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Intro to Prosthetic Training
347 Plays1 month ago
Join hosts Josh as he discusses the fascinating world of upper extremity prosthetics with Tristany. In this episode the they discuss the fundamentals of prosthetic technology, exploring different types of devices and their function.
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Transcript
Introduction to Hand Therapy Academy
00:00:08
mmateri
Hi, I'm Josh McDonald.
00:00:09
Tristany
and I'm Tristany Barry and we are Hand Therapy Academy.
00:00:14
mmateri
So we're now on our third one of these. Tristany, one of our young therapists, is bringing some questions to us. So Tristany, what what do you have for us next?
How Prosthetic Patients Arrive at the Clinic
00:00:22
Tristany
Yeah, so recently I think that we've gotten a lot more prosthetics. People who have different varying amputations and they have recently got their devices and I just wanted to kind of ask how did they come to see us?
Collaborations with Prosthetics Providers
00:00:37
mmateri
Yeah, yeah we um we honestly started when we had some patients with digit amputations, hand amputations, and they needed to get a prosthetic. And we it's on us as therapists to say like, hey, this patient could benefit from that depending on if it's cosmetic, if it's functional, if it's adaptive, and said, hey, we need to go find a prosthetics person for this. We connected to some people. And then that kind of led to, well,
00:01:02
mmateri
that person's insurance doesn't take that once we had to find another one so we establish some contacts and then those prosthetics providers realize hey this therapy clinic is good at training these people how to use them and they're gonna have way better compliance not sit in a closet somewhere if they get training on it afterwards.
Insurance and Training Referrals
00:01:20
mmateri
A lot of the prosthetic um orthotics and prosthetics um providers only get billing approval to provide the device. And when they fit it to them that final time, they'll give them a couple of quick rundown things like here's how you open and close or how you put it on and all that established the tension. And then it's good luck. They don't really get coverage for anything more than that. so They do get 12 give or take visits for prosthetics training. And so then the providers are realizing, hey, these patients are using these devices with much better carry over if they get additional training. So they started referring to us. and Now we have a pretty good relationship with a couple of different prosthetics providers in ah in our Valley area that will send patients to us for learning how to use them.
Understanding Prosthetics Complexity
00:02:02
Tristany
Sure, and with the varying providers and transradial, transhumous amputation, I've seen a lot of different types of prosthetics, and I just wanted to know how you learn how to work with the different myoelectric, claw, and when there's different motor points, it just can be a little overwhelming.
00:02:24
mmateri
Definitely, yeah. And everything from, like you said, trans-radial, trans-humoral, even like hand and digit amputations, there's a whole world of like trans P1, trans P2, where they get these, the the naked prosthetics or these mechanical ones that open and close, less less daunting and often training and more just like functionally how to
Training with Manufacturers
00:02:43
mmateri
use it. But even these, the motor point ones, the my electric or the cable based body powered understanding the patterns and mechanics on how to use these things. Honestly, it was a lot of trial and error. But when we had some of the mile electric specific ones,
00:03:00
mmateri
I contacted the the manufacturers. OSIR is one, ILIM is another, and we reached out and said, hey, can you come do some training for us? And they love it because they want their devices um used and utilized. So they have dedicated departments to send people out. um One of the provider's hangers set out sent out um an OT from Oregon who came and did a training with us alongside a rep from the ILIM company. and they had multiple devices and we could play with them. They did a little certified course where we all got a certificate out of. So um those are super helpful and effective um for the myoelectric for the body powered
Learning Prosthetic Mechanics
00:03:38
mmateri
stuff. That technology is from like the sixties and seventies, the cable driven stuff. And so if you go looking like on YouTube, how to use a body powered trans radial or trans humeral,
00:03:50
mmateri
The videos are like from the 70s. They're the same concepts. And so you learn what shoulder movements unlock an elbow, flex the elbow, lock the elbow, and then that cable now opens and closes a terminal device. And so some of it's kind of being willing to put the time in ahead of time and say, we'll go to a YouTube search and just learn the.
00:04:10
mmateri
these three movements activate the elbow or lock it. And when I lock it, then those same three movements activate the hand because the load is now transferred distal to that past that locking joint. So it can just it's a little bit of our own research and then going to the visits with the O and P providers, the orthotics and prosthetics guys, that can give you the, Hey, like just show me this. I'm here to learn stuff. And they'll appreciate that and more likely to send people to you.
00:04:37
Tristany
Sure.
Assessing Patient Device Understanding
00:04:38
Tristany
And so once you get a better understanding of the device as a therapist, what are kind of, what do you prioritize in the initial treatment sessions with these patients?
00:04:49
mmateri
So first time they walk in, I need to find out how much they know about their device. And so I'll say, how much did Tony show you about all this stuff? I'm like, oh, he showed me how to open, close, and he usually changed some settings for sensitivities, and he showed showed me how to activate a couple of things. I'm like, okay, let's see if that stuck. So you show me, open.
00:05:07
mmateri
and close and show me bend the elbow and straighten the elbow. Rotation of Supro if they have it. Sometimes I have to have an app on my phone and I set some, you know, some preferred grasp. Sometimes if it's just body powered, I'm like, show me if you know how to activate all this wherever they're at. If it's, I don't understand any of it. We got to start from scratch or sometimes they don't come to me for a couple of days or a week after that last fitting and they've been playing with it and they figured out all kinds of stuff. Great.
00:05:36
mmateri
wherever they are, I start there and I want to get to them to the point where they're able to use it as a good helper hand with graded control. So we work on not just open, close, but can you open and close halfway? Can you pick up one of our slow foam cubes without crushing it? Can we do gentle, easy movement without like overusing and good mechanics on that supporting shoulder structure so we're not getting repetitive stress injuries on it?
00:06:04
Tristany
And how are you addressing more proximal? Are you doing some isometric strengthening stuff with TheraBand, or is that prior to getting the device?
Pre-Prosthetic Treatments and Preparation
00:06:14
mmateri
Ideally, it's prior. We've seen a handful of patients where they're going to get a device and they have, we had one where he had a frozen shoulder before, so we had to get him out of that before the insurance company would authorize approval of the device. We had another guy who was post-cancer amputation, and so we had to make sure that he had um mobility of the arm after lymphatic node or lymph node impact and just range of motion. Sensitivity sometimes we're managing residual stump sensitivity and scar management because putting the device on that scar is super sensitive with neuromas or maybe the end of the humorous or radius that is not yet softened um with soft tissue around it so there's some pre prosthetic treatment that we've done.
00:07:00
mmateri
But if someone walks in, says, I just got this device, how do I use it? I might need to do some. Isometrics is great, especially if they don't have a way to attach a cuff with a band to a residual stump. If it's very proximal or mid shaft, humorous um amputation, we have to figure out how am I going to get a TheraBand loop on their wrist weights. I do stuff in side lines so they can do like kind of external rotation just to stabilize that. But isometrics work really well, um sometimes some weight-bearing things if they're if they're not overly sensitive. But yeah, that that upper quarter stability is important so we don't create rotator cuff problems and, you know, scaling neck problems, nerve occlusions, that kind of stuff.
00:07:48
Tristany
And what are you educating them on for home program?
Patient Education and Exercises
00:07:54
mmateri
So number one, I talk about how much to wear it. Like if you get a new pair of running shoes and just decide to wear them for you know a half marathon that weekend, you're gonna get blisters, you're gonna get soreness, you're gonna get redness. So I talk about weaning into it and saying your home program is to wear it for two hours in the morning, two hours in the afternoon, just to tolerate time on that residual stump that's still not yet healed over if that's the case. So we slowly increase that. And at the end of two weeks, I want them to be wearing it Maybe not full time, but most of the time, because it's a tool for a purpose. You're gonna go swimming, don't wear it. You're just hanging out with friends watching TV, you don't need it on. So it's a tool to put on when you need it, for work, for the gym, for hanging out, whatever. um So we'll talk about wear schedule, ramping that up. I'll talk about, ill I'll find what is that sweet spot, that just right challenge, to say you need to work on, can you open and close, and that's it. I want you to put it on and practice, can I find the motor pickup,
00:08:52
mmateri
control to open and close 95% accuracy. Maybe they're good with that and I say, okay, now I want you to do half open, full open, half close, full close. Maybe it's close on cotton balls without crushing them.
00:09:06
mmateri
maybe it's managing to put those on something where they don't fall off because you've got to manage the whole upper extremity. So finding that challenge for them and giving them one, maybe two things to work on because this whole thing is completely foreign and the majority of them getting used to it is just wearing it and having it on.
00:09:23
mmateri
If I give them 10 things to do, they're going to do one or two anyway. So find the most effective one or two and say, work on those. And when they come back, ideally they've mastered that and we can move on to the next. Yeah.
Adjusting to Social Aspects of Prosthetics
00:09:35
mmateri
Yeah.
00:09:35
Tristany
How are you addressing the psychosocial factors?
00:09:40
mmateri
So that's ah that's a tough one. Everyone's going to be a little bit different. I have some patients who are super excited and love this thing and can't wait to put it on and got to pick this really cool skin to put on it, whether it's um their favorite team or whatever, they're excited about it. And others are like, this is weird. This looks different. And it just takes time getting used to it. So I'll talk about where it at home when there's nobody else around. So you get used to seeing it on you and you're walking past mirrors. And so you are desensitized to it.
00:10:10
mmateri
but also understand when you walk into a restaurant people gonna turn look cuz it's not normal it's not what we usually see and so you're gonna have to get used to kids asking weird blunt questions and adults looking too long and staring you can't help but turn and look at something that we don't see every day so kind of hopefully desensitizing them to the social aspect of it, but saying like, you know, I'll even tell them, like people are going to ask you, you don't have to tell them it's not their business. Or you can tell them something completely made up and say, oh I was rescuing a baby from a burning building and that's why I lost my arm. Or it's you don't, don't feel like you owe them anything. You do what you need to do to be okay with the situation. And if you want to have fun with them, have fun with them, or just blow them off and say, I'm sorry, I'm not comfortable talking about it, but kind of disarming them with the situation.
00:10:57
mmateri
Yeah, cool.
Networking with Prosthetics Providers
00:11:00
mmateri
So if you are interested in doing some prosthetics work, definitely go reach out to the orthotics and prosthetics people in your neighborhood, in your area. Find out who they're referring people to for the training. And if they're not, say, I'd love to be that person. um What does it take to be a referral destination for you? And talk to the actual providers, not just the people at the front desk, because the providers have that felt need maybe more than the gatekeeper front desk person. So yeah.
00:11:25
mmateri
Hopefully that's helpful. If you guys have any questions or concerns or want any extra information, reach out to us at our email, info at handtherapyacademy.com or on our social media platforms, Hand Therapy Academy.