title: Advanced upper limb prosthetic devices: implications for upper limb prosthetic rehabilitation.
abstract: The number of catastrophic injuries caused by improvised explosive devices in the Afghanistan and Iraq Wars has increased public, legislative, and research attention to upper limb amputation. The Department of Veterans Affairs (VA) has partnered with the Defense Advanced Research Projects Agency and DEKA Integrated Solutions to optimize the function of an advanced prosthetic arm system that will enable greater independence and function. In this special communication, we examine current practices in prosthetic rehabilitation including trends in adoption and use of prosthetic devices, financial considerations, and the role of rehabilitation team members in light of our experiences with a prototype advanced upper limb prosthesis during a VA study to optimize the device. We discuss key challenges in the adoption of advanced prosthetic technology and make recommendations for service provision and use of advanced upper limb prosthetics. Rates of prosthetic rejection are high among upper limb amputees. However, these rates may be reduced with sufficient training by a highly specialized, multidisciplinary team of clinicians, and a focus on patient education and empowerment throughout the rehabilitation process. There are significant challenges emerging that are unique to implementing the use of advanced upper limb prosthetic technology, and a lack of evidence to establish clinical guidelines regarding prosthetic prescription and treatment. Finally, we make recommendations for future research to aid in the identification of best practices and development of policy decisions regarding insurance coverage of prosthetic rehabilitation.
authors.affiliation: Providence Veterans Administration Medical Center, Providence, RI 02908, USA. Linda.Resnik@va.gov
authors.forename: Linda
authors.initials: L
authors.lastname: Resnik
authors.forename: Marissa R
authors.initials: MR
authors.lastname: Meucci
authors.forename: Shana
authors.initials: S
authors.lastname: Lieberman-Klinger
authors.forename: Christopher
authors.initials: C
authors.lastname: Fantini
authors.forename: Debra L
authors.initials: DL
authors.lastname: Kelty
authors.forename: Roxanne
authors.initials: R
authors.lastname: Disla
authors.forename: Nicole
authors.initials: N
authors.lastname: Sasson
mesh_terms: D055826:Afghan Campaign 2001-; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D001753:Blast Injuries / Q000534:rehabilitation*; D006801:Humans; D019458:Insurance Coverage; D054542:Iraq War, 2003-2011; D008889:Military Personnel; D010348:Patient Care Team / Q000458:organization & administration; D011474:Prosthesis Design; D014481:United States; D034941:Upper Extremity; D014728:Veterans