Providence Veterans Administration Medical Center, Providence, RI 02908, USA.
Arch Phys Med Rehabil. 2012 Apr;93(4):710-7. doi: 10.1016/j.apmr.2011.11.010.
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.
在阿富汗和伊拉克战争中，简易爆炸装置造成的灾难性伤害数量增加，引起了公众、立法者和研究人员对上肢截肢的关注。美国退伍军人事务部（VA）与国防高级研究计划局和 DEKA 综合解决方案公司合作，优化了先进假肢系统的功能，使患者能够获得更大的独立性和功能。在本专题通讯中，我们检查了假肢康复的当前实践，包括假肢设备的采用和使用趋势、经济考虑因素，以及在一项退伍军人事务部研究中，我们根据使用原型先进上肢假肢的经验，探讨了康复团队成员在优化设备方面的作用。我们讨论了采用先进假肢技术的关键挑战，并就先进上肢假肢的服务提供和使用提出了建议。上肢截肢者的假肢排斥率很高。然而，通过由高度专业化的多学科临床医生团队进行充分的培训，并在整个康复过程中关注患者的教育和赋权，这些比率可能会降低。在实施先进上肢假肢技术方面出现了一些独特的重大挑战，而且缺乏关于假肢处方和治疗的临床指南制定的证据。最后，我们为未来的研究提出了建议，以帮助确定最佳实践，并就假肢康复的保险覆盖范围做出政策决策。
