Exoprothesenversorgung der oberen Extremität

[New technologies and robotics]

The development of increasingly more complex computer and electromotor technologies enables the increasing use and expansion of robot-assisted systems in trauma surgery rehabilitation; however, the currently available devices are rarely comprehensively applied but are often used within pilot projects and studies. Different technological approaches, such as exoskeletal systems, functional electrical stimulation, soft robotics, neurorobotics and brain-machine interfaces are used and combined to read and process the communication between, e.g., residual musculature or brain waves, to transfer them to the executing device and to enable the desired execution.Currently, the greatest amount of evidence exists for the use of exoskeletal systems with different modes of action in the context of gait and stance rehabilitation in paraplegic patients; however, their use also plays a role in the rehabilitation of fractures close to the hip joint and endoprosthetic care. So-called single joint systems are also being tested in the rehabilitation of functionally impaired extremities, e.g., after knee prosthesis implantation. At this point, however, the current data situation is still too limited to be able to make a clear statement about the use of these technologies in the trauma surgery "core business" of rehabilitation after fractures and other joint injuries.For rehabilitation after limb amputation, in addition to the further development of myoelectric prostheses, the current development of "sentient" prostheses is of great interest. The use of 3D printing also plays a role in the production of individualized devices.Due to the current progress of artificial intelligence in all fields, ground-breaking further developments and widespread application possibilities in the rehabilitation of trauma patients are to be expected.

[Treatment paths in the exoskeletal prosthetic care of the upper extremities]

BACKGROUND

The successful prosthetic treatment after amputations of the upper extremities has to deal with the high demands of adequate compensation for functional, sensitive and also habitual requirements. The best success can only be achieved if the involved disciplines of medicine, therapy and technology act in close dialogue with one another and pull together.

OBJECTIVES

How can an interdisciplinary understanding of prosthetic care of the upper extremity be created and implemented in corresponding treatment pathways?

METHODS

Over a period of several years, a committee of German experts in prosthetics developed a quality standard for prosthetic care of the upper extremity. In 2014, this work was published in the form of a compendium. In line with a defined treatment path, all common upper extremity amputation levels are systematically described, and their prosthetic requirements are explained and justified, and any peculiarities delineated.

RESULTS

The result is a structured and clear reference work that enables its readers to receive care-related, level-dependent information on prosthetic care. In the meantime, this work has also been included and implemented by many cost bearers as the basis for the corresponding aid supply contracts.

CONCLUSIONS

Defined treatment paths contribute to a better interdisciplinary understanding and enable structured and quality-oriented care for amputated people.