Discussion:

This systematic review looked at 620 studies done in the past 10 years, but found that only 9 of the studies pertained to specifically to rehabilitation in upper extremity amputees. These 9 studies focused on functional impairment, activities for daily living, sensory function, and pain reduction in these subjects. In all, 116 individuals with upper limb amputations were assessed. Of these, 58 were above the elbow amputees and 49 were below the elbow amputees. Note that 9 of the subjects’ amputation level wasnot specified in the studies.

The upper extremity is one of the most important parts of the body largely in part due to the roles it plays in a person’s ability to perform daily activities such as bathing, cleaning, dressing oneself, and eating. This does not even take into consideration more advanced skills such as writing, typing, driving or playing sports. These everyday tasks can become overwhelming challenges in the event of losing one’s nondominant upper limb, let alone a person’s dominant limb.

This is where the role of prostheses and prosthetic training come into the picture.It is important to target patient therapy and rehabilitation from a holistic point of view. Patients need to be educated on how to use and acclimate the prosthesis into everyday lifein order to help increase a person’s overall level of function and quality of life.Prosthetic rehabilitation facilitates independence and improvement in a person’s functional capacity. Among upper limb prosthetic rehabilitation modalities are general exercise programs, phantom exercises, muscle training system, edema control, neuromuscular re-education techniques, virtual images, and virtual reality exercises.

Overall, prosthetic rehabilitation seems to be effective and beneficial for the upper limb amputees. However, one key limitation that this review points out is that many of the studies that were involved implemented subjective responses from subjects and/or the researchers to assess benefit and improvement in pain and function. In addition, only 1 of the 9 studies was a randomized control trial. Moving forward, this area of rehabilitation would be well served if more physiatrists and researchers performed quality studies involving upper extremity amputees so that these patients can benefit and potentially improve their quality of life.

Discussion Author: Kumail S. Kazim, OMS-IV (Rowan University - School of Osteopathic Medicine)

Discussion Points:

  1. In patients who have undergone limb amputations, should the primary goal of rehabilitation be functional recovery or pain management?
  2. What are some management options for phantom limb pain?
  3. How would you imagine above the elbow amputation rehabilitation differs from below the elbow amputation rehabilitation?
  4. Do you think there is a role for prostheticrehabilitation in lower extremity amputation?
  5. What studies need to be done in order to establish stronger support in favor or against prosthetic rehabilitation?