Browsing by Author "Farnsworth, Troy"

Now showing 1 - 12 of 12
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    Angulation Osteotomy to Improve Function in Transhumeral Amputee Rehabilitation
    (2008) Farnsworth, Troy; Lipe, Del; Fergason, John; Granville, Robert; Menetrez, Jennifer; Hillard, Amy
    Regardless of prosthetic design, there exist inherent limitations which adversely affect the functionality of transhumeral prostheses. Loss of voluntary humeral rotational control, limitations in prosthetic suspension and decreased range of motion limit the user’s acceptance and functional use of a prosthesis. Various techniques have been discussed in the medical literature to compensate for these shortcomings. These include socket design techniques, harness techniques, and surgical techniques. Marquette introduced the concept of humeral angulation osteotomy to resolve these issues. By surgically angling the distal humerus the amputee can be fit with a self-suspending prosthesis that enables voluntary rotational control without restrictions to range of motion. Although this technique is discussed in various prosthetic text books, very few cases have been reported. Case studies will be presented showing surgical, rehabilitation, and prosthetic considerations.
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    CLINICAL EXPERIENCE AND REHABILITATION OF AMPUTEE MILITARY SERVICE MEMBERS AT THE CENTER FOR THE INTREPID AT BROOKE ARMY MEDICAL CENTER (BAMC): PART 1 – OCCUPATIONAL THERAPY REHABILITATION SERVICES
    (2008) Ebner, Christopher; Farnsworth, Troy; Lipe, Del; Fergason, John; Menetrez, Jennifer
    This lecture will discuss the clinical experiences and provision of rehabilitation services for amputee military service members at the Center For the Intrepid located at Brooke Army Medical Center (BAMC) Fort Sam Houston, Texas. This is part one of a series illustrating the prosthetic services, rehabilitation and research currently underway at BAMC. Case presentations will be utilized to illustrate the team approach to provide clinically appropriate amputee rehabilitation. This cohesive effort includes surgical considerations, early prosthetic fittings, long-term prosthetic care, rehabilitation services, case management, physiological and social support services. Protocols for advanced prosthetic training will be presented with emphasis on various prosthetic componentry. Advancements in the rehabilitation of the military amputee at the Center For the Intrepid will be discussed in detail to include functional capacity evaluations, drivers training, and firearms training simulator. A case study that involves an individual who sustained a dominant upper extremity transhumeral amputation with total loss of vision will also be discussed. In addition, current and future clinical research studies that involve individuals who have sustained upper extremity loss and who are undergoing rehabilitation at the Center For the Intrepid will be highlighted.
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    Clinical Experience of Fitting Amputee Soldiers at the Center for the Intrepid at Brooke Army Medical Center (BAMC): Part 2 – Prosthetic Services
    (2008) Farnsworth, Troy; Lipe, Del; Ebner, Christopher; Fergason, John; Menetrez, Jennifer
    This lecture will discuss the experiences at the Center for Intrepid located at Brooke Army Medical Center (BAMC) providing rehabilitation of amputee soldiers. This is part two of a series illustrating the prosthetic services, rehabilitation and research currently underway at BAMC. Case presentations will be utilized to illustrate the team approach to provide clinically appropriate amputee rehabilitation. This cohesive effort includes surgical considerations, early prosthetic fittings, long-term prosthetic care, rehabilitation services, case management, physiological and social support services. Prosthetic considerations will be presented, including combining the use of technology and basic prosthetic principles. Special attention will focus on unique requirements of traumatic amputations resulting from blast, gunshot, burn injuries, and high demands of the young active users. All advanced systems have been fit at various levels of amputation including fittings with patients who have undergone targeted muscle reinnervation surgery. In addition to being one of the three primary prosthetic amputee care centers, BAMC serves as the primary burn center for the Army worldwide.
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    Clinical Experience With Programable Controllers
    (1999) Farnsworth, Troy
    One of the greatest advancements in powered uppet extremity posthetics has been the advent of "programmable" controllers. These programmable controllas are allowing new operational strategies to be designed and implemented for upper extremity patient populations. Previously, existing technology provided basic functional abilities but continued to limit maximum functional restoration of upper extremity use following amputation and prosthetic fitting. Any additional changes to the "control strategy" of the prosthetic system meant changing hardware with additional costs. This was not a cost-effective treatment protocol for the provider's who were reluctant to explore available options. With these limitations, many patients were forced to adapt to decreased functional capabilities with inadequate piosthetic systems or without the assistance of any prosthesis. Programmable controllets have enhanced the rate and functional abilities of the upper extremity amputee by providing progressive adaptation throughout the rehabilitation process. Input, output and control parameters are optimized as functional demands are increased. For example, the system can be initially setup for ease of use and training and later optimized for function as signal strength and abilities increase. Two patient cases will be presented Case 1 utilizes a single-site myoelectric control, harness pull switch for mode select controlling an electric elbow, wrist and hand (or Greifer). Case 2 utilizes a single-site myoelectric control, nudge "rocker" switch for mode select to control the electric wrist and hand (or Greifer).
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    Clinical Trials of the new Boston Digital(tm) Arm System
    (2002) Farnsworth, Troy; Limehouse, Bill; Hanson, Bill; Mandacina, Steve
    Microprocessor-based controllers for upper-limb powered prostheses have made significant advances over the past few years. These devices allow prosthetists to evaluate the patient and set-up prosthetic controls to optimize performance for the user. This enables the user to obtain a controller that is customized to suit their specific needs and capabilities. The new Boston Digital(tm) Arm System is the first powered elbow prosthesis to offer this advanced technology. This System serves as a “platform” for upper-limb prosthetic control. With five motor controllers, the Boston Digital Arm System can operate hands grippers, wrist rotators, shoulder lock actuators and more. The System is universal − it works with prosthetic devices from any manufacturer, allowing prosthetist to create the optimal prosthesis for their client.
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    ELECTIVE AMPUTATION OF CEREBRAL PALSY PATIENT SUCCESSFULLY WEARS ELECTRIC PROSTHESIS
    (2002) Mandacina, Stephen; Farnsworth, Troy
    Cerebral Palsy affects 15-20 new borns in every 10,000. Currently, near a half million people in the U.S. are effected with C.P. Diagnosing the condition is done clinically, with lab test only ruling out other diseases. The tests performed, such as manual muscle testing, ROM, physical and emotional development, are all compared to normal childhood outcomes. Therefore, many infants are not diagnosed with C.P. until the age of two or three. Symptoms are normally weak or tight muscles, poor balance and gait, along with seizures in approximately half of the effected people. Over time, weak muscles can often develop severe joint contractures, classified as spastic Cerebral Palsy
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    Enhanced Functional Outcomes with Elective UE Amputations
    (2008) Farnsworth, Troy; Lipe, Del; Petersen, Branden; Mandacina, Steve; Ebner, Christopher
    With modern limb salvage procedures, successful reconstruction is not always achieved. This lecture will utilize case presentations to show increased functional benefit in patients who underwent elective amputation surgeries. Neurological damage, severe burn, and brachial plexus injuries are common occurrences that lead to a nonfunctional problematic reconstructed limb. Typically considered failures by the surgical team, potential prosthetic users need to be made aware of the positive benefits of elective surgeries. Preliminary outcomes measures will be presented including South Hampton Hand Test and Functional Capacity Evaluations.
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    Fitting The Humeral Level Brachial Plexus Amputee With Externally Powered Myoelectric Control
    (1999) Stevens, Gordon; Farnsworth, Troy
    Brachial plexus injuries present unique challenges to both the patient and prosthetist, The brachial plexus injury can be classified in many categories: complete or incomplete lesion, with either an intact or amputated limb as a result of the injury. The intact yet flail limb presents with lack of sensation, shoulder subluxation, severe pain, and is often subjected to unintentional burns and cuts. Many brachial plexus patients with an intact limb elect to undergo limb amputation to reduce complications or improve function with prosthetic fitting options. Unforttmately, some patients continue to experience similar post-amputation complications. Fusion of the shoulder joint is a surgical option in an attempt to decrease pain and reduce shoulder subluxation. This procedure may be performed before, after, or in association with amputation of the extremity.
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    Hybrid Approach to Bilateral UE Prosthetic Rehabilitation
    (2002) Farnsworth, Troy; Limehouse, Bill; Mandacina, Steve; Ullendhal, Jack
    Patients with “high” level bilateral upper extremity deficiencies require maximum functional rehabilitation to increase independence and self-care skills. Traditional prosthetic rehabilitation for these individuals utilizes various control mechanisms including body power, electric, and hybrid systems. Rehabilitation teams rarely gain experience with multiple cases using varied control methods. In most cases systems are recommended and fit based on the limited past experiences and training of the rehabilitation team members and the local prosthetist.
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    MANAGEMENT OF HIGH LEVEL BILATERAL ARM AMPUTEES WHO USE WHEELCHAIRS FOR MOBILITY
    (2005) Uellendahl, Jack E.; Farnsworth, Troy; Limehouse, Bill; Heckathorne, Craig
    Management of the high-level bilateral arm amputee poses many challenges to the prosthetist and rehabilitation team. When the amputee is also in a wheelchair, use of arm prostheses becomes more difficult. Positioning of the prosthesis without the use of the lower extremities is remarkably difficult. The work envelop is further reduced when trunk motion and stability is compromised by paralysis. Heckathorne and Uellendahl have recommended a framework for component and control strategy selection when designing prostheses for high level bilateral arm amputees.1-3 This strategy calls for use of dissimilar components on each side to enhance prosthesis usefulness and control schemes that provide dedicated control of as many components as possible allowing simultaneous control when functionally desired. Uellendahl has used this approach for over 15 years for clinical fittings. The long-term success of this fitting philosophy demonstrates the clinical efficacy of this approach. In fact, one of the amputees (MM) reported on in this paper has used prostheses of the same original design for more than a dozen years
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    Trial Fitting Protocols to Optimize Rehabilitation for Transhumeral Amputee Soldiers
    (2008) Farnsworth, Troy; Lipe, D; Fergason, John; Menetrez, Jennifer; Ebner, Christopher
    This lecture will discuss the experience at Brook Army Medical Center (BAMC) utilizing trial fitting protocols to optimize rehabilitation of upper limb amputee soldiers. Case presentations will illustrate and focus on the rehabilitation of transhumeral amputee soldiers using trial fitting protocols. Trial fittings were performed to evaluate the clinical appropriateness of fitting electric-powered elbow systems in comparison to cable-operated elbow systems in hybrid designs. Trial fittings were also utilized to optimize socket and harness systems. Through the trial fitting process each amputee was fit and trained with “loaner” systems for a fixed time period. A comprehensive clinical team evaluated the progress of the trials. The amputees were able to use their own experiences gained in the trial fitting process to give valuable input toward definitive prosthetic fittings. This in combination with the experiences gained by the clinical team results in an optimal prosthetic recommendation and design for each patient.