Screening of Above Elbow Amputees for Advanced Prosthetic Devices

Va Salt Lake City Healthcare System, Salt Lake City UT

Investigators

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Abstract

RELEVANCE: This study will further characterize the patient satisfaction, biomechanics, limb kinematic capabilities and residual limb anatomy of individuals with above elbow amputation (AEA) for use in the research and development of advanced prosthetic technologies. This work aims to specifically evaluate individuals with AEA treated with an osseointegrated (OI) prosthesis to make direct comparison between AEA OI and socket users to improve our understanding of the overall impact of this new technology on Veterans amputees. Dr. Sarina Sinclair and her team have the clinical research foundation on which to successfully complete this work. Direct skeletal attachment of prosthetic limbs through osseointegration, is currently being tested and optimized at the George E. Wahlen VA Salt Lake City Health Care System and implemented by our collaborators at Atrium Medical Center. OI technology is being developed to improve prosthetic attachment, improve functional outcomes and reduce complications commonly associated with socket interface systems. Our research team has successfully developed an OI prosthesis in Veterans with transfemoral amputation. The knowledge gained from our successful transfemoral OI program is now being applied to AEA. It is our goal to offer individuals with AEA enhanced data on OI systems that will enable them to make informed decisions on these upper extremity prosthetic technologies that have been developed in recent years to maximize function. This study will build upon of the dataset we have previously collected from AEA socket users (detailing comprehensive anatomical, quality of life, and limb kinematic data from individuals using socket technology) by comparing these data with the data that we will collect from individuals with OI devices. AIMS: Aim 1) Conduct in-person functional assessments of AEA participants being treated with an OI prosthesis for comparison to a previously collected dataset of AEA participants using socket prostheses. Aim 2) Characterize the residual limb anatomy of individuals with AEA treated with OI prostheses. METHODS: Our team of investigators will capture limb kinematics, function, and satisfaction data from an AEA cohort treated with any OI device utilizing validated tools. Data from this new patient cohort will be directly compared to our dataset previously collected from AEA socket prosthetic users. We will collect kinematic and kinetic data from the AEA cohort treated with an OI device performing advanced activities of daily living. This OI patient specific motion capture data will examine differences in limb kinematics between their intact and amputated limb when using a prosthesis. Secondary outcomes will also investigate the impact of an OI prosthetic suspension system on proprioceptive targeting motion and pain. Extended physiological proprioception (EPP) assessments will be conducted from OI prosthetic users for direct comparison to: a) their intact limb; and b) data previously collected from an AEA socket suspension cohort. In Aim 2, we will collect calibrated radiographs, DEXA, and quantitative CT scans of the amputated and contralateral limbs of individuals with AEA being treated with an OI prostheses to quantify bone health parameters (cortical thickness, bone tissue percent, and bone mineral density). Comparisons will be made to their intact contralateral limbs. Descriptive statistical analysis will assess for correlations of bone parameters with age, time since amputation, prosthetic usage, and function. SIGNIFICANCE: This work has the potential to significantly improve VA clinical care for amputees by advancing the knowledge of how OI devices that are now being offered as alternatives to socket prostheses affect biomechanics, function and patient satisfaction. This work will provide patients and providers with data to better support informed decision making about new prosthetic technologies.