original post: bilateral A/E thoughts?

original post: bilateral A/E thoughts?

6/12/2001

ORIGINAL POST:
I have a very a challenging prosthetic case in which I would like
some
input/discussion from this list if possible. In January, this
gentleman lost both of his arms in a power take-off shaft. The left
side at present is healed and is a nice 75% length A/E. His right
limb is not fully healed yet with some purulent discharge and
tenderness distally. He also has skin grafting over the posterior
upper arm which is healed nicely yet is somewhat tender. He is
receiving laser treatments for this area. His level on the right side is
50% (mid level A/E).

The person is a male in his early 50's who used to operate his own
business and is very mechanically minded. He is very good at
rebuilding and painting vehicles. This is obviously an extreme
disability for this gentleman. He is coping extremely well at this
point and is staying at our rehab facility during the day for personal
care help as well as P.T., O.T. etc. He stays at home with his wife
in the evenings. They are presently doing some modifications to
their home so that he will be able to be fairly independent. (door
handles - lever style, combination push button locks etc.)



At present, I have fit him with a body-powered A/E prosthesis on the
left side. He is wearing it approx. 6 hours per day at present. I am
using an otto bock elbow model AFB(automatic forearm balance)
With a wrist flexion unit, and a Hosmer 7LO terminal device. I am
using a northwest ring harness with medium duty cable and teflon
lining. He is slowly learning to master this body powered device,
but is having the usual problems associated with
an A/E prosthesis. He has problems opening the TD more than
=BD inch when forearm is in full flexion. All aspects of life are very
trying at present, and an O.T. is working with him daily on help with
feeding, dressing etc.



We have introduced this gentleman to another bilateral A/E
amputee who is quite proficient at using his body powered
prostheses. He consented to having us film him in many aspects of
daily living. Eating, dressing, writing, shaving, etc. He has been an
invaluable source of information to our team as well as this new
amputee.

I have made a temporary prosthesis for his right side, but the
tissue is not yet able to tolerate a prosthesis for very long. (One
hour approx. ) I have many questions regarding this gentlemans
prosthetic care. I wonder if in the future we should be looking at
hybrid type of prostheses. The use of electric elbows would enable
him to have more excursion for a body-powered TD or possibly a
electrical TD with body- powered elbow units. Any input
regarding this??



I have also considered using a triple control system with the left
prosthesis until the right side is ready, however I have never seen
bilateral body-powered triple control system being used.
I know that I don't have the expertise to attempt to fit him with
bilateral myoelectrically controlled prostheses. I don't know too
many people in this region with that expertise. I can see that
donning and doffing these prostheses might be virtually impossible
or at best very difficult without help.

Maybe some of the Occupational therapist's on this list have some
ideas or 'tricks' for this type of amputation level. I also wonder if
there are any ideas for toileting other than using your heel to use
toilet paper or the prosthesis? We have seen the experienced
bilateral A/E rotate his elbow and flex the wrist in order to reach his
peroneal area.


If there are any ideas from anyone, OT's prosthetists, Physicians
etc., would appreciate the input.

Thanks in advance. I will post all responses in the near future.
Andy d'Entremont C.P.(c)