Faculty Bibliography

Background:The purposes of this article are (1) to report on the overall desirability of the DEKA Arm by prototype and by level of prosthesis, (2) to report on user-perceived benefits of the DEKA Arm as compared to their current prostheses, and (3) to summarize user concerns about taking the device home.Study design:Qualitative content analysis of data from a multiple case study design.Methods:This study utilized data from 24 upper-limb amputees fit with a Gen 2 DEKA Arm and 13 fit with a Gen 3 DEKA Arm. Surveys were administered after fitting the DEKA Arm and at the end of training. Subjects recorded audiotaped comments about their experiences. All study sessions were videotaped.Results:In all, 79% of Gen 2 and 85% of Gen 3 users indicated that either they wanted to receive or might want to receive a DEKA Arm. In total, 95% of Gen 2 and 91% of Gen 3 prior prosthesis users reported that they were able to perform new activities that they were unable to perform with their own device.Conclusions:A large majority of subjects wanted a DEKA Arm, although desirability varied by amputation level.Clinical relevanceThe majority of amputees in this study expressed a desire to receive the DEKA Arm, a device which provides multiple powered degrees of freedom and is operated predominantly by foot controls. The majority reported functional advantages of the DEKA Arm over their existing prostheses.

Mechanical properties of the DEKA Arm and associated engineering innovations are easy to observe. What is less clear is how these advances translate into functional benefits for the user with amputation. Study aims were to (1) quantify outcomes including dexterity, performance of daily activities, and prosthetic skill and spontaneity of users of the DEKA Arm and (2) compare outcomes when using the DEKA Arm with scores using the existing prosthesis. This was a quasi-experimental study. Descriptive analyses examined outcomes by DEKA Arm configuration level. Of the 39 subjects fit with a DEKA Arm, 32 were trained in use and completed end-of-study testing. Data from 26 prosthetic users were used to compare outcomes using existing prostheses with outcomes with the DEKA Arm. Dexterity and activity performance with the DEKA Arm varied by amputation level (p < 0.01). Self-reported function and number of activities performed using the prosthesis were similar across levels. Comparisons with existing prostheses showed the effect on dexterity varied by level. Activity performance and spontaneity of prosthetic use improved for users of the shoulder configuration level, while use of the prosthesis to perform activities and perceived difficulty performing self-selected tasks improved for all levels.

The number of catastrophic injuries caused by improvised explosive devices in the Afghanistan and Iraq Wars has increased public, legislative, and research attention to upper limb amputation. The Department of Veterans Affairs (VA) has partnered with the Defense Advanced Research Projects Agency and DEKA Integrated Solutions to optimize the function of an advanced prosthetic arm system that will enable greater independence and function. In this special communication, we examine current practices in prosthetic rehabilitation including trends in adoption and use of prosthetic devices, financial considerations, and the role of rehabilitation team members in light of our experiences with a prototype advanced upper limb prosthesis during a VA study to optimize the device. We discuss key challenges in the adoption of advanced prosthetic technology and make recommendations for service provision and use of advanced upper limb prosthetics. Rates of prosthetic rejection are high among upper limb amputees. However, these rates may be reduced with sufficient training by a highly specialized, multidisciplinary team of clinicians, and a focus on patient education and empowerment throughout the rehabilitation process. There are significant challenges emerging that are unique to implementing the use of advanced upper limb prosthetic technology, and a lack of evidence to establish clinical guidelines regarding prosthetic prescription and treatment. Finally, we make recommendations for future research to aid in the identification of best practices and development of policy decisions regarding insurance coverage of prosthetic rehabilitation.

Numerous studies support the use of rehabilitative interventions in the older adult. Given the many fiscal challenges in health care today, it is of utmost importance that funding for rehabilitation result in fruitful outcomes. Specific rehabilitative interventions have been found to be very effective in the elderly and can be demonstrated through numerous studies. Outcomes for conditions including stroke, traumatic brain injury, spinal cord injury, amputation, hip fracture, and joint replacement are discussed. There is great need for ongoing research to determine optimal rehabilitative interventions in the elderly

Persons with acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection demonstrate a wide array of central nervous system impairments and may be at a significantly increased risk for cerebrovascular disease. Cerebrovascular disease can be the first manifestation of HIV infection and may be associated with a treatable etiology. Anticipating more referrals for HIV-related physical disability, we detail the rehabilitation management of three persons with HIV infection and hemiparesis. Onset of hemiparesis ranged from just before to 24 months after an AIDS-defining illness. No specific underlying etiology was identified in two of three patients, consistent with previous observations. Rehabilitation interventions included lower and upper extremity orthoses, assistive devices to aid gait and activities of daily living, therapeutic exercise and use of antispasticity medication. All patients made at least mild, temporary gains in functional status. Survival ranged from 3 to >6 months from initial contact with rehabilitation services. Neurologic and nonneurologic considerations in the rehabilitation of persons with HIV infection are discussed. We conclude that selected individuals with HIV infection and hemiparesis can benefit from rehabilitation intervention. HIV infection should be considered in any young adult presenting with stroke