Introduction
Prosthetic and orthotic practice is an iterative process. General phases include patient evaluation, synthesis of information to identify and define the healthcare problem or functional needs, development of goals for the P&O intervention, formulation of the prosthetic prescription and treatment plan, implementation of the treatment plan, and follow-up and re-evaluation to determine whether the goals were achieved. The first step is crucial to clearly understand what activities are important to the person and how the person might use a prosthesis.
The upper limb prosthetic prescription includes the following elements:
The Socket is the foundation of the prosthesis; it provides the purchase on the residual limb, extends the control function (movement and direction) of the forearm and terminal device, and allows for the transmission of force and displacement needed for forearm flexion, TD operation and elbow lock.
Suspension of the prosthesis means that the prosthesis stays in place throughout the day and during the person’s activities. The prosthesis does not slip or rotate. Suspension systems include harnesses, socket suction suspension, roll-on liners with lanyard or pin suspension, anatomical contouring such as the supracondylar socket style; or suspension may be gained through a combination of the above systems.
Control of the prosthesis implies that the device operates as commanded. There are many factors involved and the design of the control setup (e.g., harness or other input device) must fit the individual and his/her needs. Appropriate training is imperative to optimal operation and function of the upper limb prosthesis.
Components are selected based on the activity/participation needs of the individual as well as the personal and environmental factors.
The client needs education about how the components operate as well as how to care for the prosthesis and what to do when things don’t work.
The prosthetist provides basic training on donning as well as basic control operation so the client can begin to perform their desired activities.