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i. Use of artificial hands and arms: Upper extremity prosthetic care and training:
You will probably work with an Occupational Therapist (OT) to learn about prosthetic hygiene, how to put on and
remove your prosthesis, parts of the prosthesis, routine maintenance, and use in activities of daily living including self-
care, work, and leisure. You will learn how to clean the prosthesis, how to adjust the stump socks which go between your
residual limb and the prosthesis, and how often to clean your residual limb. You will practice putting on and taking off the
prosthesis with and without help (when possible). The type of prosthesis and your abilities will determine whether it is
possible to do it alone.
Your ability to adjust to wearing the prosthesis for extended periods of time (called "tolerance") involves your attitude
toward the prosthesis as well as your body's ability to bear the strain. You will probably begin by wearing it for half an
hour after which your stump will be inspected for signs of irritation. If none are noted, it will be put on again and you will
wear it for another half hour. This may be repeated until you can wear it for two hours without irritation. If irritation does
occur, the prosthesis must not be reapplied until the redness clears up. Do not be surprised if you have several one or two-
day pauses during your training. If you allow an irritation to get bad by ignoring it and keeping a "stiff upper lip" you may
cause severe skin and muscle damage which can take weeks to months to heal.
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Training begins with learning to control the prosthesis's movements and operations. The basic movements are frequently
learned in the first session. As you develop skill in controlling your prosthesis, you become ready to begin learning to use
the prosthesis for the activity you want to carry out. For example, to grasp a jar, hook "fingers" must be perpendicular to
the table or vertical. Prosthesis awareness and skills are readily learned by using the prosthesis in activities which require
two hands such as cutting meat and tying shoes. Necessary acts which have to be carried out frequently for a comfortable,
normal life are called "activities of daily living". The particular activities chosen depend on your needs and interests. You
will have to learn to recognize and deal with the limitations of your prosthesis. If you do not take the time to learn to work
with the device and adapt to its limitations, you may decide not to use one at all which would limit the range of activities
you can carry out. This could unnecessarily make you a cripple. The type of prosthesis chosen and the training you get
depend not only on the type of amputation and your physical abilities but also on the types of activities you need to carry
out. A prosthesis worn just for looks (cosmetic appearance) is very different from one used to put parts together in a
factory. Figure Fourteen shows a typical prosthetic hand. Figure Fifteen illustrates how a typical below elbow (BE)
artificial hand and arm is held on and controlled.
Some prostheses are partially powered by batteries. They are controlled by tensing various muscles in your residual
limb and shoulder so they are called "myoelectric prostheses". They are more complex and expensive than most and have
problems with reliability, performance of many tasks, weight availability of parts, and repair. Some of the very new
prosthetics are computer controlled. The computer helps regulate the amount and type of motion the arm makes so it
matches the motion you wish to make better than one with a simple joint can. Some of the prosthesis are capable of
different grip strengths. They can signal you in various ways to let you know when you are gripping strongly enough to
pick up a raw egg without dropping it but not so hard that it is crushed. They are more cosmetic, eliminate the need for
harnessing, and require less energy and movement to operate. There is still some question as to whether the electrically
powered hand is more functional than the muscle powered one. Your treatment team will do a careful evaluation of your
needs and abilities. Then they will recommend the type of prosthesis most likely to meet your needs. Each amputee has to
decide based on individual experience.
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