Browsing by Author "Miguelez, John M."
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Item Open Access ACUTE PROSTHETIC UPPER EXTREMITY REHABILITATION OF BLAST WOUND INJURIES: A 21 MONTH REVIEW(2005) Miguelez, John M.; Conyers, Daniel; Zenie, John; Lake, ChrisProviding prosthetic rehabilitative services for upper extremity amputees is a challenging endeavor. Providing acute rehabilitative services to multiple individuals who have suffered upper extremity blast wounds adds a further complexity. Perhaps not since the Vietnam War has an upper extremity traumatic amputee population of this size treated in one center utilizing consistent procedures and protocols. The authors have had the opportunity to provide upper extremity prosthetic services to over 90 U.S. soldiers injured in Iraq and Afghanistan over the last 21 months at Walter Reed Army Medical Center.Item Open Access Clinical Experiences With The Michelangelo Hand, A Four-Year Review(2011) Miguelez, John M.With the integration of multiple grasp patterns, compliant hands have advanced the functionality of upper extremity prosthetic patients while also retaining the natural appearance of a human hand. The latest and most promising evolution in compliant hand technology is the Michelangelo hand by Otto Bock. A powered, opposable thumb is positioned electronically, smoothly transferring the hand into multiple grip patterns: lateral power grip, pinch grip, opposition power grip, tripod grip, finger abduction/adduction, full open palm and half open palm. Michelangelo operates significantly faster than previous compliant hands and includes a compliant flexion wrist that patients report has improved reliability and responsiveness. Enhanced software and EMG signal processing utilize an intuitive graphic user interface, promoting control predictability. In order to maximize the functional advantages of this technology, traditional occupational therapy training protocols should be modified to address multiple grasp function. This presentation will examine the specific functional advantages of the Michelangelo hand based on four years of in-depth clinical involvement by this practitioner. The direct observations of 10 transradial level patients will be included, as will an overview of suggested modifications to occupational therapy training protocols.Item Open Access COMPARATIVE ANALYSIS OF MICROPROCESSORS IN UPPER LIMB PROSTHETICS(2002) Lake, Christopher; Miguelez, John M.The recent emergence of microprocessor based prosthetic control for the individual with upper limb deficiency has significantly expanded the spectrum of treatment options and inclusion criteria for this patient population. Microprocessors can accept a wide variety of input devices and ranges enhancing an individual’s prosthetic function allowing control options for individuals who were at one time not candidates for such prosthetic management. Additionally, myoelectric control parameters can be adjusted to optimize function while retaining the flexibility to individualize each prosthesis.Item Open Access Compliant Hands: The Next Evolution of the Prosthetic Hand(2008) Miguelez, John M.While the last 10 years have brought significant advancements to the upper extremity prosthetic patient population, the function of prosthetic terminal devices has been limited by their inability to mimic the myriad grasping patterns of the human hand. Recently, several groups have made considerable progress in the development of terminal devices that offer more anatomical articulation while retaining the aesthetics of a human hand.Item Open Access ELECTRONIC PROSTHESIS FOR THE PARTIAL HAND AMPUTEE(2002) Miguelez, John M.Item Open Access EXPERIENCES WITH THE OTTO BOCK ERGO ELBOW(2002) Miguelez, John M.Item Open Access High Level Bilateral Upper Extremity Amputee: A Case Study(1995) Alley, Randall; Miguelez, John M.The provision of an externally powered prosthesis for a high-level bilateral amputee requires careful planning and open lines of communication among all of the individuals involved in the rehabilitation effort We will be discussing the ftmctional abilities of a bilateral shoulder disarticulationamputee who suffered an industrial trauma approximately one year ago. Several successful innovations of the self donning and self-doffing prosthesis are shown, including the use of a single remote on/off switch powering both urns, bilateral rotators with unique control schemes, a free floating ServoPro control strap, a floating electrode assembly and an ultralight one-piece carbon fiber frame Control was achieved using both myoelectric and ServoPro systems. Throughout the fitting process, an occupational therapist was utilized for both pre-prosthetic and post-prosthetic training. FULL PAPER UNAVAILABLE AT THIS TIME.Item Open Access Microframe Interface Design For High Level Myoelectr1c Prostheses(1999) Miguelez, John M.The provision of a myoelectric prosthesis for high level upper extremity amputees requires consideration of a myriad of factors. Although state-of-the-art componentty can dramatically effect the outcome, other factors left unaddressed can negate any advantages that new technology canoffer. Many individrials fit with a prosthesis fiom the humeral neck level and higher often complain that the weight of the prosthesis, heat build-up while wearing the prosthesis, lack of stability, difficulty in independent donning, and reduced control of terminal device while in certain planes and body positions have resulted in reduced wearing times and in many cases discontinuation of prosthetic use all together. Of course, the factors listed above that lead to reduced wear and in some cases discontinuation are not comprehensive, but do overwhelmingly categorize the responses of over 250 high level amputees polled across the United States between 1993-1999. Although a panacea does not exist to completely eliminate the above factors that lead to discontinuation, substantial success at addressing these concerns can be found in the use of an interface design. Typical interface designs for high level amputees can generally be divided into three classes: 1) "Bucket Interface Style" that completely cover s the effected shoulder and torso often to the midline. The major disadvantage of this style is overheating of the wearer due to excessive interface to skin coverage. 2)"Modified Bucket Style" which encompasses the basicdesign of the "Bucket Interface Design" as it completely encapsulates the shoulder girdle but does not extend to the midline or inferiorly to capture a majority of the torso. This design has partial success in the reduction of heat build up experienced by the wearer, but often results in poor stability and lack of skin to electrode contact whichis manifested in poor terminal device control in certain planes and body positions. Additionally, auxiliary harnessing is required for this design which can have a negative impact on independent donning. 3)"Sander Frame Design" which involves the use of aluminum struts to reduce heat build up and provide acceptable stability and dorming effort. This design has not been universally adopted in the United States due to high degree of fabrication time and skill required. The purpose ofthis paper is to detail the Microframe Interface Design, a more effective alternative to the three current interface designs for high level myoelectric prostheses. FINAL PAPER NOT RECEIVED AT PRESS TIME