prosthetist will work closely with you, your rehabilitation specialist and other allied health team such as PT & OT to devise the solution right for you.

Upper limb prosthetics

Body Powered Prostheses (Conventional)

Body powered prostheses are the most common type of upper limb prostheses. They allow the prosthetic user to control the terminal device (usually a hook or a hand) via a harness system that fits around the chest and shoulder. This type of prosthesis is reliable, durable and can be used in environments involving dust and water though it can be cumbersome and uncomfortable for some.

Externally Powered Prostheses (Myo-electric)

Externally powered prostheses use a battery powered electric motor to control the terminal device, eliminating the need of a harness system. Sensors, embedded in the socket, pick up an EMG signal on the skin and transfer it to a processor which controls the functions of the motor. This motor then powers the elbow/wrist or terminal device. Intensive training with your prosthetist and occupational therapist is essential to ensure a successful outcome. Many myo-electric devices come with training apps that you can use in the comfort of your own home. You can also add in custom movements or settings for your specific needs in most cases. There must be enough viable muscle sites to be considered a candidate for this style of prosthesis.

Hybrid Systems

Hybrid systems are a combination of externally and body powered prostheses. This type can be used for Trans-humeral (above-elbow) amputees, providing functional restoration of elbow and hand. Usually, the elbow joint is controlled via a harness system and the terminal device is controlled through an external power source, for example myo-electrically.

Cosmetic Prosthesis

This type of prosthesis is traditionally considered purely cosmetic and does not provide functional restoration. However, there are many benefits and uses of ‘cosmetic’ Upper limb prosthetics, including but not limited to using as a support/brace when using your contralateral limb (eg. Holding down paper with your prosthesis as you write) and maintaining muscle usage/limiting wastage of the proximal muscles. Having the cosmetic prosthesis present is often beneficial for regaining a sense of self confidence, and often has a positive effect on mental health. A cosmetic glove is applied to match individual skin colour.

Socket & Interface

The purpose of the prosthetic socket is to transmit forces from the residual limb to the prosthesis. The socket suspension, interface/liner design and prescription will be chosen to work with you level of amputation, residual limb shape and available funding.

Specialty upper limb prosthesis

Upper Limb Prosthetics – More Information

For more information on Upper Limb Prosthesis, view the following pages:

 

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Multidisciplinary Care – Working with your Healthcare Team

Allied health multidisciplinary teams are important to ensure that you are provided with a holistic treatment plan. APC are proud to participate and present training days and seminars to educate our allied health peers.

Physiotherapy

If you are an amputee, you will have likely received physiotherapy during the rehabilitation stages as a part of your hospital stay. However, physiotherapy should not be seen as a service only accessed in the early years. It is important as an amputee or someone with limb difference to maintain good muscle strength, flexibility, and stability. This will ensure that your ability to use your prosthesis continues well into your later years. Working regularly with a physio throughout your life as a prosthetic user can act as a reminder to engage the muscles you may not be using as much as you should be, or to help you kick some bad gait habits you may have developed.

Physiotherapy is currently available onsite at APC ‘s Alexandria and Northmead offices to assist amputees in varying stages of their prosthetic usage:

  • Gait re-education from initial fitting of the first prosthesis through to advanced functioning (e.g., return to recreational activities, running, gym programs).
  • Upgrading/teaching the use of a new prosthetic prescription.
  • A program for the use of micro-processor knee joints.

Physiotherapy at APC Prosthetics is provided by Cathy Howells, a registered physiotherapist with a special interest in amputee rehabilitation and over 30 years’ experience working exclusively with amputees. All our sites can help put you in touch with physiotherapists in your area who have experience working with prosthetic limb users.

Exercise Physiology

Exercise Physiologists (EPs) sometimes get mixed up with physiotherapists. Where physios often manipulate the tissue, using an active hands-on method with massage along with prescribing targeted movements to improve a problem area, EPs offer ‘hands-off’ programs. Exercise physiologists are great for amputees and prosthetic users for prevention, ongoing targeted training, or if you have a sport or recreational activity you would like to learn to get back to or start doing since being an amputee. EPs develop person-centred exercise interventions that can be targeted for pain management, disability, chronic conditions, and injury. Feedback from our clients who use the services of EPs report that they move and walk better than they ever have before. Some have said that through the exercise interventions prescribed by their EP, they need to use less energy to walk and that has meant that it is easier to use their prosthesis and access the community (AKA live their life!).

Occupational Therapy

Occupational Therapists (OTs) can help you learn how to use your prosthesis (especially Upper Limb) for specific tasks and training, along with recommending any modifications that need to be made to your home or car.

You may need a consultation with a trained OT in the process of getting your license for the first time after amputation.

OTs are essential in the process of applying for funding for upper extremity (UX) prosthetics. An OT will need to be present in your NDIS (National Disability Insurance Scheme) Assistive Technology (AT) Assessment alongside your prosthetist. They will aid in performing and interpreting clinical outcome measures (COMs) which are functional tests demonstrating levels of ability and need.

Medical Services

The team at APC Prosthetics work closely with your rehabilitation specialist to ensure you receive the best treatment outcomes based on your health, healing and any other medical conditions that may affect your prosthetic use. Due to the long history of APC attending many amputee clinics for over 20 years, we have solid communication and a multidisciplinary team approach that leads to the quality service you will receive. We regularly consult with your other specialists as needed, for example, dermatologists, who can assist you with any skin conditions or concerns. If you see a new specialist or receive a new medication, it is a good idea to inform your Prosthetist as treatments may affect the fit or outcome of your prosthesis.

Funding for Allied Health Support Services

How you access a physiotherapist and other allied health services depends on your funding.

  • ENABLE:
    • A referral from your GP will be required, you can get 5 free PT visits per year if you are on a care plan. We can assist by writing a referral to back up your need for this support service.
  • NDIS:
    • Talk to your planner at your next plan review to ensure there is sufficient funding available for the number of visits you require for the length of plan. Your prosthetic AT Assessment and request will advocate for any additional services deemed necessary for you to succeed with your prosthesis and goals.
  • INSURANCE: This will be negotiated with your case manager.
  • PRIVATE: There is always the option to go directly to a PT etc if covered by private health insurance or by paying directly. Your prosthetist can write a letter of referral/handover to communicate with your chosen provider in order to best help you succeed.

Mental Health Support Services

Losing a limb can be a very emotional experience for you and those in your support group including friends or family. It is important you and those around you speak about how you are feeling with the appropriate support groups and services. Speak to your GP about how you can access the right mental health support for you.

There are also support services available through state and national amputee support groups.

Other Support Services:

Your prosthetist can help put you in touch with peer support groups that are run both on a state and national level. You will also find brochures in every APC branch or you can read our resource on Amputee/Limb Difference support groups here.

Support Services:

  • LIMBS4LIFE:
    • Limbs4Life is a charity that provides peer support options, amputee resources and wellbeing information. They also provide independent support to help you navigate disability and health-care system. They also offer social events and activities for amputees of all ages.
  • AMPUTEES NSW:
    • Amputees NSW is a volunteer based community organisation that provides support to anyone affected by limb difference. They aim to improve access to quality programmes, and news of upcoming events.

Specialty Prostheses

Specially designed prostheses are often required when an amputee wants to perform activities that exceed day to day ambulation or activities.

APC Prosthetics continues to lead the profession in prosthetic innovation. Our team is internationally recognised in specially designed and sporting prostheses in a broad range of activities including athletics, skiing, cycling, golf, weightlifting and more. If you are interested in competitive or social sporting activities, we are happy to provide contact details for the respective sports institutes and sporting bodies.

Waterproof Prostheses

The most common specialty prosthesis is a waterproof prosthesis, which enables the amputee to use the prosthesis for tasks involving water, such as showering, swimming, or accessing the beach. Recent development of waterproof fibreglass feet have provided great advances in water-based recreational activity, and specially designed devices are also available to allow for the use of flippers.

Recreational Prostheses

The development of “hybrid” prosthetic components has expanded greatly, in particular the numerous designs of prosthetic feet which allow the amputee to access a wide range of recreational activities without compromising general walking e.g. Cheetah Xplore, Pro-Flex XC Torsion, etc.

Task Specific Prostheses

A prosthesis used for a specific task/sport/activity – e.g. A weightlifting arm, drawing attachment, skiing or running prosthesis, etc.

If you have any questions about specially designed prostheses, please contact us.

Osseointegration

Osseointegration is the structural connection between living bone and a load- carrying metal implant. First introduced into dentistry in the 1960s, Osseointegration has been an option for some lower and upper limb amputees since the 1990’s in Europe. The prosthetic components are attached directly to the implant via a connector, eliminating the use of a traditional socket. Whilst there may be numerous functional benefits to Osseointegration, there are also a variety of advantages and disadvantages to explore when considering if this option is right for you.

APC Prosthetics has been actively involved in the establishment of amputee services for Osseointegration users since its introduction to Sydney in 2010 and we have been managing over 500 amputees who have undergone the procedure. If you would like to find out more about this, please ask to speak to one of our prosthetists.

New Amputees

New Amputees Treatment

The amputation of a limb for new amputees is a life changing experience, and the requirements of each client are different and will change throughout their life.

Our philosophy is to work with new amputees to comprehensively assess their needs, establish their requirements and then deliver the appropriate solutions.

All of our clients’ needs are unique, so our highly experienced prosthetists work closely with multidisciplinary health professionals to establish a customised treatment solution for each of our clients. The team includes Medical Specialists, Physiotherapists, Occupational Therapists and other health professionals.

APC Prosthetics has a strong support system to assist clients in challenging situations and work closely with Government/Health authorities and national professional bodies including EnableNSW, DVA, the NDIA and AOPA. We also maintain close relationships with global prosthetic technology groups, which allows us early access to the latest technological developments in both prosthetic components and manufacturing technology.

At APC Prosthetics, we are dedicated to achieving the best outcome for our clients, aiming for the best possible comfort, the best possible function and the best possible lifestyle.

Treatment Pathway

Interim Prosthesis:

The first phase of the prosthetic rehabilitation is the provision of an interim prosthesis. This generally occurs approximately 6 weeks after amputation when the suture wounds have sufficiently healed. The aims of the interim prosthesis are to establish early mobility and commence gait re-education as early as possible.

After a comprehensive assessment with the rehabilitation team, the rehabilitation specialist issues a prescription for the interim prosthesis. The prosthetist will then take a plaster cast of the residual limb, which is called a plaster negative. The plaster negative is then used to make a replica of the residual limb, which is modified to achieve a comfortable socket. The socket is then moulded over the plaster model.

Various liner materials are used to act as a cushion between the socket and the residual limb, absorbing and dissipating shock, shear and torque forces that occur during walking and standing on the prosthesis.

Next, the prosthetic components are connected to the socket and the client returns for their first prosthetic fitting. During this process one of our highly skilled prosthetists assesses the socket-fit and analyses gait to determine optimal alignment. The correct alignment of the prosthesis is essential to ensure maximum comfort and function.

You can expect regular modification to this first prosthesis, as the residual limb undergoes significant changes in shape and volume during the first months. After approximately 3 to 4 months the prosthetic interim socket will be replaced with the first definitive socket.

Definitive Prosthesis:

For your first definitive prosthesis, the prescription process is then repeated (dependent on your funding body, eg EnableNSW, NDIS, Insurance, etc.). The prosthetist will take a new cast of your residual limb and the manufacturing process begins again. The materials used to manufacture the definitive socket include fibreglass, carbon fibre or specially designed plastics. Utilising the latest manufacturing technologies and high-tech materials ensures a durable and extremely light socket.

The prosthesis is trialled for several days. It’s important you trial the check socket in as many real-life scenarios as possible in order to give your prosthetist quality feedback on the suitability of the fit and function. After the successful completion of the trial period, the prosthesis is cosmetically finished, to deliver a pleasing aesthetic result.

As the shape and volume of the residual limb will change over time, it is very important that the client sees their prosthetist on a regular basis (every 3 to 6 months), to ensure the socket is still fitting properly. Sometimes it is necessary for the prosthetist to make adjustments to the prosthesis to compensate for any changes. However, if the changes are too significant, a new socket (socket replacement) might be required.

Ongoing Care

Physiotherapy:

Physiotherapy is a vital factor throughout the entire rehabilitation process for new amputees, including muscle-strengthening exercises and gait training. Your amputee clinic will have onsite physiotherapists who specialise in amputee gait training, and APC also offer specialised Physiotherapy sessions in our modern and fully equipped gymnasiums tailored to the individual needs of each client.

Lower Limb Prosthetics

Our Lower Limb Prosthetics (Prosthetic Leg & Prosthetic Foot) are custom designed and made for each amputee. Over the past couple of decades significant advancements have been made in terms of prosthetic components and socket design. The use of lighter and more durable materials has resulted in improved comfort and function. The socket design and the components determine the level of comfort and function we can expect from a prosthesis. We will briefly overview the components of  the lower limb prosthetics.

Socket and Interface

The purpose of the prosthetic socket is to transmit forces from the residual limb to the prosthesis. A well-designed socket which is regularly reviewed or replaced as you change in shape will provide comfort and stability during walking and standing on a prosthesis. Your socket generally will be made of a combination of plastics, resin, fibre glass and carbon fibre to create a lightweight, durable prosthesis.

The interface/liner is intended to absorb shock and shear forces on the residual limb. It fits between your residual limb and the socket and can be made from various soft materials. Modern interfaces are generally constructed from silicon and urethane polymers, which help protect the tissue. They can also assist with suspension of the prosthesis by incorporating a pin that connects to a locking mechanism in the socket, or a seal which provides a negative pressure system.

Foot and Ankle

The human foot-ankle is a very complex functional unit. It provides stability as well as flexibility, absorbs forces and utilises muscle to generate energy for efficient and comfortable walking.

Over the past decades we have witnessed major improvements in design and manufacturing of prosthetic feet, allowing much more energy efficient and natural walking.  As each patient has different needs and lifestyles, it is vital to select the most appropriate prosthetic foot to achieve maximum comfort and function.

Knee Joints

Knee mechanisms for trans-femoral (above-knee) amputees have also seen major technological advancement in the last decade, greatly improving safety and function. Microprocessor controlled knee units have led these advances.

Incorporation of hydraulic and pneumatic mechanisms allows modern knee units to adapt to variable cadence and assists walking on slopes and stairs. New design concepts for multi-axial knee units have seen increased stability without the accompanying instability downside of higher energy expenditure. Your prosthetist will work closely with you to find a prosthetic knee prescription that works best for your lifestyle and goals.

There are many different socket design styles, suspension methods, prosthetic feet and knee units, which your prosthetist will work closely with you to prescribe the most suited based on your level of amputation, functional capabilities, goals, daily activities and lifestyle.

Prosthetics for Kids

APC has been providing prosthetics for kids with limb difference and amputation for many years. We are involved in the Limb Deficiency Clinics at Westmead Children’s Hospital and Sydney Children’s Hospital in Randwick, where we work closely together with rehabilitation teams to ensure the best outcomes for the kids we see.

We see a wide range of kids and families from across NSW; from Sydney and surrounds, to more regional and rural parts of the state. APC is an ever-growing family, now with 4 branches and associated outreach clinics, so we reach far and wide across NSW.

Working with the paediatric population is so special because each child is incredibly unique and has their own unique needs and goals. Here at APC, we love working together with kids and their families to help them realise those goals, and help dreams become a reality through providing the most appropriate prosthetics for kids; be it an upper-limb prosthesis to assist in riding a bike, or a lower-limb prosthesis for running and sports, and everything in between!

At APC we understand that each child has their own individual presentations, needs, and wants, and love working together with kids and their families to achieve the best results for all.

NDIS

Most children with limb difference are eligible for NDIS funding. If you’re not sure whether your child is eligible, speak with one of our prosthetists, or check out the eligibility criteria on the NDIS website.

We have been working closely with the NDIS since it was first rolled out in New South Wales, so we have an in-depth understanding of how to best help your child get the prosthetic services they need through the NDIS.

Funding for your Prosthesis

Depending on your individual circumstance, your prosthetic care will be funded by one of the following funding bodies:

EnableNSW

EnableNSW – Prosthetic Limb Service provides funding for a basic prosthetic limb to all eligible amputees. Residents of NSW are eligible for admission to the PLS, provided they hold a valid Medicare Card. If you would like to find out more about the PLS please click on the following link:

http://www.enable.health.nsw.gov.au/services/pls

NDIS

The National Disability Insurance Scheme provides funding for eligible amputees under the age of 65 at the time of registration. Provided you have registered with the NDIS prior to being 65 you will continue to be funded. The team at APC Prosthetics have vast experience in navigating this scheme to ensure our client’s prosthetic care is optimised. See our guide here.

If you would like to find out more about the NDIS please click on the following link:

https://www.ndis.gov.au/

Insurance Clients

Patients with an insurance claim will be assessed comprehensively by a multidisciplinary team to determine the prosthetic management plan.

Once approval has been granted by your case manager, we will commence the prosthetics treatment immediately.

If you would like to find out more about this, please contact your case manager or alternatively, contact APC.

Private Clients                                                      

APC Prosthetics is Australia’s leading private prosthetic clinic and provides comprehensive services to private clients.

Private clients are free to determine what prosthetic technologies they wish to incorporate in their prostheses without restrictions. The specialists at APC are happy to provide consultations and advice without any demands or commitments to our clients.

Please feel free to contact APC if you wish to review your current and future treatment options.

Cosmesis

Cosmetic Design: options for how your prosthesis looks

There are many different options when it comes to the cosmetic design of your prosthesis. For both upper and lower prosthetic limb users, it’s vital to consider what’s important to you so that your prosthetist can design a prosthesis that is both functional – meeting your lifestyle and goals, but also one that you like the look of it’s cosmesis. Making a prosthetic limb suit your style is fun for us, but it also has an important clinical role. Typically, if a prosthetic user is a part of the decision-making process and has a prosthetic limb that they like the look of, they are more likely to accept the limb, want to wear it and be proud of it. This can improve outcomes and can have a positive impact on mental health.

So, the more we can make your prosthesis be a part of your life, whether it be from blending in or standing out, we are willing to try and make it happen!

Realistic Cosmesis

For some, they want their prosthesis to look as close to an anatomical leg or their sound side as possible. This often helps these users to accept their prosthesis and promotes higher usage/wear rate. The level of realism attainable depends on your funding body.

Some options available are:

  • Foam cover shaped in house to resemble your sound side.
    • Covered with a cosmetic stocking or leather. (Check out our Instagram for how these are made)
    • Covered with a silicone cover ordered and fabricated externally. These vary in price dependent on the level of detail.
  • Exoskeletal prosthesis – either solid or hollow prosthesis without modular components, made in-house & shaped to your measurements, with a pigment mixed in to match your skin tone.

Fashion/Statement

Other prosthetic users prefer their device to represent their fashion sense, their football team, a favourite colour or even have tattoos! For these clients, there are many options for cosmesis that we can achieve both in-house or  by working with external companies to order in a cosmetic option right for you.

 

  • Provide your prosthetist with fabric of your choice to be embedded into the lamination of your socket.
  • Choose a colour of pigment to be mixed into the resin for your socket.
  • Custom covers can be made in-house with a cosmetic finish of your choice
  • Your prosthetist can take measurements and order a removable cover for you from companies such as Alleles and UNYQ. These can be beneficial also in filling out long pants and protecting your clothing from the componentry/preventing tear

There are many more options available so if you have something specific in mind it is important to talk to your prosthetist early on so we can make your prosthesis just right for you!

Comfort, Function & Lifestyle – The APC Philosophy

At APC Prosthetics we are committed to providing our patients with the best possible outcome. We are focused on achieving maximum comfort and function to allow our patients the best possible lifestyle.

There are two essential factors to achieve comfort

  1. Socket design and fit
  2. How the forces are absorbed by the stump/socket interface

Socket design and fit revolve around correctly determining the shape of the prosthetics socket and successfully distributing forces created when you are walking or standing on your residual limb. The appropriate socket design and liner material is determined by a skilled Prosthetist to ensure optimum socket comfort.

The keys to achieve best possible function are a comfortable socket, selection of the right components and the correct alignment of your prosthesis.

The selection of the appropriate components is a very important factor to achieve a successful outcome. Because most components are designed for specific activities and specific lifestyles, a comprehensive patient assessment is necessary to determine the right components for each patient and enable them to lead the lifestyle they desire.

The correct alignment of the prosthesis is a vital element to successful function. It means determining the correct position of the socket and components relative to each other.

When all these factors work together in harmony, the result is optimum comfort, function and lifestyle.

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