0 Item(s)
Physiatrist Perspective on Upper-Limb Prosthetic Options: Using Practice Guidelines to Promote Patient Education in the Selection and the Prescription Process
State of the Science Conference Findings
Keyword(s)
prosthetics, upper-limb, amputation, physiatry, physical medicine and rehabilitation
The purpose of this perspective is to outline the role of the treating physician, often a physiatrist, in caring for people with upper-limb loss with regard to prosthetic options. The rehabilitation process begins by encouraging the individual with amputation to take ownership in his or her care by establishing goals, researching prosthetic options, and directing the decision making of their team. The systematic review of the literature confirmed that there is limited empirical evidence to guide the prosthetic selection process. Many obstacles hinder the selection process including cost/insurance coverage, access to experienced training in prosthetic use, and unrealistic expectations for the prosthesis to restore the patient's limb. Standards of care vary greatly among institutions, both nationally and worldwide, exposing the need for a practical civilian model system of care using available resources to achieve the best possible outcomes. Guidelines must incorporate evidence-based practice when available along with expert opinion while integrating surgical and technological advances as these mature. Using goal-oriented, patient-centered shared decision making optimizes prosthetic selection. (J Prosthet Orthot. 2017;29:P40–P44)
Author(s)
Danielle H. Melton, MD
Description
A physiatrist or physical medicine and rehabilitation doctor is often the treating physician for a person with limb loss and tasked with guiding the patient with upper-limb amputations through the selection of a prosthesis during the rehabilitation process. In comparison to the lower limb, upper-limb amputations result in much different impairments that affect activities of daily living (ADLs) more than ambulation and mobility.
Initial evaluation should involve taking a detailed history and physical examination including social and functional status as well as assessments of any comorbid diagnoses that contribute to impairments. This is followed by creating a plan that begins with preprosthetic rehabilitation. Using a patient-centered approach to guide the rehabilitation plan optimizes the prosthetic selection.
Initial evaluation should involve taking a detailed history and physical examination including social and functional status as well as assessments of any comorbid diagnoses that contribute to impairments. This is followed by creating a plan that begins with preprosthetic rehabilitation. Using a patient-centered approach to guide the rehabilitation plan optimizes the prosthetic selection.