The use of electric elbows in the rehabilitation of children with upper limb deficiencies.

For those with levels of loss above the elbow, the normal prescription choice is now considered to be the use of an electric elbow combined with a myoelectric hand using a single site three state control. The lightweight VASI unit controlled by a harness mounted switch is mounted in a prosthesis the socket of which is total contact, and allows improved power transfer.

Rehabilitation engineering in pediatrics.

Applications of science and technology in the (re)habilitation of children and young adults can have dramatic, positive influences on their lives. Prosthetics, orthotics, mobility, postural support and seating, communication and education are responsibilities of the rehabilitation engineer. A holistic approach in meeting individual needs for technology is essential. The concerted rehabilitation engineering programme at The Hugh MacMillan Rehabilitation Centre supports service programmes with relevant research and development work.

A three-quarter type below-elbow socket for myoelectric prostheses.

The Muenster and Northwestern sockets have become universally prescribed for below-elbow amputees with myoelectric prostheses. The most attractive feature of these sockets is that they are self-suspending, thereby obviating the need for a harness. The sockets are designed to encompass the patient's whole elbow. Because of the intimate fit, heat build-up inside the socket is a problem. Patients with myoelectric prostheses are denied the benefit of a stump sock. Ventilation inside the socket is almost zero and excessive perspiration occurs. This leads to maceration and skin problems which negatively affect control, comfort and wearing time. This paper reports on a technique whereby the problem of no ventilation is overcome through the removal of the proximal-posterior quadrant of the socket.

Management of the upper-limb-deficient child with a powered prosthetic device.

A long-term survey of a large number of children fitted with an electrically powered upper-limb prosthesis seems not to have been reported in the literature. Children with upper-limb deficiencies (congenital or traumatic) were fitted with an electrically powered upper-limb prosthesis in Ontario during the 18-year period of 1965-1983. Seventy-eight patients responded to a questionnaire or were interviewed by telephone. The dropout rate in children with a below-elbow amputation was similar to that reported in below-elbow child amputees wearing a conventional body-powered prosthesis (10% vs. 13%). The acceptance rate in children with above-elbow amputations was higher in those wearing an electrically powered prosthesis than in those using the conventional prosthesis, testifying for improved prosthetic function in the former group.

Prosthesis with electric elbow and hand for a three-year-old multiply handicapped child.

The usefulness of wisely prescribed powered components in the rehabilitation of upper extremity amputees has long been recognized (Schmidl, 1973). Their value is especially evident in the prosthetic rehabilitation of high level adult and child amputees (Heger et al, 1985). In recent years, manufacturers of prosthetic hardware have provided practitioners with a wide selection of either myo-electrically or switch controlled electromechanical components and systems. As a rule, however, most commercially available components are designed to serve the adult amputee and do not lend themselves for use in the prosthetic rehabilitation of children. One current exception is the availability of child-size electric hands. The availability of the world's first child-size electric hand in 1970 at the Ontario Crippled Children's Centre later known as the Variety Village 105 hand, gave tremendous impetus to the fitting of younger children with externally powered components and myoelectric control systems. However, this trend served to benefit the young below-elbow patient only (Sorbye et al, 1972). The successful fitting of higher amputation levels in this age group stopped at the elbow level. Existing artificial elbows such as the Variety Village and Hosmer elbow with their necessary powerpacks are simply too bulky and too heavy for pre-school age children. The need for a lightweight compact electric elbow, suitable for 3-8 year old children, still has not been addressed. This single case report illustrates an innovative and successful conversion of a 6-3/4 Otto Bock hand into a small electric elbow. The idea was first proposed by Schmidl (1973).

Sensory feedback in a myoelectric upper limb prosthesis: a preliminary report.

Upper limb prostheses are often rejected because they do not provide the sensory feedback available from a normal hand. A system for providing sensory feedback has been developed at the University of New Brunswick for use with the three-state myoelectric controls prepared in the Bioengineering Institute there. Strain gauges mounted on the forefinger of an electric hand provide information which is processed electronically to cause a tingling sensation in the patient's stump, proportional in its intensity to the pinch force in the finger. This system has been used by a patient at the Ontario Crippled Children's Centre in Toronto, since June 1976. She uses it consistently with great satisfaction and enthusiasm. It gives her a sense of competence and confidence she does not have without it.