Occupational Therapy for Prosthetic Rehabilitation in Adults with Acquired Upper-Limb Loss: Body-Powered and Myoelectric Control Systems

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There is uncertainty as to whether occupational therapy differs between patients fitted with upper-limb prostheses using different control systems. The aim was to describe occupational therapy in upper-limb prosthetic rehabilitation and discuss potential differences in therapy between patients fitted with body-powered or myoelectric control systems. An overview and description of occupational therapy methods for upper-limb prosthetic rehabilitation is provided based on literature and clinical experience from two independent occupational therapists. Ultimately, the same phased approach to occupational therapy is used for both control systems for upper-limb rehabilitation, inclusive of the evaluation, the pre- and postsurgery phase; preprosthetic therapy; prosthetic training including both controls and functional use training; and discharge planning. The one thing that differed between control systems was the methods for evaluation and training of controls, based on the underlying nature of the systems. The time required to acquire functional use skills differed between control systems—users of myoelectric devices, especially at transhumeral level or higher, and patients with bilateral limb loss often need more time in therapy in order to learn to operate the terminal device and perform bilateral activities. Occupational therapy for prosthetic rehabilitation in adults with acquired upper-limb loss follows a basic structure that is common to several types of prosthetic control systems. Increased time is required for functional use training with myoelectric systems. The shortage of validated outcome measures restricts the ability to cover all aspects of upper-limb prosthesis use. Further studies to provide evidence in support of different training methods for upper-limb prosthesis users are warranted.

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