Browsing by Author "Heckathorne, C.W."
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Item Open Access NINETEEN YEAR FOLLOW-UP OF A BILATERAL SHOULDER DISARTICULATION (BSD) AMPUTEE(2008) Uellendahl, J.E.; Heckathorne, C.W.Management of high-level bilateral amputees poses a significant challenge for the treating parties. Selection of the most appropriate prosthetic components and controls requires knowledge of the many options available and the ability to predict which systems will most benefit the user. Long-term follow-up of these individuals is rarely reported. Through retrospective study it may be possible to identify attributes of prosthetic systems that have been successful and incorporate those attributes in future systems. This paper outlines the prosthetic management of an individual, KF, with traumatic bilateral shoulder disarticulation amputations over a nineteen-year period. In 1986, the Prosthetic/Orthotic Clinical Service Department of the Rehabilitation Institute of Chicago (RIC) and the Rehabilitation Engineering Research Center (RERC) in Prosthetics and Orthotics of Northwestern University began a collaboration to improve the prosthetic fitting of persons with higher-level bilateral amputations. By the time of KF’s admission to the RIC, a hybrid fitting concept had been developed using body-powered and electric-powered components in a complementary manner to enhance the function of the total prosthetic system [1,2]. Cable-actuated body-powered components were used on the dominant side to take advantage of the physiological proprioceptive feedback intrinsic to cable control. This prosthesis was used primarily for fine positioning and dexterous object handling and manipulation. Electric-powered components were used on the non-dominant, or assistive, side to provide higher gripping forces and greater lifting torque.Item Open Access OCCUPATIONAL THERAPY OUTCOMES WITH TARGETED HYPER-REINNERVATION NERVE TRANSFER SURGERY : TWO CASE STUDIES(2005) Stubblefield, K.A.; Miller, L.A.; Lipschutz, R.D.; Heckathorne, C.W.; Phillips, M.E.; Kuiken, T.A.The control of prostheses, both externally powered and body powered, increases in complexity with higher levels of amputation. The externally powered prosthesis has a limited number of options for controlling multiple joints myo-electrically. Some method is necessary to switch control between functions (ie: elbow and hand). Targeted hyper-reinnervation nerve transfer surgery has the potential to greatly improve control of the electric prosthesis for the above elbow and shoulder disarticulation subjects by increasing the number of control options available. When the limb is lost the Brachial Plexus typically remains intact. The nerve supply to the missing limb is viable and connected to the motor cortex, but the motor end points served are gone. In nerve transfer surgery, the peripheral nerve is relocated to an area of denervated muscle tissue in the residual limb –a muscle that no longer moves the missing limb. Hyper-reinnervation occurs resulting in an area of say the Biceps, being controlled by the Median Nerve (in the intact limb, the Median Nerve supplied finger and wrist flexors). A muscle contraction occurs in the graft area of the Biceps when the subject attempts to close his hand. A myo-control site is added if the subject can isolate the contraction from that of the Biceps muscle served by the Musculocutaneous Nerve distribution.Item Open Access SHOULDER DISARTICULATION FITTING WITH 6 INDEPENDENTLY CONTROLLED MOTORS AFTER TARGETED HYPER-REINNERVATION NERVE TRANSFER SURGERY(2005) Miller, L.A.; Lipschutz, R.D.; Weir, R.W.; Williams, T.W.; Stubblefield, K.A.; Heckathorne, C.W.; Kuiken, T.A.In 2002, targeted hyper-reinnervation nerve transfer surgery was performed unilaterally on a bilateral shoulder disarticulation amputee. The goal of this surgery was to create additional sites using the remaining unused brachial plexus nerves to allow simultaneous control of multiple movements using more natural control schemes [1,2,3]. As a result of the nerve transfer procedure, 4 new myoelectric control sites were created on the left pectoralis muscle. Subsequent prosthetic fitting found that the user was able to operate the elbow and hand in a coordinated fashion using three electrodes. Various outcome measurements showed an improvement in prosthetic function. However, with the increase in the number of input signals, a goal was set to build a prosthesis with the maximum number of controlled motors available. Six motorized components were identified: three were commercially available in the USA, one was commercially available in other countries and two were a research prototype.